Relative Value Units Do Not Adequately Account for Operative Time in Urologic Surgery.

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Physician work relative value units (wRVU) are determined based on operative time, technical skill, mental effort, and stress. In theory, wRVU should account for the operative time involved in a procedure, resulting in similar wRVU per unit time for both short and long procedures. The primary aim of this study was to assess whether operative time is adequately accounted for by the current wRVU assignments.The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed from 2015-2017. The 50 most frequently coded Urology current procedural terminology (CPT) codes were included. The primary variable was wRVU per hour of operative time (wRVU/hr). Linear regression analysis was used to assess the associations between wRVU, operative time, and the wRVU/hr variable.105,931 cases were included. Among the included Urology CPTs, median wRVU was 15.26, median operative time was 48 minutes, and median wRVU/hr was 11.2. CPTs with operative time less than 90 minutes had higher wRVU/hr compared with longer procedures (12.2 vs 8.7, p < 0.001). Univariable analysis revealed that each additional hour of operative time was associated with a decrease in wRVU/hr by 1.32 (-0.022 per minute, 95% CI: -0.037 – -0.001, p<0.001), and that wRVU was not statistically associated with wRVU/hr (-0.093, 95% CI: -0.193 – 0.007, p=0.07).This analysis of large population national-level data suggests that the current wRVU assignments do not proportionally compensate for longer operative times.

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