A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty

doi:10.1016/j.arth.2017.11.070

The Journal of Arthroplasty

Volume 33, Issue 7, Supplement, July 2018, Pages S39-S42

https://doi.org/10.1016/j.arth.2017.11.070 Get rights and content

Abstract

Background

In total knee arthroplasty (TKA), revision cases are often technically more challenging, and require more operative time and aftercare than primary cases. These time and effort differences should therefore be appropriately compensated for when using the relative value unit (RVU) system. Therefore, the purpose of this study is to compare the mean (1) RVUs; (2) operative times; and (3) RVU/min; and (4) perform an individualized idealized surgeon annual cost difference analysis for primary vs revision TKA.

Methods

Current Procedural Terminology code 27447 identified 165,439 primary TKA patients, while Current Procedural Terminology code 27487 identified 8081 revision TKA patients from the National Surgical Quality Improvement Program database. The mean RVUs, operative times, and RVU/min were calculated. Dollar amount per minute, per case, per day, and year were also calculated. Student's t-test, with a cut-off P-value of <.05, was used in order to identify any statistical differences in mean RVUs, operative times, and RVU/min.

Results

The mean RVUs for primary TKA was 22, while for revision TKA was 27 (P < .001). The mean operative time for primary TKA was 94 minutes, while for revision TKA was 149 minutes (P < .001). The mean RVU/min for primary TKA was 0.26, while for revision TKA was 0.22 (P < .001). The dollar amounts calculated for primary vs revision TKA were per minute ($9.33 vs $7.90), per case ($877.12 vs $1176.43), per day ($4385.60 vs $3529), and projected a $137,008.70 annual cost difference.

Conclusion

Orthopedic surgeons are reimbursed at a higher rate per minute for primary cases compared to revision TKA (0.26 vs 0.22, P < .001). The annual difference can amount to nearly $140,000. Orthopedic surgeons can use this information to better understand the dynamics of their time, compensation, and ultimately, their practice. Furthermore, it can be argued that there needs to be a shift to increase the RVU per unit time for revision TKAs.

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

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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.

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Health Policy & EconomicsA Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty

Abstract

Background

Methods

Results

Conclusion

Section snippets

Database

Current Procedural Terminology Codes

Mean Relative Value Units

Mean Operative Time

Discussion

Conclusion

J Pediatr Surg

Semin Radiat Oncol

Ann Thorac Surg

J Surg Res

J Arthroplasty

J Arthroplasty

J Am Soc Echocardiogr

Health Policy & Economics
A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty