Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report
Jul 31, 2019
For many surgeries and procedures, Medicare and most other insurers cover a bundle of services, including post-operative visits, during the global period. As part of 2015 MACRA legislation, Congress mandated that the Centers for Medicare & Medicaid Services (CMS) collect data on the number and level of post-operative visits delivered in the global period to assess accuracy of payment. Among other efforts, CMS conducted a practitioner survey to assess the level of visits, using three procedures as proof of concept: cataract surgery, hip arthroplasty, and complex wound repair.
Using data reported via the survey, the authors found that reported physician time and work for cataract surgery and hip replacement post-operative visits were generally similar — but slightly less — than the levels expected based on the evaluation and management visits assumed to typically occur when valuing these procedures. Reported physician time and work for complex wound repair post-operative visits were higher than Physician Time File levels.
Based on experiences with various approaches to collecting data on the level of post-operative visits as well as the status quo, the authors suggest thinking of these data collection methods as a spectrum with both benefits and trade-offs. Given the strengths and weaknesses of these approaches, the authors recommend consideration of a claims-based approach coupled with information about the level of service or the use of G-codes. A survey instrument could serve as a complement to a claims-based approach for procedures or groups of procedures for which valuation is thought to be particularly problematic.
Overview of the Current Valuation Approach for Post-Operative Services in the Global Period
Survey Development and Methods
Estimating the Level of Post-Operative Visits Through Survey Data
Lessons Learned and Limitations from Survey Development and Fielding
Summary of Direct Observation Task
Answers to Frequently Asked Questions (FAQ) About the Survey
Survey Log-In and Informed Consent Text
Survey Screening Questions
Sample Office-Based Visit Module
Sample Practice Characteristics Module
Email Invitation from CMS
Letter from CMS Leadership Accompanying Email
Additional Analyses of Survey Data