Office-Based Surgery Not Impacted by 2023 CMS Medicare Ruling

Office-Based Surgery Not Impacted by 2023 CMS Final Rule

iOR Partners is focused on perpetuating the shift to office-based surgery as a new standard of care that is better for patients, providers, and payors. Since inception, we have been advocating with CMS on behalf of their surgeon partners for national safety standards and reimbursement for ophthalmic office-based surgery (OBS).

One of the steps in accomplishing standardization is for CMS to adopt an Office-Based Surgical Facility Code, just as ASC’s utilize an established CMS Code for facility fees. We believe this methodology would be a clear, direct, and more efficient way for Medicare to reimburse practices with established Office-Based Surgical Suites. 

CMS did not change the current reimbursement method for ophthalmic OBS. As we know, changes in healthcare take time; however, the movement toward OBS continues to accelerate. The magnitude of supportive comments collected by CMS indicates change is happening. Supportive comments increased 5 times in this year’s comment period from the first time CMS requested public opinion in 2016.

CMS Continues to Evaluate Ophthalmic Office-Based Surgery for Non-Facility Codes

The Office-Based Surgery (OBS) movement achieved a key milestone as CMS recognizes OBS as an alternative option for some cataract, glaucoma, and retinal eye surgeries with its inclusion in the 2023 proposed rule. As stated in the final rule, the agency will continue to evaluate these procedures in the non-facility setting, and consider establishing non-facility codes in the future.

The primary concern from stakeholders is around OBS safety. iOR Partners met with CMS in 2020 and began collecting data from real-world cases, and will have data on over 30,000 OBS cases by the end of 2022 showing just as good or better outcomes as ASCs or hospitals.

We will continue to work with CMS and industry stakeholders to establish national accreditation standards that would provide reimbursement to fully accredited OBS facilities.  

office-based cataract surgery safety data
iOR Safety Data

What Does This Mean for Office-Based Surgery Reimbursements?

There is no change to the way iOR Partner facilities receive reimbursements as CMS continues its evaluation. Surgeons will continue to receive an enhanced professional fee from Medicare in lieu of a facility fee, in addition to their standard professional fee.

What Next for the OBS Movement?

iOR Partners will continue to advocate for CMS to develop a consensus-driven plan to provide payment for these ophthalmic OBS procedures with key stakeholders, including:

  • Continued meetings with congressional leaders to gain support on Capitol Hill
  • Ongoing discussions with AAO, ASCRS, AECOS, OMIC, the Joint Commission, and Quad A on standards for OBS
  • Sharing peer-reviewed data supporting OBS safety (to be published in Q1 2023)
  • Urging CMS to request comparable peer-reviewed safety data from ASC organizations
  • Meet with CMS in Q1/Q2 2023 in preparation for next year’s Proposed Rule

The OBS movement has made a significant leap forward, and we are committed to keeping the momentum going. iOR Partners will continue to lead the charge, and we look forward to your continued support.

In the face of inflation and standard reimbursement fee reductions, iOR is fighting on behalf of iOR Partner surgeons and their facilities to get Office-Based Surgery recognized appropriately for the safe, efficient, patient-first focus they provide. 

Do You Currently Utilize a Hospital Or an ASC For Ophthalmic Surgery? You May Benefit From Switching to Office-Based Surgery.

From the moment you become an iOR surgeon partner, you have access to a team of experts who shoulder the burden of logistical coordination—allowing you to focus on what you do best (surgery). 

Even for surgeons in smaller offices, office-based surgery can be a lucrative asset. An OBS suite can be constructed in spaces as small as 500 square feet. In some cases, unused space can be repurposed for a revenue-generating surgical suite.

When some surgeons envision bringing OBS to their clinic, they worry it will be a year-long process of disruptive construction, logistical upheaval, and long periods of empty schedules. In reality, most surgeons can incorporate an in-office surgery suite in just a few months. 

The benefits of OBS are numerous, but most physicians report an increase in patient comfort, a decrease in scheduling conflicts, and a greater number of procedures performed.

Does Office-Based Surgery Make Sense for Your Practice?

Transitioning your practice from an ASC model to OBS requires intentionality, but is rarely disruptive to your practice or your patients.  Begin by requesting a FREE OBS analysis from iOR Partners, and learn the details of how your facility could support an OBS model, along with a timeline for implementation. 

iOR Partners is committed to empowering surgeons by creating accessible and lucrative office-based surgery suites.