Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Curtis National Hand Center, Union Memorial, Baltimore, MD, USA.
Clin Orthop Surg. 2021 Mar;13(1):76-82. doi: 10.4055/cios20052. Epub 2021 Jan 7.
Many U.S. health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. A major determinant of payment and wRVU assignments is operative time. We sought to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common shoulder/elbow procedures.
We collected data on wRVUs, payments, and operative times from CMS for 29 types of isolated arthroscopic and open shoulder/elbow procedures. Using regression analysis, we compared relationships between these variables, in addition to median operative times reported by NSQIP (2013-2016). We then determined the relative valuation of each procedure based on operative time.
Seventy-nine percent of CMS operative time were longer than NSQIP time ( = 0.58), including, but not limited to, shoulder arthroplasty and arthroscopic shoulder surgery. The correlation between payments and operative times was stronger between CMS data ( = 0.61) than NSQIP data ( = 0.43). Similarly, the correlation between wRVUs and operative times was stronger when using CMS data ( = 0.87) than NSQIP data ( = 0.69). Nearly all arthroscopic shoulder procedures (aside from synovectomy, debridement, and decompression) were highly valued according to both datasets. Per NSQIP, compensation for revision total shoulder arthroplasty ($10.14/min; 0.26 wRVU/min) was higher than that for primary cases ($9.85, 0.23 wRVU/min) and nearly twice the CMS rate for revision cases ($5.84/min; 0.13 wRVU/min).
CMS may overestimate operative times compared to actual operative times as recorded by NSQIP. Shorter operative times may render certain procedures more highly valued than others. Case examples show that this can potentially affect patient care and incentivize higher compensating procedures per operative time when less-involved, shorter operations have similar patient-reported outcomes.
许多美国医疗机构采用基于工作相对价值单位（wRVUs）的补偿模式来标准化支付并激励提供者。支付和 wRVU 分配的一个主要决定因素是手术时间。我们试图确定医疗保险和医疗补助服务中心（CMS）和国家外科质量改进计划（NSQIP）之间估计手术时间的差异是否导致最常见的肩部/肘部手术的支付和 wRVU 估值错误。
我们从 CMS 收集了 29 种孤立的关节镜和开放肩部/肘部手术的 wRVUs、支付和手术时间数据。使用回归分析，我们比较了这些变量之间的关系，以及 NSQIP（2013-2016 年）报告的中位数手术时间。然后，我们根据手术时间确定每个手术的相对估值。
79%的 CMS 手术时间长于 NSQIP 时间（ = 0.58），包括但不限于肩部置换术和关节镜下肩部手术。支付与手术时间之间的相关性在 CMS 数据（ = 0.61）中比 NSQIP 数据（ = 0.43）更强。同样，当使用 CMS 数据时，wRVU 与手术时间之间的相关性更强（ = 0.87），而 NSQIP 数据（ = 0.69）。几乎所有关节镜下肩部手术（除滑膜切除术、清创术和减压术外）根据两个数据集都具有很高的价值。根据 NSQIP，翻修全肩关节置换术的补偿（$10.14/min；0.26 wRVU/min）高于初次手术（$9.85，0.23 wRVU/min），几乎是 CMS 翻修病例的两倍（$5.84/min；0.13 wRVU/min）。
与 NSQIP 记录的实际手术时间相比，CMS 可能高估了手术时间。较短的手术时间可能会使某些手术比其他手术更有价值。案例示例表明，当涉及较少、较短的手术时，当涉及较少、较短的手术时，这可能会影响患者护理并根据手术时间激励更高的补偿性手术，而患者报告的结果相似。
