Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods
Feb 5, 2021
Medicare payment for many health care procedures covers the procedure itself and most post-operative care during a fixed "global period." This report describes how the Centers for Medicare & Medicaid Services could use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. These results may inform further policy development around revaluation for global procedures.
Medicare payment for many health care procedures covers not only the procedure itself but also most post-operative care over a fixed period of time (the "global period"). The Centers for Medicare & Medicaid Services (CMS) sets payment rates assuming that a certain number and type of post-operative visits specific to each procedure typically occur.
This report describes how CMS might use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. There are links between the number of bundled post-operative visits and the components of valuation addressed in this report: work, practice expense (PE), and malpractice relative value units (RVUs). There is some ambiguity regarding how a reduction in post-operative visits translates into changes in work RVUs. In contrast, a reduction in post-operative visits has clear implications on physician time and direct PE. Changes in physician work, physician time, and direct PE will, in turn, affect the allocation of pools of PE and malpractice RVUs to individual services.
The idiosyncrasies of the resource-based relative value scale system used to determine payment for Medicare services result in some ambiguity about how procedures should be revalued to reflect reductions in post-operative visits. These results may inform further policy development around revaluation for global procedures.
Revaluation Approach Overview
Data and Methods
Variation in Reported Post-Operative Visits
Detailed Results Tables