Discrepancies created by surgeon self-reported operative time and its impact on procedural relative value units (RVUs) and reimbursement

Uppal, Shitanshu; Barber, E.L.; Reynolds, R. Kevin; Rice, L.W.; Spencer, Roy W.

doi:10.1016/j.ygyno.2019.04.039

Cited by 1 publication

(3 citation statements)

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“…Despite emergent surgery carrying increased complication, mortality, and physician effort, RVUs for elective and emergent biliary, colorectal, and hernia cases are reimbursed with the same RVUs. 9,12,13 By contrast, there are examples of appropriate proportionality of RVU for primary versus revision surgery. Doval et al 10 analyzed NSQIP and RVU-based reimbursement for hernia repairs in general surgery and noted that recurrent inguinal hernia repairs have appropriately higher RVU/min and reimbursement rates to account for the differential in the number of primary versus revision cases that a surgeon could complete in a day.…”

Section: Discussionmentioning

confidence: 99%

“…However, this methodology has flaws and does not always accurately depict the time and effort involved with different procedures across specialties. [6][7][8][9][10][11][12][13] As the incidence of shoulder arthroplasty increases, so too does the incidence of revision surgery. [14][15][16] Joint arthroplasty revisions are known to carry higher complexity, complication rate, and surgical time compared with primary procedures.…”

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confidence: 99%

“…However, this methodology has flaws and does not always accurately depict the time and effort involved with different procedures across specialties. 6-13…”

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confidence: 99%

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Relative Value Units Underestimate Reimbursement for Revision Shoulder Arthroplasty

Belay

Charalambous

Saltzman

et al. 2022

J Am Acad Orthop Surg

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Introduction:Relative value units (RVUs) have been fundamental to reimbursement calculations in payment models for arthroplasty surgeons. RVUs are based on various factors, including physician work, and have been higher for increased complexity, such as revision arthroplasty. The purpose of this study was to compare RVUs and estimated reimbursement differences between primary and revision shoulder arthroplasty.Methods:The National Surgical Quality Improvement Program database was used to collect primary and revision shoulder arthroplasty cases in 2017. Data variables collected included age at the time of surgery, surgical time, and RVU for each shoulder arthroplasty.Results:A total of 4,948 shoulder arthroplasty patients (4,657 primary and 291 revision) were included in this study. The mean age was 69.1 years (9.6 SD) for primary shoulder arthroplasty and 67.8 years (10.4 SD) for revision shoulder arthroplasty, P = 0.02. RVU for primary shoulder arthroplasty was 22.1 (0 SD) compared with 26.4 (1.1 SD) for revision shoulder arthroplasty (P = 0.0001). Surgical time was significantly higher in revision versus primary cases, 131.5 minutes (89.0 SD) versus 109.3 minutes (42.5 SD) (P = 0.0001). RVUs per minute were near equivalent for primary and revision arthroplasty at 0.20 (0.1 SD) and 0.20 (01 SD), respectively. However, owing to the difference in surgical time and cases per day, this translates to an estimated reimbursement difference of $174,554.4 per year more for primary shoulder arthroplasty over revision cases.Conclusion:The current RVU model does not adequately factor surgical time for revision shoulder arthroplasty and translates to a notable yearly reimbursement difference that favors primary shoulder arthroplasty.

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