Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records

Burgette, Lane F.; Mulcahy, Andrew W.; Mehrotra, Ateev; Ruder, Teague; Wynn, Barbara O.

doi:10.1111/1475-6773.12474

Cited by 27 publications

(35 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recognizing the powerful influence that the RUC’s time estimates exert on prices in the Medicare Physician Fee Schedule, the authors of several previous studies 5,19–21 have investigated their accuracy and potential bias. A consistent finding is that the RUC’s survey-derived measures frequently exceed the service times in estimates from other sources.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

2019

View full text Add to dashboard Cite

BACKGROUND The Relative Value Scale Update Committee (RUC) of the American Medical Association plays a central role in determining physician reimbursement. The RUC’s role and performance have been criticized but subjected to little empirical evaluation. METHODS We analyzed the accuracy of valuations of 293 common surgical procedures from 2005 through 2015. We compared the RUC’s estimates of procedure time with “benchmark” times for the same procedures derived from the clinical registry maintained by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). We characterized inaccuracies, quantified their effect on physician revenue, and examined whether re-review corrected them. RESULTS At the time of 108 RUC reviews, the mean absolute discrepancy between RUC time estimates and benchmark times was 18.5 minutes, or 19.8% of the RUC time. However, RUC time estimates were neither systematically shorter nor longer than benchmark times overall (β, 0.97; 95% confidence interval, 0.94 to 1.01; P = 0.10). Our analyses suggest that whereas orthopedic surgeons and urologists received higher payments than they would have if benchmark times had been used ($160 million and $40 million more, respectively, in Medicare reimbursement in 2011 through 2015), cardiothoracic surgeons, neurosurgeons, and vascular surgeons received lower payments ($130 million, $60 million, and $30 million less, respectively). The accuracy of RUC time estimates improved in 47% of RUC revaluations, worsened in 27%, and was unchanged in 25%. (Percentages do not sum to 100 because of rounding.) CONCLUSIONS In this analysis of frequently conducted operations, we found substantial absolute discrepancies between intraoperative times as estimated by the RUC and the times recorded for the same procedures in a surgical registry, but the RUC did not systematically overestimate or underestimate times. (Funded by the National Institutes of Health.)

show abstract

Section: Discussionmentioning

confidence: 99%

“…7–18 One recurrent concern relates to the accuracy of measures of service time and the RUC’s reliance on small-scale physician surveys to estimate that time. 5,6,11–13,19–22 We investigated the accuracy of the measures of time the RUC used to determine work RVUs for 293 common surgical procedures.…”

mentioning

confidence: 99%

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

2019

View full text Add to dashboard Cite

show abstract

“…The median total surgical procedure time was 182 (136 to 280; Table 3) minutes [17]. The median duration differed significantly between ND only (177; 125-206 min) and primary site surgery ± ND (290, 174-613 min; p < 0.001; Table 3).…”

Section: Total Surgical Procedures Timementioning

confidence: 97%

Surgical rescue for persistent head and neck cancer after first-line treatment

Steinbichler

Golm

Dejaco

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). Methods Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND). Results During the observation period, 35 patients received ND only and 17 primary site surgery ± ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery ± ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p = 0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5 ± 2; p = 0.07). Conclusion Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site ± ND should expect complications and permanent functional impairment.

show abstract

“…In this journal, researchers found evidence to support those earlier studies: On average, the time it takes to perform surgery is less than Medicare estimates in 78 percent of the procedures studied (Burgette et al. ). Other recent studies show that RUC's recommendations overstate the time it takes to perform a procedure (Government Accountability Office [GAO] , Wynn et al.…”

Section: Prior Research On Distortions In Pricingmentioning

confidence: 58%