Rochlin Danielle H, Chaya Bachar F, Flores Roberto L
From the Hansjorg Weiss Department of Plastic Surgery, New York University Grossman School of Medicine.
Plast Reconstr Surg. 2023 Mar 1;151(3):603-610. doi: 10.1097/PRS.0000000000009922. Epub 2022 Nov 22.
Relative value units (RVUs) are broadly used for billing and physician compensation; however, the accuracy of RVU assignments has not been scientifically evaluated for craniofacial surgery. The authors hypothesize that unbalanced RVU allocation creates inappropriate disparities in value among procedures performed by cleft and craniofacial surgeons.
The National Surgical Quality Improvement Program Pediatric database was queried to identify all cleft and craniofacial surgery cases performed by plastic surgeons from 2012 to 2019 based on CPT code. Microsurgical cases and CPT codes with a case count of fewer than 10 were excluded. Efficiency was defined as total RVUs divided by total operative time (ie, RVUs/hour). Mean efficiency per CPT code was ranked and compared by quartile using t tests.
The sample consisted of 69 CPT codes with 50,450 cases. In the top quartile, most CPT codes were craniofacial procedures including frontofacial procedures (23.53%) and craniectomies for craniosynostosis or bony lesions (35.29%) (mean, 15.65 ± 4.22 RVUs/hour). The lowest quartile was composed mainly of CPT codes for cleft procedures including operations for velopharyngeal insufficiency (17.65%), cleft palate repair (23.53%), and cleft septoplasty (5.88%) (mean, 7.39 ± 0.98 RVUs/hour; P < 0.001). It was 2.5 times more efficient for a cleft and craniofacial surgeon to perform a local skin flap (15.18 RVUs/hour) than a secondary palatal lengthening for cleft palate (6.09 RVUs/hour).
The current RVU allocation to cleft and craniofacial procedures creates arbitrary disparities in physician efficiency, with cleft procedures disproportionately negatively affected. RVU assignments should be reevaluated to avoid disincentivizing cleft surgical care.
相对价值单位（RVUs）广泛用于计费和医生薪酬；然而，对于颅面外科手术，RVU分配的准确性尚未得到科学评估。作者推测，RVU分配不均衡会在腭裂和颅面外科医生所实施的手术之间造成不适当的价值差异。
查询国家外科质量改进计划儿科数据库，以根据CPT编码识别2012年至2019年整形外科医生实施的所有腭裂和颅面外科手术病例。排除显微外科病例和病例数少于10的CPT编码。效率定义为总RVUs除以总手术时间（即RVUs/小时）。每个CPT编码的平均效率按四分位数排名，并使用t检验进行比较。
样本包括69个CPT编码和50450例病例。在最高四分位数中，大多数CPT编码为颅面手术，包括额面手术（23.53%）和颅骨切开术治疗颅缝早闭或骨病变（35.29%）（平均，15.65±4.22 RVUs/小时）。最低四分位数主要由腭裂手术的CPT编码组成，包括腭咽闭合不全手术（17.65%）、腭裂修复术（23.53%）和腭裂鼻中隔成形术（5.88%）（平均，7.39±0.98 RVUs/小时；P<0.001）。腭裂和颅面外科医生实施局部皮瓣手术（15.18 RVUs/小时）的效率是腭裂二期腭延长术（6.09 RVUs/小时）的2.5倍。
目前对腭裂和颅面手术的RVU分配在医生效率方面造成了任意的差异，腭裂手术受到的负面影响不成比例。应重新评估RVU分配，以避免不利于腭裂手术治疗。
