Are Joint Surgeons Being Adequately Compensated for Single-Component versus Double-Component Revision TKA? An Analysis of Relative Value Units

Abstract

Relative value units (RVUs) are used for ensuring that physicians are appropriately reimbursed based on case complexity. While past research has elucidated that surgeons are reimbursed at a higher rate for primary total knee arthroplasty (TKA) versus revision TKA, no study has explored differences in reimbursements between single-component and double-component revisions, considering a double-component revision is likely to require more effort/skill as compared with single-component revision. The 2015 to 2016 American College of Surgeons National Surgical Quality Improvement Program files were queried using Current Procedural Terminology (CPT) codes for single-component revision TKA (CPT-27486) and double-component revision TKA (CPT-27487). A total of 1,962 single-component and 4,184 double component revisions were performed during this period. Total RVUs, RVU/min, and dollar amount/min were calculated for each case. The mean RVU was 21.12 and 27.11 for single-component and double-component revision TKAs, respectively. A statistically significant difference was noted in mean operative time (single component = 100.44 vs. double component = 144.29; p < 0.001) between the two groups. Single-component revision had a significantly higher mean RVU/min (0.267) versus double-component revision (0.223). The reimbursement amounts calculated for single-component versus double-component revisions were per minute ($9.58/min vs. $8.00/min), per case ($962.22 vs. $1,154.32), and per day ($5,773.32 vs. $4,617.28) with a projected annualized cost difference of $184,966. Orthopaedic surgeons are reimbursed at a higher rate for single-component revision TKAs as compared with double-component revision TKAs, despite the higher complexity and longer operative times required in the latter. The study highlights the need for a change in the RVUs for either double-component or single-component revision to ensure reimbursement per unit time is adequate for performing a complex case such as double-component revision TKA.

Inflation-Adjusted Medicare Reimbursement for Revision Hip Arthroplasty

“…However, it is unclear whether reimbursement algorithms consider the higher resource utilization, complexity, and operative time associated with the burden of infection management with rTHA-I. Although multiple studies exploring revision total knee arthroplasties have demonstrated inadequate compensation for those due to infection [41][42][43][44] , there remains minimal information regarding whether this disparity is found for rTHA procedures. Our analysis demonstrated a consistent devaluation of both types of rTHA procedures over the past 18 years.…”

Are Orthopaedic Trauma Surgeons Being Adequately Compensated for Treating Nonunions of the Femoral Shaft?: An Analysis of Relative Value Units

“…In a similar analysis looking at total knee arthroplasties (TKAs), the authors found that revision TKAs were being under-valued with a physician reimbursement rate of $7.90/min compared with $9.33/min for primary TKAs. 7 Malik et al 8 analyzed over 6,000 cases of single- and double-component revision TKAs, and de-lineated that despite the longer surgical times and greater effort required for doing a double-component revision TKA providers are reimbursed at lower rate of $8.00/min compared with $9.58/min for a single-component revision TKA.…”

Current Relative Value Unit Scale Does Not Appropriately Compensate for Longer Orthopedic Sports Surgeries

“…[5][6][7][8] Prior studies in the orthopedic literature have compared reimbursement for specific Current Procedural Terminology (CPT) codes and found that typically longer and more complex procedures are not appropriately compensated when compared to shorter ones. [9][10][11][12][13][14] Understanding reimbursement patterns is the first step in identifying any mismatches between reimbursement and work performed for categories of procedures to help direct policy changes by subspecialty organizations. Understanding these patterns also better enables orthopedists to advocate for fair compensation for a given procedure.…”

“… 5 , 6 , 7 , 8 Prior studies in the orthopedic literature have compared reimbursement for specific Current Procedural Terminology (CPT) codes and found that typically longer and more complex procedures are not appropriately compensated when compared to shorter ones. 9 , 10 , 11 , 12 , 13 , 14 …”