Factors associated with RVU generation in common sports medicine procedures

R. Timothy Kreulen, Micheal Raad, Farah N. Musharbash, Suresh K. Nayar, Matthew J. Best, Varun Puvanesarajah, Majd Marrache, Uma Srikumaran, John H. Wilckens

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Relative value units (RVUs) are integral to the U.S. physician compensation system used by the Centers for Medicare & Medicaid Services. The use of ‘work RVUs’ (herein, wRVUs) is intended to reimburse physicians according to the amount of expertise and effort needed to safely and effectively perform a procedure. Our purpose was to determine: 1) the number of wRVUs/hour generated by common sports medicine surgical procedures; and 2) how patient characteristics, surgical approach, and practice setting are associated with the number of wRVUs/hour. This analysis was performed to infer whether wRVUs are assigned appropriately according to the factors on which they are purported to be based. Methods: We queried the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database for common sports medicine surgical procedures performed in 2018. Data from 19,877 patients (8,258 women) with a mean age of 48 years (range, 18–90) who underwent a surgical sports medicine procedure were analyzed. Work RVUs and operative time were used to calculate work RVUs/hour for each surgical procedure. Univariate and multivariate analyses were used to assess correlations between patient characteristics and wRVUs/hour. Results: Knee chondroplasty generated the most mean (± standard deviation) wRVUs/hour at 22 ± 0.5, whereas ‘open tenodesis of biceps tendon, long head’ generated the least at 9.6 ± 0.25 wRVUs/hour. Factors associated with a greater mean number of wRVUs/hour were younger patient age, female sex, arthroscopic approach, and outpatient setting. Arthroscopic procedures also generated more wRVUs/hour than the same procedures performed through an open approach. wRVUs were not correlated with case complexity or surgical time. Conclusion: wRVUs/hour in surgical sports medicine procedures vary widely depending on the procedure type, patient characteristics, surgical approach, and practice setting.

Original languageEnglish (US)
JournalPhysician and Sportsmedicine
DOIs
StateAccepted/In press - 2021

Keywords

  • American college of surgeons’ national surgical quality improvement program database
  • arthroscopic surgery
  • open surgery
  • physician compensation
  • physician reimbursement
  • relative value units
  • sports medicine

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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