Time is Money: Relative Value Units and Operative Time in Otolaryngology
Objectives Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time r...
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| Veröffentlicht in: | The Laryngoscope 2021-02, Vol.131 (2), p.E395-E400 |
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| container_title | The Laryngoscope |
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| creator | Barinsky, Gregory L. Wassef, David W. Povolotskiy, Roman Grube, Jordon G. Hsueh, Wayne D. Baredes, Soly Eloy, Jean Anderson |
| description | Objectives
Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time.
Study Design
Retrospective analysis of a surgical database.
Methods
NSQIP was queried from 2015–2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates.
Results
Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P |
| doi_str_mv | 10.1002/lary.28988 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2466771324</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2466771324</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3578-23589d18bf83bf5977fac6c8990343cbae74452b37134a470f5aa7ef13aaaccd3</originalsourceid><addsrcrecordid>eNp9kMFLwzAUxoMobk4v_gES8CJCZ9IkTeptDHXCZDA20VNI03RU2mY2rdL_3sxODx48vcP3e9973wfAOUZjjFB4U6i6G4ciFuIADDEjOKBxzA7B0IskECx8GYAT594QwpwwdAwGhITca_EQzFZ5aWDu4JOtTHcLl6ZQTf5h4LMqWgPXVd44qKoULram7pV-o4KLxu4uVxtb2E13Co4yVThztp8jsL6_W01nwXzx8DidzANNGBdBSJiIUyySTJAkYzHnmdKRFnGMCCU6UYZTysKEcEyoohxlTCluMkyUUlqnZASuet9tbd9b4xpZ5k6bolCVsa2TIY0i7pdD6tHLP-ibbevKf-cpHglBokh46rqndG2dq00mt3Ve-mASI7nrV-5Syu9-PXyxt2yT0qS_6E-hHsA98JkXpvvHSs4ny9fe9Au3IoSK</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2476883668</pqid></control><display><type>article</type><title>Time is Money: Relative Value Units and Operative Time in Otolaryngology</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Barinsky, Gregory L. ; Wassef, David W. ; Povolotskiy, Roman ; Grube, Jordon G. ; Hsueh, Wayne D. ; Baredes, Soly ; Eloy, Jean Anderson</creator><creatorcontrib>Barinsky, Gregory L. ; Wassef, David W. ; Povolotskiy, Roman ; Grube, Jordon G. ; Hsueh, Wayne D. ; Baredes, Soly ; Eloy, Jean Anderson</creatorcontrib><description>Objectives
Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time.
Study Design
Retrospective analysis of a surgical database.
Methods
NSQIP was queried from 2015–2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates.
Results
Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P < .001). Further analysis found no correlation between operative time and wRVU/hr (R2 = 0.008, P = .525). Linear regression of wRVU/hr and complication rate showed a statistically significant positive correlation (R2 = 0.113, P = .017).
Conclusion
This analysis suggests that compensation for otolaryngology procedures is positively correlated with operative time. Surgeries where more than one code is reported could not be evaluated, thus excluding some common combination of procedures performed by otolaryngologists.
Level of Evidence
4 Laryngoscope, 131:E395–E400, 2021</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.28988</identifier><identifier>PMID: 33270239</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>billing ; Current Procedural Terminology ; Databases, Factual - statistics & numerical data ; Humans ; Laryngoscopy ; NSQIP ; Operative Time ; Otolaryngology ; Otolaryngology - economics ; Otolaryngology - statistics & numerical data ; otolaryngology compensation ; Otorhinolaryngologic Surgical Procedures - economics ; Otorhinolaryngologic Surgical Procedures - statistics & numerical data ; physician compensation ; procedure complexity ; Regression analysis ; reimbursement ; Relative Value Scales ; Relative value unit ; Retrospective Studies ; Terminology ; wRVU</subject><ispartof>The Laryngoscope, 2021-02, Vol.131 (2), p.E395-E400</ispartof><rights>2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA)</rights><rights>2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).</rights><rights>2021 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3578-23589d18bf83bf5977fac6c8990343cbae74452b37134a470f5aa7ef13aaaccd3</citedby><cites>FETCH-LOGICAL-c3578-23589d18bf83bf5977fac6c8990343cbae74452b37134a470f5aa7ef13aaaccd3</cites><orcidid>0000-0002-5773-182X ; 0000-0003-2893-7818 ; 0000-0002-8877-5964 ; 0000-0001-7063-9692 ; 0000-0002-7536-0268</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.28988$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.28988$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27907,27908,45557,45558</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33270239$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barinsky, Gregory L.</creatorcontrib><creatorcontrib>Wassef, David W.</creatorcontrib><creatorcontrib>Povolotskiy, Roman</creatorcontrib><creatorcontrib>Grube, Jordon G.</creatorcontrib><creatorcontrib>Hsueh, Wayne D.</creatorcontrib><creatorcontrib>Baredes, Soly</creatorcontrib><creatorcontrib>Eloy, Jean Anderson</creatorcontrib><title>Time is Money: Relative Value Units and Operative Time in Otolaryngology</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>Objectives
Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time.
