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Page count: 94

For many surgeries and procedures, Medicare and most other insurers cover a bundle of services, including post-operative visits, during the global period. As part of 2015 MACRA legislation, Congress mandated that the Centers for Medicare & Medicaid Services (CMS) collect data on the number and level of post-operative visits delivered in the global period to assess accuracy of payment. Among other efforts, CMS conducted a practitioner survey to assess the level of visits, using three procedures as proof of concept: cataract surgery, hip arthroplasty, and complex wound repair. Using data reported via the survey, the authors found that reported physician time and work for cataract surgery and hip replacement post-operative visits were generally similar-but slightly less-than the levels expected based on the evaluation and management visits assumed to typically occur when valuing these procedures. Reported physician time and work for complex wound repair post-operative visits were higher than Physician Time File levels. Based on experiences with various approaches to collecting data on the level of post-operative visits as well as the status quo, the authors suggest thinking of these data collection methods as a spectrum with both benefits and trade-offs. Given the strengths and weaknesses of these approaches, the authors recommend consideration of a claims-based approach coupled with information about the level of service or the use of G-codes. A survey instrument could serve as a complement to a claims-based approach for procedures or groups of procedures for which valuation is thought to be particularly problematic.