Relative Value Units do Not Adequately Account for Operative Time of Urological Surgery

Chakiryan, Nicholas H.; Jiang, Da David; Gillis, Kyle; Chen, Yiyi; Acevedo, Ann Martinez; Sajadi, Kamran P.

doi:10.1097/ju.0000000000000619

Cited by 13 publications

(21 citation statements)

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“…Echoing the present study, a recent study found that general surgeons received greater compensation for more complex hernia repairs when compared to more routine cases 10 . This stands in contrast to a recent examination of physician compensation in the field of urology, which found that wRVUs did not increase appropriately with longer and more complex procedures 20 . A similar discrepancy was found when examining surgery of the upper extremity, which is likely due to CMS underestimating the length of procedures compared to actual operative times documented in NSQIP 21 .…”

Section: Discussioncontrasting

confidence: 85%

“…10 This stands in contrast to a recent examination of physician compensation in the field of urology, which found that wRVUs did not increase appropriately with longer and more complex procedures. 20 A similar discrepancy was found when examining surgery of the upper extremity, which is likely due to CMS underestimating the length of procedures compared to actual operative times documented in NSQIP. 21 These authors suggested that revising CMS estimations for operative length can help compensation more accurately reflect operative times.…”

Section: Discussionmentioning

confidence: 81%

“…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][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.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…3,4 There has been increasing interest by the medical community in the overarching trends in the current wRVU scale and several recent studies have found a mismatch between the work performed for a procedure and the reimbursement rate. [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.…”

Section: Introductionmentioning

confidence: 99%

“… 3 , 4 There has been increasing interest by the medical community in the overarching trends in the current wRVU scale and several recent studies have found a mismatch between the work performed for a procedure and the reimbursement rate. 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 …”

Section: Introductionmentioning

confidence: 99%

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

Simcox

Kreinces²,

Tarazona³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To assess whether reimbursement for orthopaedic sports procedures adequately compensates for operative time and surgical complexity. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all orthopedic sports medicine procedures performed greater than 150 times from 2016 to 2018 with regard to operative time, preoperative risk factors, morbidity, and mortality data. Physician work relative value units (wRVU) data were obtained from the 2020 Centers for Medicare & Medicaid Services (CMS) fee schedule. The primary outcome was wRVU per minute operative time (wRVU/min). Linear regressions were used to assess wRVU, operative time, and wRVU/min. Results A total of 42 CPT codes, including 84,966 cases, were stratified into the top and bottom 50%, according to mean operative time, complications, mortality, reoperations, and readmissions. Mean wRVU/min was significantly lower for longer procedures (.153 vs .187; P = .02), and comparable with regard to ASA score, complications, mortality, readmissions, and reoperations. Arthroscopy reimbursed more (.187 vs .148 wRVU/min; P = .008), with lower complications (1.5 vs 2.6%; P = .115) and operative time (56.1 vs 82.8 min; P = .001) compared to open. Multivariate linear regression revealed that after adjusting for complication rate, there was a decrease of .054 wRVU/h ( P = .026) and $116.90/hour less for every additional hour of operative time. Conclusion The current 2020 RVU scale does not fairly compensate sports procedures with longer operative times. When examining the hourly reimbursement rates for the most commonly performed sports procedures, there is a significant trend toward lower reimbursement for longer procedures even after accounting for complication rates. Furthermore, procedures of the knee reimbursed at higher rates relative to the general pool of sports procedures and open procedures are compensated at a lower rate compared to arthroscopic procedures.

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