Testing New Codes to Capture Post-Operative Care.

Area of Science:

• Health Services Research
• Medical Economics
• Health Policy

Background:

• The Centers for Medicare & Medicaid Services (CMS) uses a resource-based relative value system for physician payments.
• Medicare global payment periods include pre- and post-operative visits.
• Congressional mandate required CMS to collect data on the "number and level" of visits within these global periods.

Purpose of the Study:

• To pilot proposed nonpayment codes developed by RAND for capturing the number and level of physician visits during global periods.
• To assess whether practitioners understood and could accurately apply the proposed codes.
• To provide recommendations for refining the codes and their usage instructions.

Main Methods:

• Development of a new set of nonpayment codes by RAND at CMS's request.
• Pilot testing using a series of vignettes.
• Semi-structured interviews with a small physician sample, followed by surveys with a larger physician group.

Main Results:

• The pilot study assessed practitioner understanding and application of the proposed nonpayment codes.
• Vignette-based testing provided insights into potential challenges and areas for improvement.
• The study identified practical considerations for code implementation and refinement.

Conclusions:

• Vignette testing is an effective method for evaluating new coding systems.
• The study's findings can inform refinements to the CMS nonpayment codes and their associated instructions.
• Improved code usability can enhance the accuracy of data collection for physician services within global periods.