Study Design
Retrospective analysis of a surgical database.
Methods
NSQIP was queried from 2015–2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates.
Results
Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P < .001). Further analysis found no correlation between operative time and wRVU/hr (R2 = 0.008, P = .525). Linear regression of wRVU/hr and complication rate showed a statistically significant positive correlation (R2 = 0.113, P = .017).
Conclusion
This analysis suggests that compensation for otolaryngology procedures is positively correlated with operative time. Surgeries where more than one code is reported could not be evaluated, thus excluding some common combination of procedures performed by otolaryngologists.
Level of Evidence
4 Laryngoscope, 131:E395–E400, 2021</description><subject>billing</subject><subject>Current Procedural Terminology</subject><subject>Databases, Factual - statistics & numerical data</subject><subject>Humans</subject><subject>Laryngoscopy</subject><subject>NSQIP</subject><subject>Operative Time</subject><subject>Otolaryngology</subject><subject>Otolaryngology - economics</subject><subject>Otolaryngology - statistics & numerical data</subject><subject>otolaryngology compensation</subject><subject>Otorhinolaryngologic Surgical Procedures - economics</subject><subject>Otorhinolaryngologic Surgical Procedures - statistics & numerical data</subject><subject>physician compensation</subject><subject>procedure complexity</subject><subject>Regression analysis</subject><subject>reimbursement</subject><subject>Relative Value Scales</subject><subject>Relative value unit</subject><subject>Retrospective Studies</subject><subject>Terminology</subject><subject>wRVU</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFLwzAUxoMobk4v_gES8CJCZ9IkTeptDHXCZDA20VNI03RU2mY2rdL_3sxODx48vcP3e9973wfAOUZjjFB4U6i6G4ciFuIADDEjOKBxzA7B0IskECx8GYAT594QwpwwdAwGhITca_EQzFZ5aWDu4JOtTHcLl6ZQTf5h4LMqWgPXVd44qKoULram7pV-o4KLxu4uVxtb2E13Co4yVThztp8jsL6_W01nwXzx8DidzANNGBdBSJiIUyySTJAkYzHnmdKRFnGMCCU6UYZTysKEcEyoohxlTCluMkyUUlqnZASuet9tbd9b4xpZ5k6bolCVsa2TIY0i7pdD6tHLP-ibbevKf-cpHglBokh46rqndG2dq00mt3Ve-mASI7nrV-5Syu9-PXyxt2yT0qS_6E-hHsA98JkXpvvHSs4ny9fe9Au3IoSK</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Barinsky, Gregory L.</creator><creator>Wassef, David W.</creator><creator>Povolotskiy, Roman</creator><creator>Grube, Jordon G.</creator><creator>Hsueh, Wayne D.</creator><creator>Baredes, Soly</creator><creator>Eloy, Jean Anderson</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5773-182X</orcidid><orcidid>https://orcid.org/0000-0003-2893-7818</orcidid><orcidid>https://orcid.org/0000-0002-8877-5964</orcidid><orcidid>https://orcid.org/0000-0001-7063-9692</orcidid><orcidid>https://orcid.org/0000-0002-7536-0268</orcidid></search><sort><creationdate>202102</creationdate><title>Time is Money: Relative Value Units and Operative Time in Otolaryngology</title><author>Barinsky, Gregory L. ; Wassef, David W. ; Povolotskiy, Roman ; Grube, Jordon G. ; Hsueh, Wayne D. ; Baredes, Soly ; Eloy, Jean Anderson</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3578-23589d18bf83bf5977fac6c8990343cbae74452b37134a470f5aa7ef13aaaccd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>billing</topic><topic>Current Procedural Terminology</topic><topic>Databases, Factual - statistics & numerical data</topic><topic>Humans</topic><topic>Laryngoscopy</topic><topic>NSQIP</topic><topic>Operative Time</topic><topic>Otolaryngology</topic><topic>Otolaryngology - economics</topic><topic>Otolaryngology - statistics & numerical data</topic><topic>otolaryngology compensation</topic><topic>Otorhinolaryngologic Surgical Procedures - economics</topic><topic>Otorhinolaryngologic Surgical Procedures - statistics & numerical data</topic><topic>physician compensation</topic><topic>procedure complexity</topic><topic>Regression analysis</topic><topic>reimbursement</topic><topic>Relative Value Scales</topic><topic>Relative value unit</topic><topic>Retrospective Studies</topic><topic>Terminology</topic><topic>wRVU</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barinsky, Gregory L.