January 23, 2020

Medicare may overpay for postop care

By: Judy Mathias

Editor's Note

Medicare may be overpaying surgeons for postoperative care they provide to patients, according to a new Rand Corporation analysis in the January 23 New England Journal of Medicine.

The authors of the analysis suggest that federal officials should incorporate ways to more objectively measure the amount of postoperative care surgeons provide to their patients. Data from a sample of surgeons suggests they provide only a small amount of the postoperative care that is built into the payments they receive from Medicare.

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Modeling done by the Rand analysts suggests that if Medicare payments were adjusted to delete the money allocated for the undelivered postoperative care, reimbursements for the surgical procedures themselves would be reduced by 28% or about $2.6 billion.

For most surgical procedures, Medicare gives surgeons a single bundled payment that covers the procedure and postoperative care over a period of 10 to 90 days. About 25% of payments are for bundled postoperative care.

Rand research has found that just 4% of minor procedure and 39% of major procedure postoperative visits paid for by Medicare were provided by surgeons to their patients.


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