CMS proposed removing 285 mostly musculoskeletal procedure codes from the inpatient-only list over three years, a move spine surgeon Christian Zimmerman, MD, is watching.
Dr. Zimmerman, of St. Alphonsus Medical Group and SAHS Neuroscience Institute in Boise, Idaho, shared his thoughts on the proposed CMS move.
Note: This response was lightly edited for clarity.
Queston: Will these removals affect the spine and orthopedic landscape for better or worse?
Dr. Christian Zimmerman: The CMS selective pruning and thousand cuts strategy continues as ASCs become the next target. Depending on position and investiture, the soothsayer on this proposal is another run-up prospectus towards continued cuts and reimbursement tightening following the last two decades of history. This double-edged sword strategy reflects the 10-year solvency issues surrounding recent reporting by the Medicare Trustees and the Hospital Insurance Trust Fund.
Under the proposed rule and a three-year ramp up, CMS would eliminate the Medicare Inpatient Only (IPO) list beginning with the removal of hundreds of primarily musculoskeletal procedures in calendar year 2026. If approved, these procedures would only become eligible for payment in outpatient settings when clinically appropriate and necessarily appealed. There is no safe haven of late, and all disciplines and facilities are under macroscopic scrutiny
for screw tightening and cost amelioration.
