Relative Value Units and Operative Time in Plastic and Reconstructive Surgery

Area of Science:

• Plastic and reconstructive surgery
• Healthcare economics
• Surgical outcomes analysis

Background:

• Work relative value units (wRVUs) are crucial for physician reimbursement and compensation in the US.
• Accurate wRVU assignment should reflect the time physicians dedicate to patient care.
• The current study investigates wRVU appropriateness concerning operative time in plastic surgery.

Purpose of the Study:

• To evaluate if work relative value units (wRVUs) adequately account for operative time in plastic and reconstructive surgery.
• To identify plastic surgery procedures where wRVUs are disproportionately high or low relative to their operative duration.

Main Methods:

• Analysis of 31,156 cases from the 2015-2018 National Surgical Quality Improvement Program.
• Inclusion of the 50 most performed plastic surgery procedures with recorded operative times and assigned wRVUs.
• Utilization of linear regression to examine the relationship between operative time, wRVUs, and wRVUs per hour.

Main Results:

• A strong positive linear correlation (R²=0.78) was observed between assigned wRVUs and operative time.
• Each additional hour of operative time was associated with an increase of 5.3 wRVUs (p<0.001).
• Breast reconstruction procedures showed the highest wRVUs relative to operative time, while excisional debridements had the lowest.

Conclusions:

• While a correlation exists between wRVUs and operative time in plastic surgery, significant outliers indicate potential inequities.
• Current wRVU assignments may not be optimal across the spectrum of plastic surgery procedures.
• Further refinement of wRVU allocation is suggested to better align with physician operative time.