Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods
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 2019.
Updated Results Using Calendar Year 2019 Data
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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.
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 Share 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 Share of Post-Operative Visits Using Two Methods to Identify Clean Procedures
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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