Time is Money: Relative Value Units and Operative Time in Otolaryngology

Abstract

Objectives Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time. Study Design Retrospective analysis of a surgical database. Methods NSQIP was queried from 2015–2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates. Results Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P < .001). Further analysis found no correlation between operative time and wRVU/hr (R2 = 0.008, P = .525). Linear regression of wRVU/hr and complication rate showed a statistically significant positive correlation (R2 = 0.113, P = .017). Conclusion This analysis suggests that compensation for otolaryngology procedures is positively correlated with operative time. Surgeries where more than one code is reported could not be evaluated, thus excluding some common combination of procedures performed by otolaryngologists. Level of Evidence 4 Laryngoscope, 131:E395–E400, 2021

Published randomized controlled trials in Otolaryngology: 2016-2020

“…The authors suggested that a higher percentage of the national GDP and resources may have been assigned to research and thus accounted for difference in publication trends between countries 4 . Moreover, within the American medical system remuneration is often related to relative value units (RVU) which apportion revenue based on procedure-based time, technical expertise, mental effort, practice expense, and physician liability but neglects research obligations (20). While it is difficult to study, it would be of interest to determine how much clinical, teaching and research responsibilities differ between countries in addition to the above-mentioned factors.…”

A pragmatic, evidence-based approach to coding for abdominal wall reconstruction

“…The primary outcome measure was operative time as recorded in the ACHQC based on the following categories: 0–59, 60–119, 120–179, 180–239, and 240 + min. Operative time is a key factor in determining justification of more complex codes for operative interventions [ 13 ].…”

Discrepancies in Work Relative Value Unit Assignment Based on Operative Time in Hand Surgery

“…Case selection criteria were based on recent work in urology, otolaryngology, and plastic and reconstructive surgery. [6][7][8]…”

“…5 Recent work in the surgical literature has focused on the accuracy of this system in estimating wRVUs and thus physician time and effort. [6][7][8] This is important to understand because RVUs are currently used to calculate Medicare reimbursement directly and are used indirectly by HAND 19 (3) many private payers in their reimbursement schemata. Furthermore, many physicians' pay schedules are linked to their generated wRVUs.…”