Is Physician Work in Procedure and Test Codes More Highly Valued Than That in Evaluation and Management Codes?

Kerber, Kevin A.; Raphaelson, Marc; Barkley, Gregory L.; Burke, James F.

doi:10.1097/sla.0000000000000990

Cited by 4 publications

(5 citation statements)

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“…These data summarize which procedures were performed by each clinician in the United States and how many of each type of procedure they performed. To estimate clinical time, we linked each procedure code to an estimated total procedure time and then summed the total procedure time across all the procedures and years for each clinician . Clinicians with a specialty of neurology were linked by first name and last name to the publication database of the 1712 academic neurologists in our sample, which matched data for 79% of the respondents in the publication database.…”

Section: Methodsmentioning

confidence: 99%

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Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs

et al. 2018

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IMPORTANCE Women are underrepresented in academic neurology, and the reasons for the underrepresentation are unclear. OBJECTIVE To explore potential sex differences in top-ranked academic neurology programs by comparing the number of men and women at each academic faculty rank and how many articles each group has published. DESIGN, SETTING, AND PARTICIPANTS Twenty-nine top-ranked neurology programs were identified by combining the top 20 programs listed on either the 2016 or 2017 Doximity Residency Navigator tool with the top 20 programs listed in the US News and World Report ranking of Best Graduate Schools. An internet search of the departmental websites was performed between December 1, 2015, and April 30, 2016. For each faculty member on a program site, the following biographical information was obtained: first name, last name, academic institution, sex, academic faculty rank, educational leadership (clerkship, fellowship, or residency director/assistant director), and year of medical school graduation. MAIN OUTCOMES AND MEASURES To compare the distribution of men vs women and the number of publications for men vs women at each academic faculty rank. Secondary analyses included Scopus h-index, book authorship, educational leadership (clerkship, residency, or fellowship director/assistant director), and clinical activity as inferred through Medicare claims data in men vs women after controlling for years since medical school graduation. RESULTS Of 1712 academic neurologists in our sample, 528 (30.8%) were women and 1184 (69.2%) were men (P < .001). Men outnumbered women at all academic faculty ranks, and the difference increased with advancing rank (instructor/lecturer, 59.4% vs 40.5%; assistant professor, 56.7% vs 43.3%; associate professor, 69.8% vs 30.2%; and professor, 86.2% vs 13.8%). After controlling for clustering and years since medical school graduation, men were twice as likely as women to be full professors (odds ratio [OR], 2.06; 95% CI, 1.40-3.01), whereas men and women had the same odds of being associate professors (OR, 1.04; 95% CI, 0.82-1.32). Men had more publications than women at all academic ranks, but the disparity in publication number decreased with advancing rank (men vs women after adjusting for years since medical school graduation: assistant professor [exponentiated coefficient, 1.85; 95% CI, 1.57-2.12]; associate professor [1.53; 95% CI, 1.22-1.91]; and full professor [1.36; 95% CI, 1.09-1.69]). Men had a higher log Scopus h-index than women after adjustment (linear coefficient, 0.44; 95% CI, 0.34-0.55). There was no significant association between sex and clinical activity (linear coefficient, 0.02; 95% CI, −0.10 to 0.13), educational leadership (OR, 1.09; 95% CI, 0.85-1.40), or book authorship (OR, 2.75; 95% CI, 0.82-9.29) after adjusting for years since medical school graduation. CONCLUSIONS AND RELEVANCE Men outnumber women at all faculty ranks in top-ranked academic neurology programs, and the discrepancy increases with advancing rank. Men have more publications than women at...

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Section: Methodsmentioning

confidence: 99%

“…To estimate clinical time, we linked each procedure code to an estimated total procedure time and then summed the total procedure time across all the procedures and years for each clinician. 13 Clinicians with a specialty of neurology were linked by first name…”

Section: Identification Of Clinical Activitymentioning

confidence: 99%

Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs

et al. 2018

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“…This pay gap is associated with declining interest in primary care despite increasing need . The work relative value unit (wRVU) scale is frequently indicated as a primary driver of this compensation difference, yet to our knowledge there are few empirical evaluations …”

