The cost of doing business: An appraisal of relative value units in plastic surgery and other surgical subspecialties Review


Authors: Shim, J. Y.; Stoffel, V.; Neubauer, D.; Gosman, A. A.; Matros, E.; Reid, C. M.
Review Title: The cost of doing business: An appraisal of relative value units in plastic surgery and other surgical subspecialties
Abstract: Background: The relationship between procedural complexity and relative value units (RVUs) awarded has been studied within some specialties, but it has not yet been compared across different surgical disciplines. This study aims to analyze the association of RVUs with operative time as a surrogate for complexity across surgical specialties, with a focus on plastic surgery.Methods: A retrospective review of surgical cases was conducted with the 2019 National Surgical Quality Improvement Program database. The top 10 most performed procedures per surgical specialty were identified based on case volume. Only cases with a single CPT code were analyzed. A subanalysis of plastic surgery procedures was also conducted to include unilateral and bilateral procedures with a frequency greater than 20.Results: Overall, operative time correlated strongly with work RVUs (R = 0.86). Orthopedic surgery had one of the shortest average operative times with the greatest work RVUs per hour, in contrast to plastic surgery, with the greatest average operative time and one of the lowest work RVUs per hour. Of the plastic surgery procedures analyzed, only five were valued on par with the average calculated from all other specialties. The most poorly rewarded procedure for time spent is unilateral free flap breast reconstruction.Conclusions: Of all the surgical specialties, plastic surgery has the lowest RVUs per hour and the highest average operative time, leading to severe potential undervaluation compared with other specialties. This study suggests that further reevaluation of the current RVU system is needed to account for complexity more equitably as well as encourage value-based care.
Keywords: patient satisfaction; postmastectomy breast reconstruction; payment; bundled
Journal Title: Plastic and Reconstructive Surgery
Volume: 152
Issue: 5
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2023-11-01
Start Page: 1129
End Page: 1136
Language: English
ACCESSION: WOS:001087985900049
DOI: 10.1097/prs.0000000000010306
PROVIDER: wos
PUBMED: 36790785
Notes: Source: Wos
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Evan Matros
    207 Matros