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Examining the Relationship Between Relative Value Units and Patient-reported Outcomes: Implications for Value-based
Justin J Turcotte1, Jane C Brennan, Andrea H Johnson
1From the Luminis Health Anne Arundel Medical Center Orthopedics, Annapolis, MD.
Summary
Work relative value units (wRVUs) are common in orthopaedics but show little association with patient-reported physical function improvements. Separate measurement of work complexity and functional outcomes is crucial for value-based care.
Area of Science:
- Orthopaedic Surgery
- Health Economics
- Patient Outcomes
Background:
- Work relative value units (wRVUs) are a prevalent compensation model for orthopaedic surgeons.
- The shift towards value-based payments necessitates integrating quality and outcome measures, including patient-reported outcomes, into compensation.
Purpose of the Study:
- To evaluate the relationship between wRVUs and changes in Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) scores.
- To determine if wRVUs can serve as a proxy for improvements in patient-reported physical function.
Main Methods:
- Retrospective review of 2,996 orthopaedic surgeries.
- Analysis of patient characteristics, surgeon-billed wRVUs, operating room (OR) time, and PROMIS-PF score changes.
- Application of Pearson correlation and multivariable linear regression.
Main Results:
- A strong positive correlation was found between wRVUs and OR time (r = 0.732), explaining 54% of OR time variability.
- A weak positive correlation was observed between wRVUs and PROMIS-PF score change (r = 0.058), explaining less than 1% of the variation.
- Each 1-point increase in wRVU was associated with a 3-minute increase in surgical duration and a 0.02-point increase in PROMIS-PF change.
Conclusions:
- Significant variability exists in wRVUs and physical function improvements across orthopaedic subspecialties.
- wRVUs are strongly correlated with surgical time but demonstrate a minimal association with functional improvements.
- Value-based payment models should maintain distinct measures for work complexity and functional outcomes.
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