Undervaluation of Perioperative Work for ACL Reconstruction by Relative Value Scale Update Committee Methodology in a...

The purpose of this study was to determine the accuracy of the Relative Value Update Committee (RUC) and Centers for Medicare & Medicaid Services current times and work relative value units (wRVUs) for the perioperative work involved in anterior cruciate ligament (ACL) reconstruction by directly timing perioperative tasks as they occur in real time.

The RUC was contacted to obtain a list of perioperative tasks and the corresponding times allotted for the tasks involved in arthroscopically aided ACL reconstruction (Current Procedural Terminology code 29888). The tasks that occurred both inside and outside the operating room were timed by the attending physician as the event occurred. The time for each task was then multiplied by its respective Centers for Medicare & Medicaid Services-assigned intensity coefficient to calculate the wRVU. Calculated and allotted wRVUs were compared for accuracy.

The tasks timed in this study were allotted 100 minutes by the RUC and a total wRVU value of 2.026. Our study found that these tasks took 132.1 minutes and had a total wRVU value of 2.713. The overall time it takes to perform perioperative tasks in arthroscopically aided ACL surgeries is underestimated by 32.1 minutes, which results in an undervaluation of the total wRVU value by 0.687.

The perioperative wRVU assigned by the RUC underestimates the amount of time assigned to perform the required tasks. The RUC should consider using prospective times collected by physicians to calculate a more accurate wRVU. In addition, the RUC should consider how modern patient care practices and requirements have increased the intensity of work for physicians.