Health Policy & EconomicsA Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty
Section snippets
Database
The American College of Surgeons, National Surgical Quality Improvement Program database from January 1, 2008 to December 31, 2015 was used to identify primary and revision TKAs. This database contains demographics, operative time, and RVU data, as well as many another variables [12]. Institutional Review Board deemed this study exempt because these data are de-identified and publically available.
Current Procedural Terminology Codes
Medical, surgical, and laboratory procedures are CPT coded. The code links procedures or services
Mean Relative Value Units
The mean RVUs for primary TKA were 22 (range 21-23, ±1.3). The mean RVUs for the revision TKA were 27 (range 26.9-27.1, ±0.05). There was a statistically significant higher RVU assigned to the revision TKA than the primary TKA (P < .001).
Mean Operative Time
The mean operative time for the 165,439 primary TKA procedures was 94 minutes (range 30-475, ±36 minutes). The mean operative time for the 8081 revision TKA procedures was 149 minutes (range 30-475, ±61 minutes). Primary TKA had a significantly shorter
Discussion
Most physicians are currently compensated based on their RVUs. Physician work RVUs assigned to CPT codes are supposed to reflect technical skill, mental effort, stress, and time required to perform a procedure, as well as the effort required for aftercare [5]. However, because of the nature of these RVU assignments, they may not accurately reflect the above specifications, in particular the time required to perform a case. Revision TKA is a more complex procedure that requires greater skill and
Conclusion
When looking at the pure RVU value for revision TKA in comparison to primary TKA (27 vs 22), it appears that there is appropriately higher compensation for more difficult procedures. Unfortunately, this value does not adequately compensate for the longer operative times required. The RVU/min value for revision TKA was lower than that for a primary TKA (0.22 vs 0.26, P < .001). Based on these numbers it would seem that the current RVU allocations do not reflect the added complexity, time
References (15)
- et al.
Relative value units correlate with pediatric surgeons' operating time: when perceived myth becomes reality
J Pediatr Surg
(2006) - et al.
The role of physicians and medical organizations in the development, analysis, and implementation of health care policy
Semin Radiat Oncol
(2008) - et al.
How is physician work valued?
Ann Thorac Surg
(2017) - et al.
Relative value units poorly correlate with measures of surgical effort and complexity
J Surg Res
(2014) - et al.
Quantifying and predicting surgeon work effort for primary and revision total knee arthroplasty
J Arthroplasty
(2016) - et al.
Medicare fails to compensate additional surgical time and effort associated with revision arthroplasty
J Arthroplasty
(2015) - et al.
Pediatric echocardiography by work relative value units: is study complexity adequately captured?
J Am Soc Echocardiogr
(2016)
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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2017.11.070.