Posted in: Government Outreach
September 15, 2025
Dr. Mehmet Oz
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1828-P
P.O. Box 8013
Baltimore, MD 21244-8013
RE: CMS-1834-P
Submitted via: https://www.regulations.gov
Dear Dr. Oz,
The Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) appreciates the opportunity to submit comment to the Centers for Medicare & Medicaid Services (CMS) regarding the recently proposed rule entitled Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency.
AAAHC is a private and independent 501(c)(3) non-profit accrediting organization formed in 1979. Since its inception, AAAHC has promoted a voluntary, peer-based, and educational survey process to advance patient care. These values hold true today, as embodied in our mission statement: Improving health care quality through accreditation. With more than 6,700 accredited organizations in a variety of ambulatory health care settings, AAAHC is a leader in developing Standards to advance and promote patient safety, quality care, and value for ambulatory health care through its accreditation programs, education, research, and other resources. Currently, more than 1,000 ASCs are committed to excellence through AAAHC accreditation under the deemed status program, making AAAHC the leading Medicare-deemed ambulatory surgical center accrediting organization in the country.
AAAHC also provides accreditation services to the United States Coast Guard (USCG) ambulatory health centers, Federally Qualified Health Centers (FQHCs) that receive funds from the United States Health Resources and Services Administration (HRSA), and Indian Health Services (IHS) funded health centers. Other AAAHC-accredited organizations include Community Health Centers, Student Health Centers, Medical Group Practices, and office-based surgery (OBS) centers.
As one of four accreditation organizations granted deeming authority for ambulatory surgical centers (ASCs), AAAHC has a significant interest in providing thoughtful and meaningful commentary to the agency in support of a continuing effective relationship. The following includes AAAHC comments, recommendations, and positions as a partner to CMS with the shared goal of improving the quality of health care, and in support of federal government initiatives to increase access to health care services, reduce burden, and provide for consistency across similar programs.
Note: For ease of reading, this comment lists the specific sections to which AAAHC is responding. Any sections for which AAAHC does not provide comment should not be interpreted to mean that AAAHC supports or opposes the proposal.
III. Proposed OPPS Ambulatory Payment Classification (APC) Group Policies
F. Comment Solicitation on Payment Policy for Software as a Service (SAAS)
AAAHC supports CMS’s effort to explore appropriate payment models for Software as a Service (SaaS) and AI technologies under the Physician Fee Schedule. As CMS considers alternative pricing strategies, we recommend grounding any payment model in quality standards established by nationally recognized accreditation organizations. We support CMS’s consideration of methodologies such as aligning with OPPS geometric mean costs or crosswalking from OPPS technical components as interim strategies. However, we also encourage CMS to develop models that reflect the longitudinal value of SaaS tools in improving outcomes and reducing unnecessary utilization.
SaaS technologies offer significant potential to enhance outpatient care by streamlining clinical and administrative workflows. These tools can improve scheduling, provide real-time access to clinical data, support procurement and cost analysis, verify insurance eligibility, and automate reminders. Additionally, SaaS can generate diagnostic summaries and wellness visit insights that inform or even mitigate the need for certain services. These efficiencies improve the patient experience and promote better resource use and care coordination.
However, integrating SaaS and AI technologies requires a strong governance framework to ensure ethical and responsible use. This includes obtaining patient consent for data use, maintaining transparency in AI-driven decisions, and addressing risks related to bias and discrimination. Because many AI tools operate as “black boxes,” clinicians and patients may struggle to understand the rationale behind certain recommendations.
AAAHC expects accredited organizations to implement robust governance structures and risk mitigation strategies when adopting modern technologies. Our standards require training for physicians and other practitioners on the use of technology, emphasize clinical judgment in interpreting outputs, and prioritize patient safety and privacy. AAAHC’s Standards highlight the importance of data integrity, clinical oversight, and continuous quality improvement. We also require organizations to implement policies that ensure appropriate use, documentation, and evaluation of digital tools, especially those that support clinical decision-making and chronic disease management.
IX. Proposed CY 2026 Changes to IPO List
C. Proposed CY 2026 Changes to IPO List
1. CY 2026 Proposal To Eliminate the IPO List
The Accreditation Association for Ambulatory Health Care welcomes the opportunity to comment on CMS’s proposal to phase out the Inpatient-Only (IPO) list over a three-year period, beginning with the removal of 285 musculoskeletal procedures in CY 2026.
