Childers Christopher P, Maggard-Gibbons Melinda
David Geffen School of Medicine, Department of Surgery, University of California, Los Angeles, Los Angeles.
JAMA Surg. 2020 Jun 1;155(6):493-501. doi: 10.1001/jamasurg.2020.0422.
The work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures have been blamed for pay differences across specialties, but to our knowledge, a comprehensive assessment is lacking.
To assess how compensation rates built into work RVUs contribute to differences in physician compensation across specialties.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis examined 2017 Part B fee-for-service Medicare data. The data were analyzed from May 1 to May 30, 2019.
A specialty-wide compensation rate (wRVUs/min) was generated for 42 medical and surgical specialties defined as the sum of wRVUs for all billed current procedural terminology codes divided by the presumed time to perform those services. This measure accounted for the volume and diversity of services each specialty provides. Sensitivity analyses were performed to assess the association of errors in wRVU time estimates with average compensation rates.
The final sample included 42 specialties and 6587 distinct Current Procedual Terminology (CPT) codes. The number of CPT codes attributed to a specialty ranged from 575 (medical oncology) to 4346 (general surgery). Compensation rates ranged from 0.029 wRVUs/min (pathology) to 0.057 wRVUs/min (emergency medicine). Most specialties (34/42 [81.0%]) had compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant. This narrow range reflects the fact that most specialties had more than 60% of time allocated to activities outside the intraservice period. Assuming that time values for surgical procedures are significantly overestimated increased the difference in average compensation between surgical and medical specialties to 23.4%.
Compensation rates assumed in wRVU valuations are small contributors to differences in physician compensation. Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.
医师服务的工作相对价值单位（wRVUs）可被概念化为医师花费的时间量乘以补偿率（wRVUs/分钟）。分配给手术的过高补偿率被认为是各专科薪酬差异的原因，但据我们所知，尚缺乏全面评估。
评估工作RVUs中包含的补偿率如何导致各专科医师薪酬的差异。
设计、设置和参与者：本横断面分析研究了2017年B部分按服务收费的医疗保险数据。数据于2019年5月1日至5月30日进行分析。
为42个内科和外科专科生成了全专科补偿率（wRVUs/分钟），定义为所有计费的当前程序术语代码的wRVUs总和除以执行这些服务的预计时间。该指标考虑了每个专科提供的服务量和多样性。进行敏感性分析以评估wRVU时间估计误差与平均补偿率之间的关联。
最终样本包括42个专科和6587个不同的当前程序术语（CPT）代码。归属于一个专科的CPT代码数量从575个（医学肿瘤学）到4346个（普通外科）不等。补偿率从0.029 wRVUs/分钟（病理学）到0.057 wRVUs/分钟（急诊医学）不等。大多数专科（34/42 [81.0%]）的补偿率在0.035至0.045 wRVUs/分钟之间。外科专科的平均补偿率比内科专科高7.2%，差异无统计学意义。这一狭窄范围反映了大多数专科超过60%的时间分配给了服务期之外的活动这一事实。假设手术程序的时间值被显著高估，会使外科和内科专科之间的平均补偿差异增加到23.4%。
wRVU估值中假设的补偿率对医师薪酬差异的影响较小。如果希望缩小各专科之间的薪酬差异，可以针对wRVU系统之外的因素，如付款人组合和工作时间。
