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Comparing the Relative Value of Elective and Traumatic Hand Surgery Procedures.

Caroline C Bay1, Robert E George1, Keenan S Fine1

  • 1From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison.

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Traumatic hand surgeries yield significantly lower working relative value units (wRVUs) per minute compared to elective procedures. This study suggests a need to re-evaluate the compensation model for traumatic hand surgery cases.

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Area of Science:

  • Orthopedic Surgery
  • Health Economics
  • Surgical Outcomes

Background:

  • The Resource-Based Relative Value Scale (RBVS) and its working relative value units (wRVUs) are standard for surgeon compensation.
  • wRVU values are negotiated based on procedure complexity, time, skill, and labor.
  • Quantifying wRVUs per minute can reveal discrepancies in compensation models.

Purpose of the Study:

  • To compare the rate of wRVUs per minute between elective and traumatic hand surgeries.
  • To identify potential inequities in the current surgeon compensation model.

Main Methods:

  • Analysis of elective and traumatic hand surgery cases from a single academic institution (Oct 2015 - Jul 2023).
  • Calculation of average operative duration and wRVU/min rates for CPT codes with ≥10 occurrences.
  • Estimation of expected values using Centers for Medicare & Medicaid Services (CMS) data.

Main Results:

  • Endoscopic carpal tunnel release (CPT 29848) showed the highest rate (0.80 wRVUs/min).
  • Flexor tendon repair (CPT 26350) had the lowest rate (0.09 wRVUs/min).
  • Elective procedures averaged over double the wRVU/min rate of traumatic procedures (0.34 vs. 0.15 wRVUs/min, p<0.001).

Conclusions:

  • Traumatic hand surgeries demonstrate a significantly lower average wRVU/min rate than elective procedures, despite their complexity and urgency.
  • Findings indicate a need to reassess the RVU valuation for traumatic hand surgeries to ensure fair compensation.
  • The study highlights potential disparities in surgeon compensation based on surgical case type.