Quantifying Clinical Encounters for Orthopaedic Hip and Knee Surgeries: A Retrospective Analysis of Provider Workload

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Healthcare Economics

Background:

• Postoperative care for total hip arthroplasty (THA) and total knee arthroplasty (TKA) significantly impacts provider workload.
• Current estimations of work Relative Value Units (wRVUs) by the Relative Value Scale Update Committee (RUC) may not accurately reflect this workload.

Purpose of the Study:

• To quantify the postoperative work performed by surgeons and their teams for THA and TKA within the 90-day global period.
• To compare the actual postoperative work intensity and communication time with current wRVU estimates.

Main Methods:

• Retrospective evaluation of patients undergoing primary total joint arthroplasty (TJA) between January 1, 2019, and December 31, 2024.
• Primary outcome: number of postoperative interactions (office visits, telehealth, phone calls, patient portal messages) from discharge to 90 days post-surgery.

Main Results:

• Average postoperative TJA interactions per patient increased, with a notable rise in phone calls and a fivefold increase in portal messages.
• Office visits averaged 2.3 per patient, exceeding the two visits recognized by RUC.
• Hospital lengths of stay decreased, indicating a shift of care to outpatient and virtual settings.

Conclusions:

• Postoperative care for THA and TKA increasingly involves surgeon teams, with a rise in office visits, virtual encounters, and administrative messaging.
• Current RUC valuations do not capture the true scope of postoperative care in modern joint arthroplasty practice.
• Updated valuation models are needed to accurately reflect physician reimbursement for contemporary joint replacement postoperative care.