As an organization committed to advancing patient safety and quality in ambulatory health care, we recognize that this policy change could significantly expand access to care, especially for older adults who may benefit from receiving procedures in more convenient, lower-acuity outpatient settings. Shifting appropriate procedures to outpatient environments can reduce barriers to care, enhance patient experience, and promote more efficient use of health system resources.
However, the success of this transition hinges on the strength of safeguards that protect care quality. With the elimination of the IPO list, ensuring that patients are screened for the most appropriate site of care becomes critically important. Accreditation provides those safeguards by requiring ambulatory organizations to implement clear clinical guidance for determining whether a patient is suitable for outpatient surgery. AAAHC-accredited organizations demonstrate that procedures are performed in settings that meet—and in many areas exceed—nationally recognized standards for safety, appropriateness, and patient-centered care. These standards ensure that clinical decisions are guided by medical necessity rather than financial incentives, while governance structures reinforce accountability through oversight of operational, ethical, and clinical compliance, including disciplinary procedures when standards are breached. As CMS expands outpatient options, it must also strengthen oversight to prevent fraud, waste, and abuse. Enhanced transparency, rigorous data collection, and robust enforcement mechanisms are essential to identifying and addressing patient safety risks. Without these protections, the benefits of this policy change could be compromised by inconsistent implementation or misuse.
We support CMS’s efforts to modernize care delivery and encourage a collaborative approach that leverages accreditation, clinical judgment, and regulatory oversight. Together, these elements can ensure that patients receive safe, effective, and appropriate care—regardless of the setting in which their care is delivered.
X. Nonrecurring Policy Changes
B. Request for Information: Adjusting Payment Under the OPPS for Services Predominately Performed in the Ambulatory Surgical Center or Physician Office Settings
The Accreditation Association for Ambulatory Health Care supports CMS’s initiative to advance value-based care and reduce unnecessary Medicare spending through site-neutral payment reforms. We agree that aligning payment rates across care settings—when clinically appropriate—can help eliminate financial incentives that drive services from lower-cost settings, such as Ambulatory Surgical Centers (ASCs) and physician offices, to higher-cost hospital outpatient departments (OPDs).
We believe that targeted payment adjustments for services that have experienced volume increases in the HOPD setting due to financial motivations, rather than clinical necessity, are both appropriate and necessary. Aligning OPPS payments with ASC or Physician Fee Schedule (PFS) rates for services that can be safely delivered in those settings promotes cost efficiency and encourages care delivery in high-quality, lower-cost environments. However, we urge CMS to ensure that any payment reforms are grounded in a strong commitment to patient safety and quality of care. All ambulatory settings must meet rigorous quality and safety standards, whether established by CMS or nationally recognized health care accreditation organization bodies such as AAAHC. Payment policies should reinforce—not undermine—these expectations.
We are particularly concerned about CMS’s proposal to significantly reduce payments for procedures such as endoscopic procedures in ASCs and HOPDs while simultaneously increasing payments for the same procedures in physician offices. While we support physicians’ ability to exercise clinical judgment in selecting the most appropriate setting, we caution that increasing payment for office-based procedures could replicate the very incentive-driven migration that CMS seeks to address.
Financial alignment must not override clinical appropriateness or patient-centered decision making. Physician’s must retain the flexibility to consider each patient’s unique needs, comorbidities, and comfort when determining the safest and most effective site of care. AAAHC Standards require governing bodies of accredited organizations to establish policies on the scope of services provided and patient population served, ensuring that care is delivered in settings that are equipped to meet those needs. We encourage CMS to adopt a balanced framework that promotes cost containment while preserving patient choice and clinical integrity. Site-neutral payment policies should be accompanied by robust quality oversight and accreditation requirements to ensure that all care settings—regardless of cost—deliver safe, effective, and appropriate care.
Thank you again for the opportunity to comment on these significant proposals. For any questions regarding this comment, please contact Ann Carrera, Senior Counsel, Legal & Corporate Affairs, at 847-853-6060 or acarrera@aaahc.org.
Sincerely,
Noel M. Adachi, MBA
President & CEO
