Discrepancies in Assigned vs. Observed Operative Times: Consequences for RVU-Based Reimbursement in Plastic Surgery

Area of Science:

• Plastic Surgery
• Health Economics
• Surgical Outcomes

Background:

• Discrepancies between assigned and actual operative durations can distort time-based valuation of surgical procedures.
• Accurate time valuation is crucial for fair reimbursement in reconstructive plastic surgery.

Purpose of the Study:

• To evaluate the impact of operative time source on work Relative Value Unit (wRVU) per minute and reimbursement per minute.
• To compare actual operative times with Centers for Medicare & Medicaid Services (CMS)-assigned times for plastic surgery procedures.

Main Methods:

• Utilized 2023 National Surgical Quality Improvement Program (NSQIP) data for 11 common plastic surgery CPT codes.
• Compared NSQIP-observed operative times with CMS-assigned times from the Physician Fee Schedule.
• Calculated wRVU per minute and reimbursement per minute using both data sources; employed statistical analyses including regression and correlation.

Main Results:

• CMS underestimated operative time in 5 of 11 procedures, notably in immediate implant insertion, free flap breast reconstruction, and breast augmentation.
• Time discrepancies strongly correlated with reduced wRVU/min (ρ=-0.84).
• Modeled underpayment totaled over $751,000 for single-CPT cases and over $2 million for multi-CPT cases.

Conclusions:

• CMS operative time assignments frequently underestimate plastic surgery procedure durations.
• Discrepancies lead to substantial reductions in wRVU/min and $/min, especially for complex procedures.
• Current CMS time assignments may not capture operative complexity, potentially causing systematic underpayment in reconstructive surgery.