Not enough data for CMS to know implications: 3 observations on procedures list

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CMS finalized the 2022 ASC payment rules and approved procedures list on Nov. 2, with 255 procedures removed from the outpatient surgery list. These leader spoke to Becker's ASC Review about what that could mean:

CMS flip-flopping adds to physician burnout

David Rothbart, MD. President of Spine Team Texas in Southlake:

Physician burnout [makes me nervous]. It's the real deal; we're seeing it more and more, and I think that the challenges with COVID have only thrown gasoline onto the fire. 

This flip-flop between inpatient-only and outpatient. … I think it also plays into that physician burnout piece of the equation. … To have either the government or the insurance company tell us how to practice is a huge issue. 

Will commercial insurers follow CMS to move ASC surgeries back to the hospital?

I. Naya Kehayes. Principal and ASC practice leader at healthcare advising firm ECG Management Consultants:

I think the surgery centers that have already moved these cases are absolutely at risk to have to move them back to the hospital, especially with the Medicare population.

I think more concerning is whether or not the commercial payers will follow suit. 

I would be going back to the commercial payer about sharing the concerns and potentially asking them for carve-outs from the methodology, because typically if you can get the case carved out in your contract, that will keep you from potentially having an adverse effect.

Hospitals' bottom lines possible motivator for CMS changes

Ms. Kehayes:

I think that there's probably been a lot of feedback from the hospitals and health systems with concerns about the magnitude of cases that potentially could come out of hospitals. With the financial implications, it could be devastating for many hospitals.

But I don't think there was really a methodical process that went into reviewing what the [financial] implications are, because there's not enough data.

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