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

Updated Results Using Calendar Year 2019 Data

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

Full Document

Full Document

FormatFile SizeNotes
PDF file 1.1 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Appendix C

FormatFile SizeNotes
PDF file 0.2 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Questions

  1. How many post-operative visits were reported following a procedure with a 10- or 90-day global period for which Medicare required reporting visits?
  2. How did the volume of post-operative visits reported in Medicare claims data vary over time and across states, practice sizes, 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 10 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 2019, building on two prior reports that analyzed data for procedures furnished from July 1, 2017, through June 30, 2018, and for the entire 2018 calendar year.

During calendar year 2019, 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 many 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

  • This suggests that many expected post-operative visits are not delivered and that underreporting is unlikely to fully explain the low ratio of expected post-operative visits provided.

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 standard evaluation and management codes.
  • 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.
  • If CMS decided to not revalue global procedures to 0-day global procedures or revalue procedures based on reported post-operative visits, then CMS could address the potential overvaluation of global surgical packages by adding procedures with large discrepancies between assumed and observed post-operative visits as potentially misvalued codes. The American Medical Association Relative Value Scale Update Committee (RUC) could then reassess these codes, giving consideration to the results on post-operative visits presented in this report. After receiving the RUC’s recommendations, CMS could decide on the final valuation using the survey responses and other inputs.

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 Share 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 Share of Post-Operative Visits 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.

This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.