“The Cost of Doing Business: An Appraisal of Relative Value Units in Plastic Surgery and Other Surgical Subspecialties”

Abstract

Background: The relationship between procedural complexity and relative value units (RVUs) awarded has been studied within some specialties, but it has not yet been compared across different surgical disciplines. This study aims to analyze the association of RVUs with operative time as a surrogate for complexity across surgical specialties, with a focus on plastic surgery. Methods: A retrospective review of surgical cases was conducted with the 2019 National Surgical Quality Improvement Program database. The top 10 most performed procedures per surgical specialty were identified based on case volume. Only cases with a single CPT code were analyzed. A subanalysis of plastic surgery procedures was also conducted to include unilateral and bilateral procedures with a frequency greater than 20. Results: Overall, operative time correlated strongly with work RVUs (R = 0.86). Orthopedic surgery had one of the shortest average operative times with the greatest work RVUs per hour, in contrast to plastic surgery, with the greatest average operative time and one of the lowest work RVUs per hour. Of the plastic surgery procedures analyzed, only five were valued on par with the average calculated from all other specialties. The most poorly rewarded procedure for time spent is unilateral free flap breast reconstruction. Conclusions: Of all the surgical specialties, plastic surgery has the lowest RVUs per hour and the highest average operative time, leading to severe potential undervaluation compared with other specialties. This study suggests that further reevaluation of the current RVU system is needed to account for complexity more equitably as well as encourage value-based care.

Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties”

“…A previous study demonstrated that plastic surgery, when compared with other surgical subspecialties, had the lowest average wRVU despite the longest operative times. 19 This further supports the relative devaluation of plastic surgery as a surgical subspecialty and can easily result in further reduction of caseload. Reduction in caseload by dedicated subspecialty providers may result in a substantial reduction in patient access.…”

Discussion: Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties

“…Prior observations indicate that plastic surgeons receive lower payments for physician work per hour than other surgeons. 5,6 Stoffel et al discussed that reimbursement for plastic surgery may not sufficiently account for physician work, particularly with respect to the increased operative time and surgical complexity encountered today. Variation in reimbursement per RVU may be explained by the fact that it is challenging to accurately quantify physician work, leading to some codes reflecting the amount of physician work involved more accurately than others.…”