Revaluation of Otolaryngologic Procedures With 10- and 90-Day Global Periods in the Medicare Physician Fee Schedule

Abstract

A recent investigation by the Centers for Medicare and Medicaid Services (CMS) suggests that physicians provide fewer postoperative visits (POVs) than expected for procedures with 10- and 90-day global periods. CMS is now contemplating revaluation of these procedures, which could result in lower Medicare payments to otolaryngologists. To estimate the impact of such reform on otolaryngologic procedures, we conducted a secondary subgroup analysis of CMS-contracted research, which used claims-based estimates of POVs to revalue procedures with 10- and 90-day global periods. Among the top 10 highest volume procedures performed in 2018, the proportion of median physician-reported to CMS-expected POVs ranged between 0.0% (myringotomy ± ventilation tube insertion, mouth biopsy, and complex wound repair) and 40.0% (total thyroidectomy). The top 5 procedures accounted for nearly three-quarters ($6.2 million and $8.6 million; 72.6%) of the estimated Medicare payment reduction. Further study is necessary to guide the development of equitable and effective payment reform.

Keywords

CMS Medicare global period physician fee schedule relative value units RVU RUC

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