Sodhi Nipun, Dalton Sarah E, Garbarino Luke J, Gold Peter A, Piuzzi Nicolas S, Newman Jared M, Khlopas Anton, Sultan Assem A, Chughtai Morad, Mont Michael A
Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Ann Transl Med. 2019 Feb;7(4):74. doi: 10.21037/atm.2018.08.14.
Relative value units (RVUs) are a physician reimbursement model based on the effort required, or value, in providing a procedure or service for a patient. Procedures such as conversion total hip arthroplasties (THAs) can be compared to primary THAs, but many studies have revealed increased difficulties in conversion cases. Despite the increased time and effort for conversion THA, it is unknown if this is reflected in the RVU compensation model. Therefore, the purpose of this study was to compare the: (I) mean operative times; (II) mean RVUs; (III) RVU/minute for primary and conversion THAs; and (IV) perform an individualized idealized surgeon annual cost difference analysis.
A total of 103,702 primary THA patients were identified using CPT code 27130 and 2,986 conversion THA patients were identified using CPT code 27132 using the National Surgical Quality Improvement Program (NSQIP) database. The mean RVUs, operative times (minutes), and RVU/minute were calculated and compared. An annualize cost analysis of dollar amounts per case, day, and the year was also performed.
The mean operative times for the primary and conversion THA cohorts were 94 146 minutes (P<0.001) and mean RVUs were 21.24 25.68 (P<0.001). Interestingly, the mean RVU per minute was higher for the primary THA compared to the conversion THA groups (0.26 0.21, P<0.001). Annualized cost analysis revealed a potential $173,529 difference from performing primary conversion THAs.
Even though conversion THA can be considered to a more complex and demanding procedure, based on RVUs per minute of surgery, orthopaedic surgeons are reimbursed better for primary THA cases. This data could be used by orthopaedic surgeons to administer their practices better to yield the highest return on time.
相对价值单位（RVUs）是一种基于为患者提供手术或服务所需的努力程度或价值的医生报销模式。诸如全髋关节置换术（THA）翻修手术等手术可与初次THA进行比较，但许多研究表明翻修病例的难度增加。尽管翻修THA所需的时间和精力增加，但尚不清楚这是否反映在RVU补偿模式中。因此，本研究的目的是比较：（I）平均手术时间；（II）平均RVUs；（III）初次和翻修THA的每分钟RVU；以及（IV）进行个体化的理想化外科医生年度成本差异分析。
使用国家外科质量改进计划（NSQIP）数据库，通过CPT编码27130识别出103702例初次THA患者，通过CPT编码27132识别出2986例翻修THA患者。计算并比较平均RVUs、手术时间（分钟）和每分钟RVU。还对每个病例、每天和每年的美元金额进行了年度成本分析。
初次和翻修THA队列的平均手术时间分别为94±146分钟（P<0.001），平均RVUs分别为21.24±25.68（P<0.001）。有趣的是，与翻修THA组相比，初次THA组的每分钟平均RVU更高（0.26±0.21，P<0.001）。年度成本分析显示，进行初次与翻修THA之间存在潜在的173529美元差异。
尽管翻修THA可被认为是一种更复杂且要求更高的手术，但基于每分钟手术的RVUs，骨科医生在初次THA病例中的报销更好。骨科医生可利用这些数据更好地管理他们的业务，以获得最高的时间回报率。
