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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

• This suggests that many expected post-operative visits are not delivered and that underreporting is unlikely to fully explain the low ratio of expected post-operative visits provided.

Medicare payments for most surgical procedures cover both procedures and post-operative visits occurring within a global period of either 10 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 2019, building on two prior reports that analyzed data for procedures furnished from July 1, 2017, through June 30, 2018, and for the entire 2018 calendar year.

During calendar year 2019, 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 many 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 Share 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 Share of Post-Operative Visits Using Two Methods to Identify Clean Procedures