Relative value units poorly correlate with measures of surgical effort and complexity

Abstract

Background The relationship between procedural relative value units (RVUs) for surgical procedures and other measures of surgeon effort are poorly characterized. We hypothesized that RVUs would poorly correlate with quantifiable metrics of surgeon effort. Methods Using the 2010 ACS-NSQIP database, we selected 11 primary CPT codes associated with high volume surgical procedures. We then identified all patients with a single reported procedural RVU who underwent non-emergent, inpatient general surgical operations. We used linear regression to correlate length of stay, operative time, overall morbidity, frequency of serious adverse events (SAEs), and mortality with RVUs. We used multivariable logistic regression using all pre-operative NSQIP variables to determine other significant predictors of our outcome measures. Results Among 14,481 patients, RVUs poorly correlated with individual length of stay (R2=0.05), operative time (R2=0.10), and mortality (R2=0.35). There was a moderate correlation between RVUs and SAEs (R2 =0.79), and RVUs and overall morbidity (R2=0.75). However, among low to mid-level RVU procedures (11 to 35) there was a poor correlation between SAEs (R2=0.15), overall morbidity (R2=0.05), and RVUs. On multivariable analysis, RVUs were significant predictors of operative time, length of stay, and SAEs (OR 1.06, 95%CI: 1.05–1.07), but RVUs were not a significant predictor of mortality (OR 1.02, 95%CI: 0.99–1.05) Conclusion For common, index general surgery procedures, the current RVU assignments poorly correlate with certain metrics of surgeon work, while moderately correlating with others. Given the increasing emphasis on measuring and tracking surgeon productivity, more objective measures of surgeon work and productivity should be developed.

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

“…9 Shah et al analyzed 11 different high-volume elective general surgical procedures and found that the current RVU system poorly co-related with individual operative times and morbidity of procedures, and thus are a poor index reflective of surgeon's work and effort. 10 Our study has several limitations. It is important to note that the current analysis is aimed at understanding the financial constraints of the current RVU system for singlecomponent and double-component revision TKAs.…”

The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

“…Compared with that of United States’ RBRVS, the underestimation of a spinal physician’s labor was even more significant. Concerns that the RVs under RBRVS may not accurately reflect a surgeon’s work, productivity or value is not surprising, and has already been an issue also in other surgical specialty societies8). The problem is, that not much attention has been paid for this problem for a long period of time in our surgical society and maybe this lack of interest for proper reimbursement might have led to this discrimination of RVs.…”

Ethics in contemporary health care management and medical education

“…To evaluate physicians' output, hospitals must measure surgical costs and values. These values by necessity reduce a multitude of nominal, ordinal, and numeric values to something that can be measured with an interval scale; they are subjectively determined and fail to represent physicians' work comprehensively . Any performance‐based payment system lets each surgical case generate a certain number of relative value units per unit time, depending on the evaluation of case complexity, which is subjectively determined or, rather, chosen .…”