Ingram Michael T, Wisner David H, Cooke David T
Section of General Thoracic Surgery, University of California Davis Medical Center, Sacramento, Calif.
Department of Surgery, University of California Davis Medical Center, Sacramento, Calif.
J Thorac Cardiovasc Surg. 2014 Oct;148(4):1162-6. doi: 10.1016/j.jtcvs.2014.04.035. Epub 2014 Apr 19.
We hypothesized that academic adult cardiac surgeons (CSs) and general thoracic surgeons (GTSs) would have distinct practice patterns of, not just case-mix, but also time devoted to outpatient care, involvement in critical care, and work relative value unit (wRVU) generation for the procedures they perform.
We queried the University Health System Consortium-Association of American Medical Colleges Faculty Practice Solution Center database for fiscal years 2007-2008, 2008-2009, and 2009-2010 for the frequency of inpatient and outpatient current procedural terminology coding and wRVU data of academic GTSs and CSs. The Faculty Practice Solution Center database is a compilation of productivity and payer data from 86 academic institutions.
The greatest wRVU generating current procedural terminology codes for CSs were, in order, coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement. In contrast, open lobectomy, video-assisted thoracic surgery wedge, and video-assisted thoracic surgery lobectomy were greatest for GTSs. The 10 greatest wRVU-generating procedures for CSs generated more wRVUs than those for GTSs (P<.001). Although CSs generated significantly more hospital inpatient evaluation and management (E & M) wRVUs than did GTSs (P<.001), only 2.5% of the total wRVUs generated by CSs were from E & M codes versus 18.8% for GTSs. Critical care codes were 1.5% of total evaluation and management billing for both CSs and GTSs.
Academic CSs and GTSs have distinct practice patterns. CSs receive greater reimbursement for services because of the greater wRVUs of the procedures performed compared with GTSs, and evaluation and management coding is a more important wRVU generator for GTSs. The results of our study could guide academic CS and GTS practice structure and time prioritization.
我们推测，学术型成人心脏外科医生（CSs）和普通胸外科医生（GTSs）不仅在病例组合方面，而且在门诊护理时间、重症监护参与度以及他们所实施手术的工作相对价值单位（wRVU）生成方面，会有不同的执业模式。
我们查询了大学卫生系统联盟 - 美国医学院协会教职员工实践解决方案中心数据库在2007 - 2008财年、2008 - 2009财年和2009 - 2010财年中学术型GTSs和CSs的住院和门诊当前操作术语编码频率以及wRVU数据。教职员工实践解决方案中心数据库是86个学术机构的生产力和付款人数据的汇总。
CSs产生wRVU最多的当前操作术语编码依次为冠状动脉旁路移植术、主动脉瓣置换术和二尖瓣置换术。相比之下，开放性肺叶切除术、电视辅助胸腔镜手术楔形切除术和电视辅助胸腔镜手术肺叶切除术对GTSs来说产生的wRVU最多。CSs产生wRVU最多的10种手术所产生的wRVU比GTSs的多（P <.001）。尽管CSs产生的医院住院评估和管理（E&M）wRVU显著多于GTSs（P <.001），但CSs产生的总wRVU中只有2.
