Association of Work Measures and Specialty With Assigned Work Relative Value Units Among Surgeons

Childers, Christopher P.; Dworsky, Jill Q.; Russell, Marcia M.; Maggard-Gibbons, Melinda

doi:10.1001/jamasurg.2019.2295

Cited by 47 publications

(80 citation statements)

References 10 publications

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“…BMI cutoffs utilized are based on World Health Organization recommendations 21 . Work relative value units (RVUs) were dichotomized to highlight major surgery given association between this measure and operative time as well as morbidity 22 . The threshold value of 20 was chosen to identify major surgery that may not be described by anatomical classification.…”

Section: Methodsmentioning

confidence: 99%

Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score

Hammer

Althoff

Platzbecker

et al. 2021

Acta Anaesthesiol Scand

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BackgroundA substantial proportion of patients undergoing inpatient surgery each year is at risk for postoperative institutionalization and loss of independence. Reliable individualized preoperative prediction of adverse discharge can facilitate advanced care planning and shared decision making.MethodsUsing hospital registry data from previously home‐dwelling adults undergoing inpatient surgery, we retrospectively developed and externally validated a score predicting adverse discharge. Multivariable logistic regression analysis and bootstrapping were used to develop the score. Adverse discharge was defined as in‐hospital mortality or discharge to a skilled nursing facility. The model was subsequently externally validated in a cohort of patients from an independent hospital.ResultsIn total, 106 164 patients in the development cohort and 92 962 patients in the validation cohort were included, of which 16 624 (15.7%) and 7717 (8.3%) patients experienced adverse discharge, respectively. The model was predictive of adverse discharge with an area under the receiver operating characteristic curve (AUC) of 0.87 (95% CI 0.87‐0.88) in the development cohort and an AUC of 0.86 (95% CI 0.86‐0.87) in the validation cohort.ConclusionUsing preoperatively available data, we developed and validated a prediction instrument for adverse discharge following inpatient surgery. Reliable prediction of this patient centered outcome can facilitate individualized operative planning to maximize value of care.

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Section: Methodsmentioning

confidence: 99%

Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score

Hammer

Althoff

Platzbecker

et al. 2021

Acta Anaesthesiol Scand

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“…Childers et al called for more objective work measures to assign RVUs by utilizing NSQIP data of median operative time, postoperative LOS, rate of readmission, and rate of reoperation to create a valuation model. 1 Operative time and LOS were found to be stronger proxies of surgical complexity, yet there were many nuances in accurately capturing the intensity of a procedure. This study raised many questions regarding the need for more objective means to define RVUs, particularly given the availability of numerous national surgical databases.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] As the fee-for-service health care model transitioned to a relative value scale in 1992, the Centers for Medicare & Medicaid Services introduced a Resource-Based Relative Value Scale and the American Medical Association's Relative Value Update Committee (RUC) was developed. 1,[4][5][6][7] The RUC is composed of 31 members representing over 20 subspecialties who drive RVU determinations based primarily on survey data of physicians. Response rates to such surveys are typically low (median 2.2%), and thus, RUC decisions are often driven by the perspectives of a limited sample of providers.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Inguinal Hernia Repair: Undervalued by the Relative Value Unit System

Kapadia

Ozao‐Choy

Virgilio

et al. 2020

The American Surgeon™

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Work relative value units (wRVUs) serve as a proxy of surgeon’s effort, technical skill, and time to determine reimbursement. The aim of this study is to determine how accurately wRVUs reflect the work effort of surgeons performing laparoscopic inguinal hernia repair (LIHR) as compared to open repair (OIHR). Within the National Surgical Quality Improvement Program database, 40 099 patients who underwent LIHR and 99 176 patients who underwent OIHR between 2012 and 2017 were identified. Mean wRVUs, wRVUs per minute, and operative times were compared between 8 groups based on clinical factors (unilateral vs. bilateral; obstructed vs. non-obstructed; primary vs. recurrent; 2 × 2 × 2 = 8). In both aggregate and matched cohorts, wRVUs for LIHR were significantly lower than OIHR in all 8 categories ( P < .001). On regression analysis, the mean difference in assigned vs. calculated relative value units (RVUs) was most divergent among unilateral, recurrent, obstructed IHR (3.12 mean RVUs, P < .001). Despite the rising utilization of LIHR, current wRVUs significantly undervalue this technique across all categories and consequently the work of surgeons who perform laparoscopic procedures. This RVU discrepancy in an increasing minimally invasive, value-driven surgical environment calls for more objective criteria to assign RVUs, whereby the value is measured by operative complexity—patient clinical factors and severity of the hernia itself—not solely operative technique.

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“…The relationship between estimated complexity, risk, and skill required of various procedures and the assigned wRVUs has been studied previously across a variety of specialties, revealing areas in which the system adequately estimates cost and others in which the system undervalues specific procedures 5–11 . Specifically, otolaryngology surgeries have been shown to have a greater proportion of procedures with lower than expected wRVUs when compared with other specialties 12 . As the demand for otolaryngology surgeries continues to rise, the need for proper consensus on adequate compensation for otolaryngologists is evident 13 .…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11] Specifically, otolaryngology surgeries have been shown to have a greater proportion of procedures with lower than expected wRVUs when compared with other specialties. 12 As the demand for otolaryngology surgeries continues to rise, the need for proper consensus on adequate compensation for otolaryngologists is evident. 13 A common perception among surgeons is that shorter procedures are more lucrative than longer ones due to inadequate wRVU scaling as operative time increases.…”

Section: Introductionmentioning

confidence: 99%

Time is Money: Relative Value Units and Operative Time in Otolaryngology

et al. 2020

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Objectives Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time. Study Design Retrospective analysis of a surgical database. Methods NSQIP was queried from 2015–2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates. Results Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P < .001). Further analysis found no correlation between operative time and wRVU/hr (R2 = 0.008, P = .525). Linear regression of wRVU/hr and complication rate showed a statistically significant positive correlation (R2 = 0.113, P = .017). Conclusion This analysis suggests that compensation for otolaryngology procedures is positively correlated with operative time. Surgeries where more than one code is reported could not be evaluated, thus excluding some common combination of procedures performed by otolaryngologists. Level of Evidence 4 Laryngoscope, 131:E395–E400, 2021

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Association of Work Measures and Specialty With Assigned Work Relative Value Units Among Surgeons

Cited by 47 publications

References 10 publications

Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score

Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score

Laparoscopic Inguinal Hernia Repair: Undervalued by the Relative Value Unit System

Time is Money: Relative Value Units and Operative Time in Otolaryngology

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