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 2019.

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

Updated Results Using Calendar Year 2019 Data

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

ResearchPublished Sep 14, 2021

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

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.

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Crespin, Daniel J., Ashley M. Kranz, Teague Ruder, Ateev Mehrotra, and Andrew W. Mulcahy, Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data, RAND Corporation, RR-A203-2, 2021. As of September 7, 2024: https://www.rand.org/pubs/research_reports/RRA203-2.html
Chicago Manual of Style
Crespin, Daniel J., Ashley M. Kranz, Teague Ruder, Ateev Mehrotra, and Andrew W. Mulcahy, Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data. Santa Monica, CA: RAND Corporation, 2021. https://www.rand.org/pubs/research_reports/RRA203-2.html.
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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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