Why getting rid of the IPO is good for ophthalmology

Blog post description.

8/5/20252 min read

Why Eliminating the inpatient only list is good news for ophthalmology and office based surgery

1. Legitimizes Non-Hospital Settings

By proposing that many complex surgeries no longer require inpatient admission, CMS is signaling confidence in advances in anesthesia, infection control, and post-op recovery—the same arguments that support cataract surgery in office-based settings.

🔎 Implication: If CMS trusts total joint replacements and spine surgery to be safely done outpatient, ophthalmic surgery in a clean OBS suite is increasingly defensible.

2. ASC Covered Procedure List (CPL) Expansion Creates Precedent

CMS is expanding the number of procedures allowed in ASCs by nearly 550 codes in 2026. This opens the door to revisiting site-of-service guidelines for OBS, especially for specialties like ophthalmology that:

  • Use only local or topical anesthesia

  • Have short recovery times

  • Offer procedures like cataracts, LASIK, blepharoplasty, and intravitreal injections

🧠 If procedures once thought to require hospitals are now ASC-eligible, it’s reasonable to argue some ASC procedures can be safely done in the office.

3. Cost Pressures Encourage OBS Shift

CMS and commercial payers are increasingly cost-sensitive, and OBS suites:

  • Avoid ASC facility fees

  • Have lower overhead and staffing costs

  • Eliminate transport and scheduling delays

📉 Cataract surgery in an OBS setting can cost 25–40% less than in a hospital or ASC, depending on the market.

4. More Commercial Payers Are Embracing OBS

UnitedHealthcare, Humana, and regional Blues plans have started authorizing or reimbursing cataract surgery in accredited office-based settings. As CMS leads policy trends, this ruling could give legal and economic cover to expand office-based reimbursements.

💬 If CMS deems complex surgeries as outpatient safe, private payers will likely see office-based eye surgery as "low-risk, low-cost, high-volume."

5. Provider Autonomy and Efficiency

CMS's proposed rule emphasizes physician judgment in determining the site of care. Ophthalmologists who own their OBS suite benefit from:

  • Improved scheduling control

  • No competition for OR time

  • Ownership of the patient experience

  • Facility fee retention

🛠 This further incentivizes high-volume surgeons to invest in OBS infrastructure rather than cede revenue to hospitals or ASCs.

🚧 What’s Still Needed for Growth

While this ruling supports the policy environment for OBS expansion, further adoption in ophthalmology depends on:

What's needed:

  • Payer coverage - CMS must define reimbursement pathways or modifiers

  • Accreditation- Widespread use of AAAASF, ACHC, or The Joint Commission

  • Data - Continued publication of safety/outcomes from office-based cataract procedures

  • State regulations - OBS compliance must align with state-specific rules on anesthesia & facility class

✅ Conclusion

While not directly aimed at ophthalmology, CMS's move to dismantle the IPO list validates the outpatient-first mindset and strengthens the case for OBS adoption in eye care. It encourages a shift from:

  • Hospital → ASC → Office

In a field that already delivers some of the safest, most standardized surgeries (like cataracts), this is a powerful signal:

The future of ophthalmic surgery is smaller, faster, cheaper, and closer to the patient.