Financial woes tied to healthcare are nothing new for the common people. Now, a cost-saving change in Medicare launched in the final days of the Trump administration is expected to add to those woes and cause a great deal of confusion. 

For several years, 1,740 surgeries and other services were put in the category of extremely risky for older adults, and Medicare would pay for them only when these adults were admitted to the hospital as inpatients. This requirement will soon be phased out by the new rule, which has crossed off 1266 shoulder, spine, and other musculoskeletal surgeries from the inpatient-only list. The list also includes a variety of complicated procedures, including brain and heart operations.

According to medical experts, some of the procedures included in the list are very complex and involve cutting, sewing, and post-op care to reduce complications. CMS should have tested the change first to be sure it’s safe for patients.

While the medical experts term this as a risky move, CMS officials say that the changes have been designed to give patients different options and help lower costs by promoting more competition among medical facilities. 

Done with an intent to ‘cut costs’ for the patients, these changes may have the opposite effect. Here’s why. While the government did remove several surgeries from the in-patient-only list, they were not approved to be performed anywhere else. So patients will still have to get care at hospitals, but they don’t have to be considered admitted patients; they can receive services on an outpatient basis.

Outpatient services are charged differently, with Medicare paying 80% of the Medicare-approved amount for the services of the outpatient surgery center and surgeons’ fees and the patient typically paying the rest of it. The Medicare-approved amount differs based upon the outpatient surgery procedure the patient receives, and there are several other expenses that the patient has to bear, such as – a second payment for blood transfusions and several other payments based on what’s included in the surgery charge and how many other separately billed items are required by the patient. 

In most cases, the outpatient service charge cannot exceed $1,484, but the total co-payment for all outpatient services can sometimes be higher than the inpatient hospital deductible.

With the proposed changes affecting the Americans’ medical costs, they are looking at the Biden administration with lots of hope. Since the Biden administration inherited the new policy, it is expected that CMS will rescind it.