Section: Introductionmentioning

confidence: 99%

“…2,3 The work relative value unit (wRVU) scale is frequently indicated as a primary driver of this compensation difference, 2,4-6 yet to our knowledge there are few empirical evaluations. 7,8 In 1992, Medicare changed physician compensation, replacing "usual, customary, and reasonable charges" with the Resource Based Relative Value Scale. One goal of this system was to balance compensation across specialties to slow the trend toward specialization.…”

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confidence: 99%

Assessment of the Contribution of the Work Relative Value Unit Scale to Differences in Physician Compensation Across Medical and Surgical Specialties

Childers

Maggard-Gibbons

2020

JAMA Surg

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IMPORTANCEThe work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures have been blamed for pay differences across specialties, but to our knowledge, a comprehensive assessment is lacking.OBJECTIVE To assess how compensation rates built into work RVUs contribute to differences in physician compensation across specialties.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis examined 2017 Part B fee-for-service Medicare data. The data were analyzed from May 1 to May 30, 2019. MAIN OUTCOMES AND MEASURESA specialty-wide compensation rate (wRVUs/min) was generated for 42 medical and surgical specialties defined as the sum of wRVUs for all billed current procedural terminology codes divided by the presumed time to perform those services. This measure accounted for the volume and diversity of services each specialty provides. Sensitivity analyses were performed to assess the association of errors in wRVU time estimates with average compensation rates. RESULTSThe final sample included 42 specialties and 6587 distinct Current Procedual Terminology (CPT) codes. The number of CPT codes attributed to a specialty ranged from 575 (medical oncology) to 4346 (general surgery). Compensation rates ranged from 0.029 wRVUs/min (pathology) to 0.057 wRVUs/min (emergency medicine). Most specialties (34/42 [81.0%]) had compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant. This narrow range reflects the fact that most specialties had more than 60% of time allocated to activities outside the intraservice period. Assuming that time values for surgical procedures are significantly overestimated increased the difference in average compensation between surgical and medical specialties to 23.4%.CONCLUSIONS AND RELEVANCE Compensation rates assumed in wRVU valuations are small contributors to differences in physician compensation. Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.

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“…[13][14][15][16] Critics of their use argue that this system correlates poorly with surgical effort/complexity, incentivizes a competitive culture among surgeons, eliminates predictability, and incentivizes the overuse of procedures. 17 Furthermore, relevant to hospital-or academic-based plastic surgeons, some aesthetic procedures do not have associated relative value units, making the quantification of productivity difficult for these procedures. For these aesthetic plastic surgeons, productivity is often quantified by other measures, such as net charges or collections (discussed below).…”

Section: Productivity-based Compensation Models: Relative Value Unitsmentioning

confidence: 99%

Plastic Surgeon Financial Compensation–Incentivization Models in Surgical Care Delivery: The Past, Present, and Future

Lopez

Shenaq

Schechter

et al. 2021

Plastic &Amp; Reconstructive Surgery

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In 1965, President Lyndon B. Johnson signed the Social Security Act Amendments, establishing Medicare and Medicaid and bringing into law federal financial support for fee-for-service. 1 Fearing that physicians and the American Medical Association would refuse to care for Medicare and Medicaid patients, this law established the precedent of paying physicians based on fees that were "usual, customary, and reasonable." 2 This established fee-for-service as health care's most common and traditional payment model (Fig. 1). 3,4 Unfortunately, over the next several decades, fee-for-service modeling became a large contributor to rising health care costs. In 1973, the Health Maintenance Organization Act was tasked with creating a system that would limit health care providers' ability to maximize the number of procedures performed and focus on preventative care. 5 As a result, large health care systems began to consolidate and experiment with the employment of physicians, offering physicians competitive flat salaries as compensation models. Some of these health maintenance organizations flourished (e.g., Kaiser Permanente), but most did not survive the ever-growing artificial competitive environment. 6

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Is Physician Work in Procedure and Test Codes More Highly Valued Than That in Evaluation and Management Codes?

Abstract: We did not find evidence of a systematic higher valuation of physician work in procedure/test codes than in E/M codes in the CMS RVU system.

Cited by 4 publications

References 2 publications

Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs

Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs

Assessment of the Contribution of the Work Relative Value Unit Scale to Differences in Physician Compensation Across Medical and Surgical Specialties

Plastic Surgeon Financial Compensation–Incentivization Models in Surgical Care Delivery: The Past, Present, and Future

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