CMS recently released its proposed rule for the 2026 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System, which includes changes that will directly impact spine surgeons and outpatient spine care, according to information from Blank Rome health lawyer Eric Tower.
Here are five things to know:
- CMS is proposing site neutral payment policies, making set rates for certain services no matter what setting they are performed in. The agency is initially targeting drug administration services, but has signaled that they will look to expand this approach to high-volume and high-cost services such as spine surgery.
- The change aims to get rid of incentives where hospitals receive higher Medicare payments for outpatient procedures compared to ASCs and physician practices, which has often led to hospitals acquiring ASCs and physician practices to move services to the higher-paying hospital setting.
- If site neutral payment policies are applied to spine surgery, it may not be financially advantageous to perform spine procedures in a hospital setting. Spine surgeons may need to reassess their models and possibly move some procedures and services to ASCs to offset higher overhead costs that are associated with hospitals.
- CMS is also proposing phasing out the Inpatient Only list over the next three years, starting in 2026, with the removal of many spine procedures. By removing some spine procedures from the IPO list, it will allow surgeons to perform spine procedures in hospital outpatient departments and ASCs that were previously only permitted in hospitals.
- The rule also includes updates to the ASC device-intensive procedure policy, which could lead to more accurate payment for spine procedures performed in ASCs.
