Billing rules / global period affect postoperative follow-up practices following total hip arthroplasty

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.