Medicare’s Global Surgery Payment Policy
Background
Under the current system, Medicare pays surgeons and other
specialists a single fee when they perform complex procedures
such as back surgery, brain tumor removal, joint replacement,
heart surgery, or colon resection. This single fee covers the
costs of the surgery plus all follow-up care within a 10- or 90-
day timeframe. The surgeon gets one payment, and the
Medicare beneficiary only pays a single co-pay. In the CY 2015
Medicare Physician Fee Schedule (PFS) final rule, the Centers for
Medicare & Medicaid Services (CMS) included a policy that
would have eliminated global surgical payments, which would
have negatively affected patients and physicians alike.
Recognizing the significant problems associated with this
proposal, Congress was united in opposing this global surgery
code policy because of concerns that the change would
compromise patient care and significantly increase
administrative burdens. Instead, Congress required CMS to
collect data, starting January 1, 2017, on the number and level
of visits furnished during the global period. Specifically, Section
523 of the Medicare Access and CHIP Reauthorization Act
(MACRA) explicitly calls for CMS to gather information needed
to value surgical services from a “representative sample” of
physicians. Beginning in 2019, CMS must use these data to
facilitate accurate valuation of surgical services
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