CMS’ proposal to bring 285 mostly musculoskeletal codes off the inpatient only list provides new opportunities for physicians and patients, orthopedic surgeon Wael Barsoum, MD, said.
Dr. Barsoum, president & chief transformation officer at Healthcare Outcomes Performance Co., spoke with Becker’s about what these potential changes mean for orthopedics and how he is staying ahead of the curve.
Note: This conversation was lightly edited for clarity.
Question: How do you feel about the proposed removal of these codes from the IPO list?
Dr. Wael Barsoum: I’m very excited about it. I believe that more decision making needs to happen between the provider and the patient, and less decision making being made by the payer. If I’m a doctor, and I’m confident that the ASC that I’m affiliated with has good outcomes and safety mechanisms in place, I want to have the option to be able to offer that to my patient. I think increasing the opportunities for decision making between the provider and the patient, would lead to better patient outcomes.
Q: Can you talk about how physicians and ASCs and practices can best improve these processes for determining if a patient is best fit for a procedure versus going to the hospital?
WB: To give an example, starting preoperatively we use predictive modeling in our practices, where based on a patient’s age, co-morbidities, ASA score and their support at home same-day, we’ll make a decision on if we think it’s safe to be done in an ASC.
You want to make sure that your anesthesia providers are comfortable managing an acute or sub-acute situation, and I would say 99.9% of the time they are. These are very highly trained professionals that do this for a living, and they’re very good at handling emergencies.
And postoperatively we’re looking at whether the recovery room has the right protocols in place to flag if a patient is having a problem or shouldn’t be discharged directly home. Finally, once the patient goes home is there enough connectivity there to ensure they can reach their provider?
Q: How have similar removals from the IPO list affected your own work and HOPCo?
WB: We’ve always been a little bit ahead of the game when it comes to value-based care and ensuring that patients have choice. As opportunities have come up to give patients more choice, especially ones that end up saving them and their insurer money, we want to explore them.
When total knee replacements came off the inpatient only list, we moved volume to the outpatient spaces. When total shoulder replacement came off, we moved volume to the ASCs. We’ve done this in a very responsible way. Not only did we move patients, we are actually reporting on our outcomes with those moves. As we’ve shifted volume into the outpatient space, and as we have decreased lengths of stay in the HOPD we found that our readmissions have gone down. Anytime we make these moves, we wrap the move with an entire network of safety protocols around it, and that’s why we’ve been able to do it successfully.
Q: Are there any procedures in this new list that stand out to you?
WB: There are plenty of spine opportunities that we can safely move. There are also very basic revision procedures that should be done in an outpatient space.
For example, some simple revision knee replacements are a 25 to 30 minute procedure done with a tourniquet with almost no blood loss. It’s a revision, but it’s a very minor revision. In fact, it’s probably a lower risk procedure than the primary knee replacement to begin with. I think we’ll start seeing more adoption of those types of procedures in an outpatient setting.
We’ve been able to do them outpatient already, but we just couldn’t get paid for it to do them in that setting, so nobody would do them in that setting. Moving forward, I think we’ll find that more and more of those simple-type procedures will go to the outpatient setting.
And over time, as we improve, we’ll start moving more complex procedures outpatient. Twenty years ago, nobody would have ever considered doing a knee or hip replacement in an ASC. Today, it’s all around the country. As the world evolves, our safety protocols evolve and our processes evolve.
Q: There’s a lot going on in federal healthcare updates from CMS’ proposed 2026 physician fee schedule to the GOP spending bill signed July 4. What do you make of these moves and how will they affect orthopedics?
WB: I believe that 99.999% of providers want to always do what’s best for patients as long as they have the tools to do it. If a surgeon is moving volume to an ASC I don’t believe that it’s predominantly for financial reasons for that surgeon. I think it’s predominantly because we know the ASC setting is preferred by the majority of patients. In my view, increasing choice on the part of the provider and the patients is a good thing. We just have to ensure that providers have the right tools to make the very best decisions. They have to be aware of the predictive models out there of who can be safely operated on in that kind of environment. The anesthesia provider has to be on the cutting edge of knowing what kind of anesthetic they ought to be using. What are the signs in the recovery room that a patient is potentially at risk or in danger? It’s important to make sure we’re very comfortable with that because once the patient leaves your door, they’re only going to be contacting you through the emergency department or through a phone call.
