Department of Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2020 Sep;35(9):2318-2322. doi: 10.1016/j.arth.2020.04.066. Epub 2020 Apr 25.
The Centers for Medicare and Medicaid Services has recently designated the codes for total hip and knee arthroplasty as misvalued and has asked the Relative Value Scale Update Committee (RUC) to review the work required to perform these procedures. Although other studies have reported time spent on perioperative and postoperative care, time spent on coordinating and performing preoperative care is not included in current RUC methodology and has yet to be addressed in literature.
We prospectively tracked a consecutive series of 438 primary total hip arthroplasty and total knee arthroplasty patients by one of the 5 surgeons over a 3-month period. Each clinical staff member tracked the amount of time to perform each preoperative care task from the last clinic visit until day of surgery. Data were analyzed separately between providers and ancillary medical staff.
Although the current RUC review includes 40 minutes of preservice time on the day of surgery, surgeons spent an average of an additional 43.2 minutes while physician assistants and nurse practitioners spent an additional 97.9 minutes per patient on preoperative care prior to that time. Ancillary medical staff spent a mean of 110.2 minutes per patient. The most common tasks include preoperative phone calls, templating and surgical planning, and preoperative patient education classes.
Surgeons and advanced practice providers spend nearly 2 hours per arthroplasty patient on preoperative care not accounted for in current RUC methodology. As readmissions, hospital stay, and complication rates continue to decline, Centers for Medicare and Medicaid Services should consider the substantial work required during the preoperative phase to allow for these improved outcomes.
医疗保险和医疗补助服务中心最近将全髋关节和全膝关节置换术的代码指定为估值过高，并要求相对价值更新委员会（RUC）审查执行这些程序所需的工作。尽管其他研究报告了围手术期和术后护理所花费的时间，但目前 RUC 方法中并未包括协调和执行术前护理所花费的时间，且这方面的文献也尚未涉及。
我们前瞻性地跟踪了 5 位外科医生在 3 个月内进行的 438 例初次全髋关节置换术和全膝关节置换术患者的连续系列。每位临床工作人员都从最后一次就诊到手术日跟踪执行每个术前护理任务所花费的时间。数据分别在提供者和辅助医疗人员之间进行分析。
尽管当前的 RUC 审查包括手术当天 40 分钟的术前服务时间，但外科医生平均额外花费了 43.2 分钟，而医师助理和执业护士在此之前为每位患者额外花费了 97.9 分钟进行术前护理。辅助医疗人员平均每位患者花费 110.2 分钟。最常见的任务包括术前电话、模板和手术计划以及术前患者教育课程。
外科医生和高级实践提供者在每个关节置换患者的术前护理上花费了近 2 个小时，而这在目前的 RUC 方法中并未考虑到。随着再入院率、住院时间和并发症率的持续下降，医疗保险和医疗补助服务中心应考虑术前阶段所需的大量工作，以实现这些改善的结果。
