Correlation of Relative Value Units With Surgical Complexity and Physician Workload: A Contemporary Nationwide Analysis of Orthopaedic Procedures

Abstract

Introduction:Although previous studies have demonstrated inconsistencies between surgeon work and reimbursement, no previous study has calculated expected relative value units (RVUs) based on procedure-specific variables. Our study aimed to evaluate how measures of physician workload and surgical complexity correlate with the work RVUs (wRVUs) assigned to orthopaedic procedures and compare our predicted wRVUs with actual wRVUs. Methods: The National Surgical Quality Improvement Program was used to identify orthopaedic surgeries with the highest procedural volume in 2019. For each Current Procedural Terminology (CPT) code, variables related to surgical complexity and postoperative management were retrieved. A multivariable linear regression was conducted, and R 2 values were calculated. Results: A total of 229,792 cases from the top 20 CPT codes by frequency in 2019 were identified. Base RVU values ranged from 7.03 mRVUs for arthroscopic meniscectomy to 30.28 mRVUs for revision total hip arthroplasty. A total of 15 (75%) of the projected mRVUs were lower than the actual mRVU of the procedure. For the 5 (25%) procedures with mRVU projections higher than actual values, the largest differences were seen for CPT codes 29,888 (arthroscopic anterior cruciate ligament [ACL] repair; difference: 7.81), 22,630 (posterior arthrodesis of the lumbar interbody; difference: 7.75), and 27,487 (revision total knee arthroplasty; difference: 4.04). Conclusion: Our analysis demonstrates that current orthopaedic wRVUs do not appropriately compensate for objective measures of overall complexity as it relates to each procedure. Significant undercompensation in projected RVUs was noted for several highvolume orthopaedic procedures including arthroscopic ACL repair and revision total knee arthroplasty.

Are Orthopedic Trauma Surgeons Appropriately Compensated for Treating Acetabular Fractures? An analysis of operative times and RVUs

“…3,4 However, there may be discrepancies between RVUs assigned and these 3 components. 2,[5][6][7][8] Several studies have evaluated the correlation between operative time and wRVUs assigned. 2,8 In a review of more than 100,000 total hip arthroplasty cases, there was an increase in time required for revision hip arthroplasty and thus a decrease in wRVUs generated per operative minute compared with primary arthroplasty.…”

Comparing Relative Value Units for Intramedullary Limb Lengthening Procedures to Common Pediatric Orthopaedic Surgeries to Determine Adequate Compensation

“…R elative value units (RVUs) are the measure developed by the Centers for Medicare and Medicaid Services in 1992 to determine reimbursement for physicians' services. 1 RVUs represent the value of a medical service or procedure measured relative to other medical services and procedures. The work relative value unit (wRVU) is a physician compensation model that emerged to encompass the physicians' efforts in correlation to the complexity of services provided.…”

“…Within orthopaedic surgery, a lack of accounting for surgical complexity and perioperative work has been identified as a limitation of using the RVU system. 1 In addition, wRVUs do not account for the level of provider skill and experience required for appropriate patient care or the quality of patient care outcomes. 3 As surgical techniques and implants evolve over time, the original valuation of RVUs assigned to CPT codes may not continue to adequately represent the physician's efforts and workload.…”

“…If the number of wRVUs assigned to a particular CPT code seems especially inaccurate, the value may be reviewed upon request of the members of a speciality society after a survey of the members has been completed. 1 Within orthopaedics, including pediatric orthopaedics, strategies to safely correct complex limb deformities have evolved over the past several decades. These new and improved patient management concepts have largely been driven by the increasing sophistication of the available technology and techniques.…”