MANAGEMENT ESSENTIALS

Global periods: a benefit to patients, a drain on practices

Follow-up exams may serve clientele well, but a closer look reveals they cost a great deal of time.

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.

By Farrell “Toby” Tyson, MD, FACS

Ophthalmologists have long strived for excellent patient care in spite of regulations that have limited or eliminated compensation for their services. Over time, global periods have been instituted to bundle care of certain procedures out to 90 days. These global periods were derived based on what care was deemed necessary for the health of the patient and the appropriate post-procedure evaluation, not the care of other unrelated diagnoses.

NEW PROCEDURE CHANGES

Practices have been hit hard with declining reimbursement, usually based on the belief that the procedures are becoming routine and less time-consuming. Yet, most practices have not adjusted their post-procedure schedules to take into account the changes in patient care necessary with the quicker recovery from newer techniques.

Cataract surgery has probably had the most significant changes. It was not uncommon a decade ago to schedule cataract surgeries a month apart with one-day, one-week, and one-month postoperative visits. Over a two-month period, uneventful cataract surgeries resulted in six postoperative visits. Over time, many practices have reduced the interval between eyes to one week. This allowed a one-day post-op on the first eye followed by a one-day or week, and one-month post-op visit on both eyes. This has resulted in a reduction in post-op visits.

POST-OP CONUNDRUM

This may not appear to be a big difference since post-op visits are usually very quick for the doctor. The staffing requirements to see those extra visits can be enormous. The practice needs to make the appointment, give a reminder call, check in and work up the patient, have the doctor see the patient, check out, post the visit and make the next appointment. Multiply this by three extra visits and it becomes clear those “free” post-op visits can become costly.

DRY EYE FOLLOW-UPS

Dry eye practices also have to be wary of global periods when it comes to punctal plugs. This minor procedure has a 10-day global period. Many practices fail to remember this and see the patients back early or for unrelated diagnoses. If the unrelated diagnosis visit is within the global period, use the appropriate modifiers to get reimbursed. Dry eye follow-up visits can be scheduled outside the global period because the exam is not simply evaluating the punctal plug insertions, but a total eye health review.

Luckily, for retinal specialists, intravitreal injections do not have global periods. Still retinal specialists do have to be careful about times with their retinal laser treatments. The global period includes any office visits during the period. The global period for all procedures does not preclude the reimbursement of most diagnostic codes. Through constant vigilance of time periods and scheduling, physicians can continue to provide good cost-effective medicine for their patients. OM