Department of Urology, Oregon Health & Science University, Portland, OR; O'Brien Research Group, Portland, OR.
Department of Urology, Oregon Health & Science University, Portland, OR; O'Brien Research Group, Portland, OR.
Urology. 2020 Aug;142:94-98. doi: 10.1016/j.urology.2020.05.004. Epub 2020 May 14.
To assess whether inaccurate operative time estimates utilized by the Relative Value Update Committee (RUC) contribute to the undervaluation of longer urologic procedures.
The National Surgical Quality Improvement Program (NSQIP) and Centers for Medicare and Medicaid Services (CMS) data sets were reviewed from 2015 to 2017. NSQIP operative time is directly measured, contrasting with CMS times which are determined by the RUC via survey-generated estimates. The 50 most frequently coded urology current procedural terminologies were included. Operative time difference was compared between the 2 data sets, and Spearman's correlation coefficient was utilized to assess differences in wRVU/h.
A total of 105,931 cases were included. Overall, RUC operative time estimates were longer than NSQIP (124.4 vs 103.5 minutes, P < .001). RUC data overestimated operative time by 42.9% for procedures ≤90 minutes and 16.4% for longer procedures (P < .001). Using NSQIP, procedures ≤90 minutes had higher wRVU/h than longer procedures (12.2 vs 8.7, P < .001), but this was not statistically different using RUC estimates (8.4 vs 7.7, P = .13). Spearman's correlation coefficient confirmed a statistically significant negative relationship between wRVU/h and operative time using NSQIP data (r = -0.57, 95% confidence interval: -7.4 to -0.36), and no statistically significant relationship using RUC data (r = -0.24, 95% confidence interval: -0.49 to 0.04).
The RUC-intended wRVU/h is more equitable than the NSQIP real-world wRVU/h with regard to operative time. Inaccurate RUC operative time estimates contribute to the undervaluation of longer urologic procedures.
评估相对价值更新委员会（RUC）使用的不准确手术时间估计是否导致对较长泌尿科手术的低估。
从 2015 年至 2017 年，审查了国家手术质量改进计划（NSQIP）和医疗保险和医疗补助服务中心（CMS）数据集。NSQIP 的手术时间是直接测量的，与 CMS 时间形成对比，后者是通过调查生成的估计值由 RUC 确定的。纳入了 50 个最常编码的泌尿科当前程序术语。比较了两个数据集之间的手术时间差异，并使用斯皮尔曼等级相关系数评估了 wRVU/h 的差异。
共纳入 105931 例病例。总体而言，RUC 手术时间估计值长于 NSQIP（124.4 分钟比 103.5 分钟，P<.001）。对于 90 分钟以内的手术，RUC 数据高估了手术时间 42.9%，对于较长的手术则高估了 16.4%（P<.001）。使用 NSQIP，90 分钟以内的手术的 wRVU/h 高于较长手术（12.2 比 8.7，P<.001），但使用 RUC 估计值则无统计学差异（8.4 比 7.7，P=.13）。斯皮尔曼等级相关系数证实，使用 NSQIP 数据时，wRVU/h 与手术时间之间存在统计学上显著的负相关关系（r=-0.57，95%置信区间：-7.4 至-0.36），而使用 RUC 数据时则无统计学显著关系（r=-0.24，95%置信区间：-0.49 至 0.04）。
与 NSQIP 的实际 wRVU/h 相比，RUC 预期的 wRVU/h 在手术时间方面更为公平。不准确的 RUC 手术时间估计值导致对较长泌尿科手术的低估。
