In theory, work relative value units (wRVUs) are a neutral way to quantify surgeon workload and determine appropriate reimbursement. wRVU assignments should reflect the technical complexity of a procedure and the time required for the procedure itself and postoperative visits. However, across specialties, surgeons commonly voice the opinion that wRVUs are not linked to any rational measure and reimbursement is unfairly low for longer, more complex cases.
Lorine Haeuser, MD, of the Division of Urology at Brigham and Women’s Hospital, Quoc-Dien Trinh, MD, director of ambulatory clinical operations in the division, and colleagues decided to investigate using real-world data. In The American Journal of Managed Care, they say wRVUs correlate well with mean operative time for the most commonly performed surgical procedures across various specialties.
The research team consulted the National Surgical Quality Improvement Program database of the American College of Surgeons from 2011 to 2017. This program provides pre- and postoperative data, including reimbursement data, out to 30 days after surgery.
Medicare payment for most surgical procedures covers both the procedure and postoperative visits within a “global period” of either 10 days or 90 days. The researchers analyzed the 15 most frequently performed surgical procedures that have a 90-day global period, as those are (a) more complex than procedures with a 10-day global period, and (b) more comparable to each other in complexity.
In descending order of frequency, the procedures analyzed were inguinal hernia repair, cholecystectomy, mastectomy, appendectomy, colectomy, knee arthroplasty, hysterectomy, thyroidectomy, hip arthroplasty, thrombendarterectomy, laminectomy, radical prostatectomy, pancreatectomy, parathyroidectomy, and femoropopliteal bypass. The study cohort comprised 1,994,394 patients.
The researchers determined the mean wRVUs and mean operative time of the grouped Current Procedural Terminology codes for each procedure. They then calculated the Spearman correlation coefficient to evaluate the strength of correlation between wRVUs and operative time.
The overall Spearman coefficient was 0.81. The most frequently performed procedures congregated around the line of best fit.
Defining, quantifying, and comparing the complexity of different surgical procedures, especially across specialties, is very difficult. Furthermore, there’s evidence from The New England Journal of Medicine that postoperative visits occur less frequently than expected.
Thus, operative time may be considered a legitimate metric for calculating wRVUs. If that premise is accepted, this study shows that physician reimbursement based on wRVUs is fair.