Department of Surgery, Division of Plastic Surgery, Dartmouth-Hitchcock Medical Center, Dartmouth, NH, USA.
J Am Coll Surg. 2012 Jun;214(6):937-42. doi: 10.1016/j.jamcollsurg.2012.02.003. Epub 2012 Apr 6.
The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement.
Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time.
Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30).
The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review.
相对价值单位系统依赖于医生在患者护理过程中主观衡量的投入。单位时间支付模型将外科医生的报酬纳入手术室、术后住院和诊所时间的总护理时间，以定义单位时间的报酬。我们旨在通过使用总护理时间和单位时间支付方法比较普通普外科手术，以展示更客观的医生报酬衡量标准。
获得了普外科 5 例门诊手术和 4 例住院手术的每位医生平均总病例支付。总护理时间定义为手术时间、每位患者住院每天 30 分钟和每次就诊 30 分钟的总和。单位时间支付是通过将每位患者的报酬除以总护理时间来计算的。
每种手术的总护理时间、每位患者的报酬和单位时间支付显示，住院手术的平均每小时支付为 455.73 美元，门诊手术略高，为 467.51 美元。原发性吻合的部分结肠切除术总护理时间最长（8.98 小时），单位时间支付最低（188.52 美元）。腹腔镜胃旁路手术的单位时间支付最高（707.30 美元）。
总护理时间和单位时间支付方法可作为机构层面和国家层面比较不同手术报酬的辅助手段。尽管许多手术的支付趋势相似，基于外科医生的工作时间，但使用这种方法存在支付差异，可能需要进一步审查。
