You may or may not know that surgeons don’t bill for care provided after a major operation. Why? Well, postoperative care is already included in your bill. Really? For a longtime, the Centers for Medicare and Medicaid Services (CMS) has set billing associated with a procedure to cover 0, 10, or 90 days. Therefore, CMS will pay only one bill for all services provided for a procedure or operation. This is called the “global”. So, if you see your doctor 1 time or 15 times after an operation, it is generally included in the bill.
Why have one large bill for an operation?
CMS decided long ago that it would be easier and likely save money if a single bill was generated rather than pay for each and every clinic visit. For example, an uncomplicated operation may require only one postoperative visit (maybe even just a phone call); but, a complicated operation may require numerous visits and significant care. CMS wouldn’t have to foot the larger bill. CMS is now looking to change the current system of global billing for surgery.
Why change how we pay for care after surgery?
Health systems have recognized the benefits of a global payment system for procedures. Increasing efficiency of the system can result in significant financial gain for providers and health system. You might ask why you never see your cardiac surgeon after your open heart surgery? Well, a postoperative clinic visit with your heart surgeon is not “value-added”. You might see a physician assistant, nurse, or even receive a call from a discharge social worker or outpatient nurse. All of these interactions are designed to optimize care (keep you healthy) and decrease postoperative costs (to the health system). CMS recognizes these health system optimizations and whats to also benefit.
What are the changes?
CMS has proposed a new billing method for postoperative care (include face-to-face clinical staff visits, ie G-codes). Instead of paying a “global”, CMS may pay for postoperative care in 10 minute intervals. Details of the CMS plan are here. Not everyone is happy about these proposed changes. The American Medical Association has prepared a statement essentially rejecting the proposal.
What does this mean for you?
We don’t know. Will this increase postoperative interaction with your surgeon? Will surgeons be re-incentivized to see their patients after surgery? Will health systems create new billing mechanisms to benefit? As expected, procedures that have a high complication rate will receive reimbursement for complications. For relatively uncomplicated procedures, providers will see decreased reimbursement. I worry that all the gains we have seen to decrease complications, lower length of stay, and optimize postoperative care will be lost. I am also concerned that patients will be less likely to return to their surgeon for postoperative care if it results in another pile of bills. While the current system has its problems, I love caring for my patients particularly after an operation and don’t feel money should take center stage during a period of high vulnerability for my patients.
To be continued…