全球智库信息集成服务系统

The share of procedures with any post-operative visit 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 0.38 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 is not observed in the data, suggesting the need to revalue procedures with a global period

Medicare payments for most surgical procedures cover both procedures and post-operative visits occurring within a global period of either ten or 90 days following procedures. 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, the Centers for Medicare & Medicaid Services (CMS) required select practitioners to report on post-operative visits after select procedures with 10- or 90-day global periods. The authors of this report summarize patterns of post-operative visits for procedures furnished during calendar year 2018, building on a prior report that analyzed data for procedures with July 1, 2017, through June 30, 2018, service dates.

During calendar year 2018, 96.5 percent 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; however, the ratio of observed to expected post-operative visits provided for 90-day global period procedures was only 0.38.

Underreporting of post-operative visits might be driving these low rates. However, in sensitivity analyses limited to practitioners who were actively reporting their post-operative visits, post-operative patterns were largely similar to the main analysis. Collectively, these findings suggest that a large share of expected post-operative visits are not delivered, and that underreporting is unlikely to fully explain the low ratio of expected post-operative visits provided.

• Chapter One

  Background

• Chapter Two

  Data and Methods

• Chapter Three

  Examining the 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

  Additional Sensitivity Analyses

• Chapter Nine

  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

• Appendix E

  Comparison of the Timing of Post-Operative Visits and the Fraction of Expected Post-Operative Visits Reported Using Two Methods to Identify Clean Procedures