ASA Submits Comments to CMS on OPPS Proposed Rule, Emphasizing Patient Safety and Physician Judgment

This week, ASA cautioned the Centers for Medicare and Medicaid Services (CMS) from eliminating the Inpatient Only List (IPO) and expanding the Covered Procedures List (CPL) in comments on the CMS 2026 Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) proposed rule. Should CMS proceed with eliminating the IPO list, ASA stressed that CMS policies must preserve physician authority in determining appropriate sites of care and be supported by safeguards and monitoring to protect patient safety. If the IPO list is eliminated, ASA recommended that CMS work with specialties, ASCs, and other stakeholders to track patient outcomes, complications, and other patient-centered measures in the ASC and outpatient settings.

The proposed rule included several policy proposals related to the expansion of the CPL, including a proposal to eliminate important safety standards and exclusion criteria. Those safety standards currently prohibit procedures in ASCs that may result in extensive blood loss, require prolonged invasion of body cavities, directly involve major blood vessels, are emergent or life-threatening, or commonly require systemic thrombolytic therapy. ASA argued the exclusions recognize certain procedures as high-risk and require immediate access to hospital-level resources such as blood products, critical care services, and emergency surgical backup. ASA fears the elimination of these safeguards may open doors to workarounds where procedures with substantial inherent risks are shifted into outpatient or office-based environments not designed to manage complications, and jeopardizing patient safety.

Finally, ASA expressed support for expanding access to non-opioid alternatives that could reduce the risk of opioid misuse among surgical patients. ASA encouraged CMS to implement policies expanding physician access to opioid alternatives as it will allow patients greater access to reduced or non-opioid postoperative pain management.

Click here to read ASA's comment letter.

Please contact the ASA Department of Quality and Regulatory Affairs at [email protected]with any questions.