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Accuracy Of The Relative Value Scale Update Committee's Time Estimates And Physician Fee Schedule For Joint
John W Urwin1, Emily Gudbranson2, Danielle Graham3
1John W. Urwin is a resident physician in the Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, in Boston, Massachusetts, and a research assistant in the Department of Medical Ethics and Health Policy at the University of Pennsylvania, in Philadelphia.
Abstract:
Even though relative value units guide 70 percent of physician payment, little research has assessed their accuracy. We analyzed actual service time for total hip and knee replacements at two academic hospitals in the period January 1, 2013-October 1, 2016, using electronic health record time-stamp data, and we compared that time with the Medicare Physician Fee Schedule and most recent Relative Value Scale Update Committee recommendations. We found that the committee and fee schedule overestimated the operating time of original hip replacements by 18 percent and original knee replacements by 23 percent. Revision hip replacements were overestimated by 61 percent and knee replacements by 48 percent. In a multivariate analysis we found that faster operating time was not associated with more complications or admissions to the intensive care unit. Complication rates varied tenfold across physicians and twofold across hospitals. The fee schedule and the committee significantly overestimated operating times for original and revision hip and knee replacements. Policy makers should use empirical time-stamp data instead of self-reported estimates to determine physician payment.