Are Orthopaedic Trauma Surgeons Adequately Compensated for Longer Procedures? An Analysis of Relative Value Units and Operative Times From the American College of Surgeons National Surgical Quality Improvement Program Database

Abstract

Background:The physician work relative value unit (wRVU) scale is the primary determinant of compensation. Operative time, technical skill, effort, and surgical complexity contribute to wRVU allocation. The aim of this study was to identify the relationship between these factors and reimbursement for trauma procedures. Methods:The National Surgical Quality Improvement Program database was queried for orthopaedic trauma procedures from 2016 to 2018. Physician wRVU data were obtained from the 2020 Centers for Medicare & Medicaid Services fee schedule. The primary outcome measured was mean wRVU per minute of operative time (wRVU/min). Wilcoxon rank sum test and quantile regression were used to determine the association between wRVU, operative time, complication rate, upper or lower extremity procedure, and wRVU/ min.Results: Sixty-three current procedural terminology codes or 107,171 cases were queried. Median wRVU/min was significantly lower for longest 50% of procedures (0.119 vs. 0.160, P , 0.001) and higher for the top 50% with regard to complication rate (0.161 vs. 0.124, P , 0.001). Upper extremity procedures were reimbursed less than lower extremity (0.110 vs. 0.145, P , 0.001). Quintile regression showed that adjusted for complication rate, median wRVU/min decreased by 0.0005 (95% confidence interval: 0.0007-0.0003, R 1 = 0.27, P , 0.001) for every additional minute of operative time. Conclusions:The 2020 wRVU scale does not allocate sufficient wRVUs to orthopaedic trauma procedures with longer mean operative time or to procedures performed on the upper extremity. There is a negative correlation between operative time and hourly reimbursement, equating to a decrease of $64.96/h per hour of operation.

Are Orthopaedic Trauma Surgeons Appropriately Compensated for Treating Acetabular Fractures? An Analysis of Operative Times and Relative Value Units

“…The wRVUs generated per surgical minute for acetabular fractures are low when compared with almost all other reported orthopaedic trauma and arthroplasty procedures. 1,4,9,11,13,20 In addition, nonsurgical room time was significant and impacts perceived surgeon productivity when measured only by RVUs. Orthopaedic trauma surgeons are vital to the treatment of patients with acetabular fractures and maintenance of trauma accreditation.…”

“…9,12 Other models may not directly factor wRVUs into compensation but still use these values as a measure of productivity or need for additional resource allocation. 1…”

“…Relative value units (RVUs) are assigned by the "Relative Value Scale Update Committee," which consists of 31 physicians from various specialties. 1,2 RVUs are associated with a current procedural terminology (CPT) code and consist of 3 components: (1) work RVU (wRVU), (2) practice expense RVU, and (3) malpractice RVU. wRVUs include preoperative and postoperative care and are also intended to be reflective of the operative time required, the amount of expertise required, and the amount of effort required by surgeons.…”

“…9,12 Other models may not directly factor wRVUs into compensation but still use these values as a measure of productivity or need for additional resource allocation. 1 There is a paucity of information regarding operative times and wRVUs for acetabular fracture fixation. These fractures are unique because they often require treatment by fellowship trained orthopaedic trauma surgeons.…”

What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty

“…This equates to $257.7/h for each additional hour of operative time using the 2020 Medicare conversion factor ($36.09). [ 27 , 28 ] While this value is general and does not apply to all surgeon reimbursement structures, this is a significant finding given that physician reimbursement for a procedure may affect the rate at which CDA is performed and therefore its utilization, advancement, and technological perfection.…”