MACRA requires CMS to collect data to value surgical services
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare & Medicaid Services (CMS) to develop and implement a process to gather and analyze the necessary data to value surgical services on pre- and post-operative visits and other services furnished during global surgical periods other than the surgical procedure itself.
CMS proposes in the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule to require reporting by any practitioner furnishing a service with a 10- or 90-day global period.
MACRA requires CMS to collect data to value surgical services starting Jan. 1, 2017.
The data must include:
? The number and level of medical visits furnished during the global period, and
? Other items and services related to the surgery and furnished during the global period.
CMS intends to accomplish this using a three-pronged approach:
? Claims-based reporting on the number and level of pre-and post-operative visits;
? A survey of a representative sample of practitioners about the activities involved in and resources used in providing pre- and post-operative visits; and
? A more in-depth study including direct observation in a small number of sites, including accountable care organizations.
CMS is soliciting comments on how to use CPT(R) code 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure to capture the statutorily-required data on the number and level of visits.
The 2017 MPFS proposed rule describes features of the survey and approach that will be used, including the sample size of approximately 5,000 practitioners. Each of those responding practitioners will report on approximately 20 discrete visits during a fixed reporting period of approximately two weeks.
The third avenue for data collection outlined in the proposed rule is a set of direct observation activities, such as collecting information not amenable to survey-based reporting.
CMS admits it is unsure how the data will be used because there is no precedent. ?What is clear,? CMS states in Section 523 of the 2017 MPFS proposed rule, ” we would know far more than we do now about how post-operative care is delivered and gain insight to support appropriate packaging and valuation.?