The Correlation Between Case Total Work Relative Value Unit, Operative Stress And Patient Frailty
*Katherine M Reitz1, *Patrick R Varley1, *Nathan L Liang1, *Ada Youk1, *Elizabeth L George2, *Myrick C Shinall, Jr.3, Paula K Shireman4, *Shipra Arya5, Edith Tzeng1, *Daniel E Hall1
1University of PIttsburgh Medical Center, Pittsburgh, PA;2Stanford University School of Medicine, Standford, CA;3Vanderbilt University Medical Center, Nashville, TN;4University of Texas Health San Antonio, San Antonio, TX;5Stanford University School of Medicine, Stanford, CA
OBJECTIVES- Procedure-specific work Relative Value Units (wRVU) determine reimbursement and are generated from physician surveys, estimating intensity and time for typical patient care services. We hypothesized wRVU do not account for patient-specific factors that modify physician work, regardless of procedural complexity. METHODS- Using NSQIP and VASQIP (2015-2018), we evaluated the correlation between case total wRVU, patient frailty (Risk Analysis Index [RAI]) and physiologic stress (Operative Stress Score [OSS]). RESULTS- 4,247,126 cases (mean age, 58+/-16 years; 53% male; 18% VA) with mean RAI 24.6+/-8.4, median OSS 2 (IQR, 2-3), and mean total wRVU 18.8+/-10.5. Comparing highest to lowest wRVU cases, lowest quintile patients were younger (53+/-18 vs 61+/-14) and more robust (42% vs 22%). As hypothesized, the correlation between total wRVU and operative stress was moderate (correlation, 0.57; P<0.001)(Fig1A), but negligible with frailty (correlation, 0.17; P<0.001)(Fig1B). Very high stress procedures (N=34,332 [1%]) generated 55.2+/-13.0 total wRVU, comprising 7%, 2%, and 1% of thoracic, vascular, and general surgical cases (Fig1C). Very frail patients (N=160,062 [4%]) generated 21.7+/-13.6 total wRVU, comprising 9% and 10% of thoracic and vascular cases (Fig1D). Non-frail patients undergoing low-stress procedures (N=80,115 [2%]) nonetheless generated the highest wRVU quintile, comprising 15% of plastic surgical cases. CONCLUSIONS- Surgeon reimbursement correlates with operative complexity, but not patient frailty. The wRVU does not reflect patient-specific factors that increase the physician workload required to optimally care for complex patients.
Back to 2021 Abstracts