ARTICLE SUMMARY:
MS has eliminated all orthopedic procedures from the inpatient-only rule, as of January 1, 2026—part of a three-year plan to remove the list entirely--and is working on other policy changes that expand access to lower-cost ambulatory surgery centers. Experts highlight how these changes will affect manufacturers’ commercial strategies and influence ASC procurement in ways that both incentivize and discourage adoption of high-cost technologies.
Medicare’s phased-in elimination of the inpatient only rule (IPO) and simultaneous expansion of the list of procedures it covers in ambulatory surgery centers (ASCs) are forcing medical device manufacturers to rethink where and how much they get paid.
CMS’ stated goal is to move away from rigid requirements over the next three years toward greater reliance on physician judgment in choosing the most appropriate site of service, arguing that technology and practice patterns have outpaced 25-year-old safety assumptions (see Figure 1).
These gestures, combined with legislative proposals to implement site-neutral payments, which peg rates for the same service more closely across settings, are leading to long-term structural changes in healthcare reimbursement that have strategic implications for manufacturers. While the trends they tap into have been ongoing for years, they are accelerating and becoming more entrenched.
