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Billing rules / global period affect postoperative follow-up practices following total hip arthroplasty
Philip P Ratnasamy1, Oghenewoma P Oghenesume1, Peter Y Joo1
1Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, United States of America.
Insights
Post-total hip arthroplasty (THA) care shows a significant increase in follow-up visits and surgeon involvement after the global billing period ends. This shift highlights potential billing impacts on clinical practice patterns.
Area of Science:
- Orthopedic Surgery
- Health Services Research
Background:
- Total hip arthroplasty (THA) is a common orthopedic procedure.
- Postoperative care and follow-up visits are crucial for optimizing patient outcomes after THA.
- The global billing period for THA typically covers the first 90 postoperative days (approximately 13 weeks).
Purpose of the Study:
- To assess clinical practice patterns related to follow-up visits following total hip arthroplasty.
- To analyze the timing and frequency of Evaluation and Management (E&M) codes within 26 weeks post-THA.
- To compare follow-up care provided by surgeons versus advanced practice providers (APPs) within and beyond the global billing period.
Main Methods:
- Utilized the PearlDiver M91Ortho dataset to identify 77,843 THA cases.
- Examined the incidence and timing of E&M codes in the 26 weeks following THA.
- Determined follow-up visit patterns, including provider type (surgeon vs. APP) and timing relative to the 90-day global billing period.
Main Results:
- Follow-up visits peaked at postoperative weeks 3, 7, and 14.
- A significant increase (over 4-fold) in follow-up visits occurred between weeks 13 and 14, immediately after the global billing period.
- While 73.8% of visits in the first 13 weeks were with surgeons, this increased to 86.8% in the subsequent 13 weeks (p<0.0001).
Conclusions:
- A notable increase in follow-up visits and a shift towards greater surgeon involvement occur after the THA global billing period concludes.
- These findings suggest that billing structures may influence clinical practice patterns and the delivery of postoperative care.
- Understanding these patterns is essential for optimizing patient management and healthcare resource allocation post-THA.
Background:
Total hip arthroplasty (THA) is a common procedure following which postoperative visits are important to optimize outcomes. The associated global billing period includes the 90 postoperative days (or approximately 13 weeks), during which professional billing is included with the surgery itself. The current study assessed clinical practice patterns relative to the global billing period.
Methods:
Using the PearlDiver M91Ortho dataset, the incidence and timing of Evaluation and Management (E&M) codes in the 26 weeks following THA were assessed. The follow-up visits within and beyond the global billing period, and those conducted by surgeons versus non-surgeon advanced practice providers (APPs) were determined.
Results:
77,843 THAs were identified. Follow-up visits peaked at postoperative weeks 3, 7, and 14. The greatest week-to-week variation in the number of follow-ups was from weeks 13 to 14 immediately following the global billing period (representing a greater than 4-fold increase in visits.) During the first 13 postop weeks, 73.8% of patients were seen by orthopedic surgeons (as opposed to APPs). In the following 13 weeks, a significantly greater percentage of visits were with surgeons (86.8%, p<0.0001).
Conclusions:
Following the THA global billing period, there was marked increase in the number of follow-ups and transition to a greater percentage being performed by the surgeons. These results provide interesting insight into the potential impact of the billing structure on how practice is pursued.
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