What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments
Autor: | Assem A Sultan, Michael A. Mont, Anton Khlopas, R. Douglas Orr, Thomas E. Mroz, Sarah E. Dalton, Jason W. Savage, Jared M. Newman, Morad Chughtai, Nipun Sodhi |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male Current Procedural Terminology Adolescent Databases Factual Operative Time Context (language use) Young Adult 03 medical and health sciences 0302 clinical medicine Humans Medicine Orthopedic Procedures Orthopedics and Sports Medicine 030212 general & internal medicine Instrumentation (computer programming) Aged Retrospective Studies Aged 80 and over 030222 orthopedics Relative value business.industry Retrospective cohort study Health Care Costs Middle Aged Relative Value Scales Quality Improvement Spine Resource-based relative value scale Cohort Costs and Cost Analysis Female Surgery Neurology (clinical) Nuclear medicine business Student's t-test |
Zdroj: | The Spine Journal. 18:1727-1732 |
ISSN: | 1529-9430 |
Popis: | Relative value units (RVUs) are a compensation model based on the effort required to provide a procedure or service to a patient. Thus, procedures that are more complex and require greater technical skill and aftercare, such as multilevel spine surgery, should provide greater physician compensation. However, there are limited data comparing RVUs with operative time. Therefore, this study aims to compare mean (1) operative times; (2) RVUs; and (3) RVU/min between posterior segmental instrumentation of 3-6, 7-12, and ≥13 vertebral segments, and to perform annual cost difference analysis.A total of 437 patients who underwent instrumentation of 3-6 segments (Cohort 1, current procedural terminology [CPT] code: 22842), 67 patients who had instrumentation of 7-12 segments (Cohort 2, CPT code: 22843), and 16 patients who had instrumentation of ≥13 segments (Cohort 3, CPT code: 22844) were identified from the National Surgical Quality Improvement Program (NSQIP) database. Mean operative times, RVUs, and RVU/min, as well as an annualized cost difference analysis, were calculated and compared using Student t test. This study received no funding from any party or entity.Cohort 1 had shorter mean operative times than Cohorts 2 and 3 (217 minutes vs. 325 minutes vs. 426 minutes, p.05). Cohort 1 had a lower mean RVU than Cohorts 2 and 3 (12.6 vs. 13.4 vs. 16.4). Cohort 1 had a greater RVU/min than Cohorts 2 and 3 (0.08 vs. 0.05, p.05; vs. 0.08 vs. 0.05, p.05). A $112,432.12 annualized cost difference between Cohorts 1 and 2, a $176,744.76 difference between Cohorts 1 and 3, and a $64,312.55 difference between Cohorts 2 and 3 were calculated.The RVU/min takes into account not just the value provided but also the operative times required for highly complex cases. The RVU/min for fewer vertebral level instrumentation being greater (0.08 vs. 0.05), as well as the $177,000 annualized cost difference, indicates that compensation is not proportional to the added time, effort, and skill for more complex cases. |
Databáze: | OpenAIRE |
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