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

Area of Science:

• Health Services Research
• Medical Economics
• Surgical Outcomes

Background:

• Medicare payments bundle surgical procedures with post-operative care within global periods (10 or 90 days).
• Concerns exist regarding the discrepancy between the number of post-operative visits considered in procedure valuation and those actually provided.

Purpose of the Study:

• To analyze patterns of post-operative visit delivery for Medicare-covered surgical procedures in 2018.
• To inform accurate valuation of surgical procedures by assessing post-operative visit utilization.

Main Methods:

• Analysis of Medicare claims data for procedures with 10- or 90-day global periods during calendar year 2018.
• Comparison of reported post-operative visits against expected utilization based on global period definitions.

Main Results:

• 96.5% of procedures with 10-day global periods lacked associated post-operative visits.
• Two-thirds of procedures with 90-day global periods had visits, but the observed-to-expected ratio was only 0.38.
• Sensitivity analyses indicated that underreporting does not fully explain the low visit rates.

Conclusions:

• A significant proportion of expected post-operative visits are not being delivered for Medicare surgical procedures.
• The low utilization of post-operative visits suggests a systemic issue beyond simple underreporting by practitioners.