Vascular surgery and the Resource-based Relative Value Scale five-year review

Area of Science:

• Health economics
• Medical policy
• Surgical practice management

Background:

• The Medicare Resource-based Relative Value Scale (RBRVS) underwent its first 5-year review, impacting work values (RVUs) effective January 1, 1997.
• The Society for Vascular Surgery (SVS) and International Society for Cardiovascular Surgery, North American Chapter (ISCVS-NA) Joint Council Government Relations Committee (GRC) evaluated vascular surgery RVUs.

Purpose of the Study:

• To summarize the methods used by the SVS/ISCVS-NA GRC to evaluate vascular surgery work RVUs.
• To report the outcomes of the RVU evaluation and their impact on vascular surgery compensation.

Main Methods:

• A work study was conducted to determine accurate skin-to-skin operative times for vascular and nonvascular procedures.
• Operative times and intraservice work per unit time (IWPUT) values were compared to original Harvard/Hsiao estimates.
• Multiple work analysis methods, including surveys and E&M building-block approaches, were used to support RVU increase justifications.

Main Results:

• Vascular procedures' operative times were longer than original estimates, indicating undervaluation.
• The Health Care Financing Administration (HCFA) proposed RVU increases of 11.5% to 44.6% for nine cited vascular procedures.
• HCFA also proposed substantial increases for Evaluation and Management (E&M) services outside global surgical packages.

Conclusions:

• The Final Rule approved 11 vascular work value improvements and E&M increases for non-global services.
• A budget-neutral policy mandated an 8.3% reduction in all Part B work payments to offset E&M increases.
• The net fiscal impact for vascular surgery from the 5-year review was an estimated +0.5%.