The Centers for Medicare & Medicaid Services (CMS) bundles payments for post-operative care within 10 or 90 days after many surgical procedures. Congress mandated that CMS collect data on the number and level of post-operative visits to enable CMS to assess the accuracy of global surgical package valuation. The authors of this report summarize patterns of post-operative visits for procedures furnished during calendar year 2018.

Cover: Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods
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Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods

Updated Results Using Calendar Year 2018 Data

by Daniel J. Crespin, Ashley M. Kranz, Teague Ruder, Ateev Mehrotra, Andrew W. Mulcahy

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Research Questions

  1. How many post-operative visits were reported following a Medicare requirement to report of visits in select states?
  2. How did the volume of post-operative visits reported in Medicare claims data vary over time and across state, practice size, and physician specialty?
  3. What share of procedures had any post-operative visits?
  4. What was the ratio of observed to expected post-operative visits?

Medicare payments for most surgical procedures cover both procedures and post-operative visits occurring within a global period of either ten or 90 days following procedures. There have been concerns that fewer post-operative visits are provided than the number of post-operative visits considered when the procedure was valued. To help inform accurate valuation of procedures with global periods, the Centers for Medicare & Medicaid Services (CMS) required select practitioners to report on post-operative visits after select procedures with 10- or 90-day global periods. The authors of this report summarize patterns of post-operative visits for procedures furnished during calendar year 2018, building on a prior report that analyzed data for procedures with July 1, 2017, through June 30, 2018, service dates.

During calendar year 2018, 96.5 percent of procedures with 10-day global periods did not have an associated post-operative visit. Approximately two-thirds of procedures with 90-day global periods had an associated post-operative visit; however, the ratio of observed to expected post-operative visits provided for 90-day global period procedures was only 0.38.

Underreporting of post-operative visits might be driving these low rates. However, in sensitivity analyses limited to practitioners who were actively reporting their post-operative visits, post-operative patterns were largely similar to the main analysis. Collectively, these findings suggest that a large share of expected post-operative visits are not delivered, and that underreporting is unlikely to fully explain the low ratio of expected post-operative visits provided.

Key Findings

The share of procedures with any post-operative visit is low

  • The vast majority of procedures with 10-day global periods did not have an associated post-operative visit.
  • Approximately two-thirds of procedures with 90-day global periods had an associated post-operative visit.

Fewer total visits were provided than what was expected

  • The ratio of observed to expected post-operative visits provided was 0.04 for procedures with 10-day global periods and 0.38 for procedures with 90-day global periods
  • Using a more expansive definition of post-operative care did not have a substantive impact on the patterns observed.

A large share of expected post-operative visits is not observed in the data, suggesting the need to revalue procedures with a global period

Recommendations

  • Because the share of procedures with 10-day global periods and any post-operative visits was very low, CMS could consider converting some or all 10-day global procedures to 0-day global procedures. Practitioners who furnish post-operative visits for such procedures would be paid separately by billing typical evaluation and management codes.
  • To address the potential overvaluation of global surgical packages, CMS could request new information from the RVS (Relative Value Scale) Update Committee on expected counts of post-operative visits. The RVS Update Committee could use the data in this report to inform those revaluations or conduct new surveys on the typical number of post-operative visits. CMS could decide on the final valuation using the new survey responses and other inputs.
  • Using the information on post-operative visits collected in the nine states, CMS could consider revaluing all procedures with 90-day global periods using the number of post-operative visits reported in the claims data or from other sources.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Data and Methods

  • Chapter Three

    Examining the Number of Post-Operative Visits Reported

  • Chapter Four

    Examining the Share of Practitioners Engaged in Claims-Based Reporting of Post-Operative Visits

  • Chapter Five

    Timing of Post-Operative Visits and the Fraction of Expected Post-Operative Visits Reported

  • Chapter Six

    Sensitivity Analysis: Examining Procedures Performed by Practitioners Actively Reporting Post-Operative Visits

  • Chapter Seven

    Sensitivity Analysis: Using an Expanded Definition of Post-Operative Visits

  • Chapter Eight

    Additional Sensitivity Analyses

  • Chapter Nine

    Conclusions

  • Appendix A

    Examining Characteristics of Clean Procedures

  • Appendix B

    Identifying Robust Reporters of Post-Operative Visits

  • Appendix C

    Observed-to-Expected Ratio of Post-Operative Visits for All Procedures

  • Appendix D

    Exploring Visits Immediately Following Global Periods

  • Appendix E

    Comparison of the Timing of Post-Operative Visits and the Fraction of Expected Post-Operative Visits Reported Using Two Methods to Identify Clean Procedures

Research conducted by

This research was funded by the Centers for Medicare & Medicaid Services (CMS) and carried out within the Payment, Cost, and Coverage Program in RAND Health Care.

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