</creatorcontrib><creatorcontrib>Wassef, David W.</creatorcontrib><creatorcontrib>Povolotskiy, Roman</creatorcontrib><creatorcontrib>Grube, Jordon G.</creatorcontrib><creatorcontrib>Hsueh, Wayne D.</creatorcontrib><creatorcontrib>Baredes, Soly</creatorcontrib><creatorcontrib>Eloy, Jean Anderson</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barinsky, Gregory L.</au><au>Wassef, David W.</au><au>Povolotskiy, Roman</au><au>Grube, Jordon G.</au><au>Hsueh, Wayne D.</au><au>Baredes, Soly</au><au>Eloy, Jean Anderson</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Time is Money: Relative Value Units and Operative Time in Otolaryngology</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2021-02</date><risdate>2021</risdate><volume>131</volume><issue>2</issue><spage>E395</spage><epage>E400</epage><pages>E395-E400</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><abstract>Objectives
Physician compensation for procedures is typically rooted in the work relative value unit (wRVU) system. Operative time is one of the factors that goes into the determination of wRVU assignment. There should be consistency between the wRVU/hr rate, irrespective of average operative time required to perform certain procedures. We investigate if wRVU assignment for otolaryngology procedures adequately accounts for increased operative time.
Study Design
Retrospective analysis of a surgical database.
Methods
NSQIP was queried from 2015–2018 for the top 50 most frequently performed otolaryngology Current Procedural Terminology (CPT) codes completed as standalone procedures. Median operative time was determined for each CPT code, and wRVU/hr was calculated. Correlations between operative time, wRVU, and wRVU/hr were investigated using linear regression analysis. A secondary analysis using complication rate as an indicator for procedure complexity was performed to examine the relation between wRVUs and complication rates.
Results
Fifty CPT codes containing 64,084 patients where only one code was reported were included in this analysis. The median operative time was 84 minutes, median wRVU was 11.23, and median wRVU/hour was 7.96. Linear regression analysis demonstrated a strong positive correlation between operative time and wRVU assignment (R2 = 0.805, P < .001). Further analysis found no correlation between operative time and wRVU/hr (R2 = 0.008, P = .525). Linear regression of wRVU/hr and complication rate showed a statistically significant positive correlation (R2 = 0.113, P = .017).
Conclusion
This analysis suggests that compensation for otolaryngology procedures is positively correlated with operative time. Surgeries where more than one code is reported could not be evaluated, thus excluding some common combination of procedures performed by otolaryngologists.
Level of Evidence
4 Laryngoscope, 131:E395–E400, 2021</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>33270239</pmid><doi>10.1002/lary.28988</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-5773-182X</orcidid><orcidid>https://orcid.org/0000-0003-2893-7818</orcidid><orcidid>https://orcid.org/0000-0002-8877-5964</orcidid><orcidid>https://orcid.org/0000-0001-7063-9692</orcidid><orcidid>https://orcid.org/0000-0002-7536-0268</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | billing Current Procedural Terminology Databases, Factual - statistics & numerical data Humans Laryngoscopy NSQIP Operative Time Otolaryngology Otolaryngology - economics Otolaryngology - statistics & numerical data otolaryngology compensation Otorhinolaryngologic Surgical Procedures - economics Otorhinolaryngologic Surgical Procedures - statistics & numerical data physician compensation procedure complexity Regression analysis reimbursement Relative Value Scales Relative value unit Retrospective Studies Terminology wRVU |
| title | Time is Money: Relative Value Units and Operative Time in Otolaryngology |
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