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

Area of Science:

• Health Services Research
• Healthcare Policy
• 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 expected and actual post-operative visits provided.
• Accurate procedure valuation by the Centers for Medicare & Medicaid Services (CMS) necessitates understanding post-operative visit patterns.

Purpose of the Study:

• To analyze post-operative visit patterns for Medicare-covered surgical procedures in 2019.
• To build upon previous research analyzing post-operative visit data from 2017-2018.
• To inform accurate valuation of surgical procedures with defined global periods.

Main Methods:

• Analysis of Medicare claims data for procedures with 10- and 90-day global periods during calendar year 2019.
• Comparison of observed post-operative visits against expected visit numbers based on procedure valuation.
• Sensitivity analyses conducted on data from practitioners actively reporting post-operative visits.

Main Results:

• 96.5% of procedures with 10-day global periods had no associated post-operative visit in 2019.
• Approximately two-thirds of procedures with 90-day global periods had at least one post-operative visit.
• The ratio of observed to expected post-operative visits for 90-day global periods was 0.38.

Conclusions:

• A significant number of expected post-operative visits are not being delivered for Medicare surgical procedures.
• Underreporting of visits is unlikely to be the sole reason for the low observed-to-expected visit ratio.
• Findings suggest potential gaps in post-operative care delivery within Medicare's global payment model.