Relative value units do not adequately account for operative time in pediatric urology

• Published in: Journal of pediatric surgery 2021-05, Vol.56 (5), p.883-887
• Main Authors: Jiang, Da David, Chakiryan, Nicholas H, Gillis, Kyle A, Acevedo, Ann Martinez, Chen, Yiyi, Austin, J Christopher, Seideman, Casey A
• Format: Article
• Language: English
• Subjects: Operative time; Pediatric urology; Relative value scales; Work RVU
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2020.06.043

Relative value units (RVUs) are the measure of value used in United States Medicare and Medicaid reimbursement. The Relative Update Committee (RUC) determines physician work RVU (wRVUs) based on operative time, technical skill and effort, mental effort and judgment, and stress. The primary aim of this study was to assess whether operative time is adequately accounted for in the wRVU system in pediatric urology. The American College of Surgeons National Surgical Quality Improvement Program Pediatric Participant User File (ACS-NSQIPP-PUF) was reviewed from 2012 to 2017. Most common single pediatric urology current procedural terminology (CPT) codes were included. The primary variable was wRVU per hour of operative time (wRVU/h). Linear regression analysis was used to assess the relative influence that operative time had on wRVU/h. 25,432 cases were included in the final study population from 45 unique CPT codes. The median operative time was 79 min, and the median RVU/h was 12.2. Procedures with operative time less than 79 min had higher wRVU/h compared with procedures longer than 79 min (14.5 vs 10.5, p