How CMS’s Removal of 285 Inpatient‑Only Procedures Is Reshaping the Surgical Landscape

Orthopedics is entering a defining moment where the site of care is becoming just as important as the procedure itself. For decades, the Centers for Medicare & Medicaid Services (CMS) maintained an Inpatient‑Only (IPO) list that reflected an earlier era of musculoskeletal care, when longer hospital stays and intensive monitoring were the norm. But the field has changed. Advances in surgical techniques, anesthesia, and recovery pathways have reshaped what surgeons can safely accomplish as an outpatient procedure outside the hospital walls.

CMS’s decision to remove 285 musculoskeletal procedures from the IPO list reflects that reality. These procedures can now be performed in hospital outpatient departments and ambulatory surgery centers (ASCs), and with the full IPO list scheduled for elimination by 2028, the shift toward outpatient orthopedics is only accelerating. Perhaps more significantly, the CMS change moves site-of-care decisions back to where they belong: with clinicians and patients.

The Accelerating Shift Toward Outpatient Orthopedics

CMS justified the change as a result of clinical evolution and advancements in modern surgical safety. Many procedures once considered too complex for outpatient care can now be performed safely and predictably outside the inpatient setting. Enhanced recovery protocols and minimally invasive techniques have shortened recovery times and broadened the pool of patients eligible for outpatient surgery. Earlier IPO removals, such as total knee and hip arthroplasty, demonstrated this shift while showing significant declines in inpatient volume without compromising outcomes.

ASCs have become central to this evolution. Purpose‑built for efficiency and same‑day recovery, they offer reduced costs, and a more personalized patient experience. Surgeons often tell me how much they value the control ASCs give them over scheduling, staffing, and workflow. These factors can directly influence consistency and outcomes. CMS’s decision simply accelerates a trend that has been unfolding for years.

We see the tremendous opportunity ahead. Because of this continued migration trajectory, we are investing meaningfully in ZBX ASC Solutions through our product portfolio and, just as importantly, in our people—because lasting growth in this space requires both innovation and expertise.

For physicians, the expanded ability to perform these procedures outside the hospital represents a meaningful increase in clinical autonomy. Surgeons can now align each patient with the environment that best supports their recovery. Procedures that once required hospitalization, such as total knee replacement revision surgeries, can now shift to outpatient settings, allowing patients to recover at home and offering the potential for shorter wait times.

Technology and Infrastructure Powering the ASC‑Driven Future

This transition underscores the importance of technologies and solutions designed specifically for outpatient and ASC environments. It puts a greater importance on efficient instrumentation, streamlined implant systems, handheld robotic surgical options and data‑driven patient selection models. And, it recognizes how all of those play a critical role in enabling safe, predictable same‑day surgery.

As we get closer to 2028, when the IPO list is fully eliminated, the orthopedic ecosystem will look markedly different: more decentralized, more patient‑centric, and better aligned with outcomes and efficiencies.

What the CMS Shift Means for the Road Ahead

Innovation in orthopedics is no longer just about improving the procedure itself. It’s about optimizing the entire episode of care, from preoperative planning to postoperative recovery, in settings that prioritize speed, safety, and patient comfort and experience. The organizations that thrive in this next chapter will be the ones that view outpatient innovation not simply as a cost‑saving opportunity, but as a catalyst for reimagining the orthopedic experience.