Before the COVID-19 pandemic, Stephanie Van Zandt, M.D., medical director of physician advisor services at BayCare Health System in Florida, realized it was forfeiting big dollars for procedures on the inpatient only (IPO) list because patients weren’t admitted as inpatients. For example, some surgeons who discharged patients within a day of performing certain lumbar fusions then on the IPO list refused to call them inpatients. “They insisted they could not be inpatients because they didn’t stay long enough,” Van Zandt said. The surgeons required a lot of convincing that Medicare only pays for procedures on the IPO list if they’re performed on inpatients, as the phrase implies—and now the same is true of Medicare Advantage (MA) plans because of the 2024 rule on policy and technical changes to MA (CMS-4201-F). “It’s obligatory,” she noted. “There are no exceptions.”