CMS Proposal to Eliminate Inpatient Only List
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When it comes to health care, the Centers for Medicare and Medicaid Services are trying to put control back into patients’ and doctors’ hands. For 2021, CMS proposes to work toward this by dropping the Inpatient Only list. To explain what this means, we’ve highlighted some key points below. We also provide updates about other CMS initiatives in the coming year.
What is the Medicare Inpatient Only List
In summary, the Inpatient Only list is a list of procedures that Medicare will pay for when care takes place in a hospital inpatient setting. Important to note is that the same safety and quality standards apply to both inpatient and outpatient services.
However, most times, the rate at which Medicare pays for services in ambulatory surgical centers (ASCs) is lower than at hospital outpatient departments. The Inpatient Only list is extensive, and many procedures have been added and removed over the years.
CMS Proposals for Inpatient Only List
Recently, CMS proposed eliminating the Inpatient Only list. The changes intend to give patients more freedom of choice in their health care options and save them money. Through this, out-of-pocket services would be lower when the procedure takes place in an ASC.
Over three years, CMS would phase-in the proposal. Eventually, 1,700 additional services could take place in outpatient settings. Three-hundred musculoskeletal services (including joint replacements) would be added in 2021.
CMS also proposed two alternatives. The first alternative is a process where additional services could be nominated by the public. The second alternative is a revision of criteria that would add almost 300 procedures to the list of services that could be performed in ASCs.
In addition to the proposal to eliminate the Inpatient Only List, updates have been provided for some additional initiatives.
What is the 340B Program?
In light of a need to help people save on drugs prescribed in hospital outpatient departments, CMS implemented the 340B program. This program allows specific hospitals to purchase outpatient drugs at lower prices.
In 2021, CMS plans to expand this program and increase discounts. With the proposed discounts, those on Medicare could save $85 million on these drugs.
CMS Patients Over Paperwork Initiative in 2021
In the Patients Over Paperwork initiative, CMS attempts to lessen regulations that serve as a burden to patients. The goal is to have providers spend more time with patients.
Starting in Calendar Year 2021, CMS is revising its methodology to calculate Overall Hospital Quality Star Rating. These ratings help patients make educated health care decisions. This action is in response to stakeholder feedback. Calculations will also account for people in Medicare and Medicaid.
CMS Rethinking Rural Health Initiative in 2021
CMS’s Rethinking Rural Health initiative strives to provide affordable, high-quality healthcare to individuals living in rural areas. Its payment system, Inpatient Prospective Payment System (IPPS), has increased the wage index for hospitals with low wage indexes.
In 2021, CMS is continuing to adopt the IPPS and will use the system for a minimum total of four years. Disparities in hospital wage indexes will continue to be addressed. Additionally, CMS estimates payment for outpatient services in rural areas nationwide would increase by 3 percent. This percentage is 0.5 above the national average, which is 2.5 percent.