ACS 2018: Correlation of Relative Value Units with Surgical Complexity and Physician Workload in Urology

Boston, Massachusetts ( Case M. Wood presented research examining the correlation of RVUs with surgical complexity and physician workload in the field of urology. They examined the 2012 through 2016 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) databases to select 56 current procedural terminology (CPT) codes that represent the spectrum of urologic surgery. Linear regression was used to correlate RVUs with measures of operative time, length of hospital stay (LOS), and the probability of morbidity and mortality, and R-squared (R2) values are reported. Log-binomial regression, with relative risks (RR) reported estimated associations with readmissions and the occurrence of serious adverse events (SAEs).

A total of 190,322 non-emergent urologic procedures were identified with RVUs ranging from 4.62 for transurethral resection of small bladder tumor to 44.26 for radical cystectomy with neobladder. On average, RVUs poorly correlated with LOS (R2 = 0.16), and mortality (R2 = 0.04). There was a moderate correlation between RVUs and operative time (R2 = 0.55) and morbidity (R2 = 0.44). RVUs were significant predictors of SAEs (RR = 1.082, 95% CI: 1.081 – 1.083) and unplanned readmissions (RR = 1.057, 95% CI: 1.055 – 1.059).

In the field of urology, certain measures of surgical complexity and overall physician workload appear to correlate with RVUs, while other measures do not. RVUs for individual CPT codes should be reassigned using a data-driven approach. Such high value based care and approach to global cost of care will be the future of medicine and these findings suggest further research needed.
Presented By: Case M. Wood, University of North Carolina, Chapel Hill, North Carolina

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts