Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report
Feb 5, 2021
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.
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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.
Data and Methods
Examining the Number of Post-Operative Visits Reported
Examining the Share of Practitioners Engaged in Claims-Based Reporting of Post-Operative Visits
Timing of Post-Operative Visits and the Fraction of Expected Post-Operative Visits Reported
Sensitivity Analysis: Examining Procedures Performed by Practitioners Actively Reporting Post-Operative Visits
Sensitivity Analysis: Using an Expanded Definition of Post-Operative Visits
Additional Sensitivity Analyses
Examining Characteristics of Clean Procedures
Identifying Robust Reporters of Post-Operative Visits
Observed-to-Expected Ratio of Post-Operative Visits for All Procedures
Exploring Visits Immediately Following Global Periods
Comparison of the Timing of Post-Operative Visits and the Fraction of Expected Post-Operative Visits Reported Using Two Methods to Identify Clean Procedures