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The share of procedures with any post-operative visits is low

• The vast majority of procedures with 10-day global periods did not have an associated post-operative visit.
• Approximately two-thirds of procedures with 90-day global periods had an associated post-operative visit.

Fewer total visits were provided than what was expected

• The ratio of observed to expected post-operative visits provided was 0.04 for procedures with 10-day global periods and 0.39 for procedures with 90-day global periods.
• Using a more expansive definition of post-operative care did not have a substantive impact on the patterns observed.

A large share of expected post-operative visits are not observed in the data, suggesting the need to revalue procedures with a global period

This report was initially published in 2019; this update was published in 2021 and includes clarification on RAND's definition of clean procedures.

Medicare payment for most surgical procedures covers both the procedure and post-operative visits occurring within a global period of either ten or 90 days following the procedure. There have been concerns that fewer post-operative visits are provided than the number of post-operative visits considered when the procedure was valued. To help inform accurate valuation of procedures with global periods, Medicare required select practitioners to report on their post-operative visits beginning July 1, 2017.

Medicare fee-for-service claims data from practitioners who billed Medicare for select procedure codes between July 1, 2017, and June 30, 2018, in the nine states where practitioners were required to report post-operative visits were analyzed. To correctly link a given procedure and post-operative visit(s), analyses were limited to procedures that did not occur within the global period of another procedure with a 10- or 90-day global period.

There were 1.4 million procedures linked to 931,640 post-operative visits. The share of procedures with one or more associated post-operative visits reported was 3.7 percent for procedures with 10-day global periods and 70.9 percent for procedures with 90-day global periods. The ratios of observed to expected post-operative visits provided for procedures with 10- and 90-day global periods were 0.04 and 0.39, respectively.

• Chapter One

  Background

• Chapter Two

  Data and Methods

• Chapter Three

  Examining Number of Post-Operative Visits Reported

• Chapter Four

  Examining the Share of Practitioners Engaged in Claims-Based Reporting of Post-Operative Visits

• Chapter Five

  Timing of Post-Operative Visits and the Fraction of Expected Post-Operative Visits Reported

• Chapter Six

  Sensitivity Analysis: Examining Procedures Performed by Practitioners Actively Reporting Post-Operative Visits

• Chapter Seven

  Sensitivity Analysis: Using an Expanded Definition of Post-Operative Visits

• Chapter Eight

  Conclusions

• Appendix A

  Examining Characteristics of Clean Procedures

• Appendix B

  Identifying Robust Reporters of Post-Operative Visits

• Appendix C

  Observed to Expected Ratio of Post-Operative Visits for All Procedures

• Appendix D

  Exploring Visits Immediately Following Global Periods