Visit-level acuity and resource-based relative value unit utilization in a pediatric emergency department
Jay Pershad1, Michelle Whitley, Martin Herman
1Department of Pediatrics, Division of Emergency Services, University of Tennessee Health Science Center & Le Bonheur Children's Medical Center, Memphis, TN 38103, USA. pers2260@bellsouth.net
Pediatric Emergency Care
|June 28, 2006
Summary
Pediatric emergency departments (PEDs) can use relative value units per hour (RVUs/h) to measure physician productivity. Observational codes may increase RVUs for certain diagnoses compared to standard evaluation and management (E&M) codes.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Administration
- Health Economics
Background:
- Limited data exists on evaluation and management (E&M) code distribution and resource utilization in pediatric emergency departments (PEDs).
- Understanding these metrics is crucial for assessing healthcare provider productivity and optimizing resource allocation.
Purpose of the Study:
- To determine the distribution of visit-level acuity in a PED.
- To calculate mean relative value units per physician hour (RVUs/h) as a productivity measure.
- To examine the correlation between patient volume and RVUs/h.
- To compare RVUs generated by observation codes versus higher-level E&M codes for specific diagnoses.
Main Methods:
- A retrospective analysis of patient encounters in a tertiary-level, university-affiliated PED from January to December 2004.
- Calculation of total RVUs using 2004 national Medicare data, adjusted for Tennessee.
- Review of frequency for three diagnoses requiring extended care: status asthmaticus, volume depletion, and sickle cell disease with crisis.
- Comparison of RVUs generated using E&M code 99285 versus observation code 99236 for these diagnoses.
Main Results:
- 61,444 patient encounters occurred, with 7.6% admitted.
- The most common E&M code was 99283 (53.7%).
- Mean RVUs/h were 4.36 for physicians and 3.08 for pediatricians/nurse practitioners.
- A strong correlation (r = 0.85) was found between RVUs/h and patients seen per hour.
- Observation code 99236 generated higher total RVUs (15,143) compared to E&M code 99285 (10,408) for the studied diagnoses.
Conclusions:
- This study provides benchmarking data for PEDs regarding E&M code distribution and RVU utilization.
- RVUs/h can serve as a reliable indicator of healthcare provider productivity in PEDs.
- Utilizing observational codes for specific diagnoses in PEDs may better reflect service levels and potentially increase generated RVUs, despite requiring additional documentation.
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