Reimbursement for Complex Carpal Trauma
DOI:
https://doi.org/10.55576/job.v2i1.12Keywords:
complex carpal trauma, relative value units, wRVU, reimbursement, distal radius fractureAbstract
Objectives: To compare Relative Value Unit (RVU)-based reimbursement of operative fixation of complex carpal trauma versus primary operative fixation of distal radius fractures.
Design: Database review.
Setting: National Surgical Quality Improvement Program (ACS-NSQIP) database
Intervention: Surgical treatment of complex carpal trauma and distal radius fracture.
Main outcome measurement: Mean and median total work Relative Value Unit (wRVU), surgical time, wRVU/minute, reimbursement/minute, reimbursement/surgical case.
Results: The 139 patients who underwent fixation of complex carpal trauma and 222 patients who underwent fixation of distal radius fractures were included in this study. The mean wRVUs were 10.56 for the complex carpal trauma group and 12.46 for the distal radius fracture group. Complex carpal trauma cases were an average of 31 minutes longer than distal radius fracture cases. Mean wRVU/minute (0.19 vs 0.14) and median wRVU/minute (0.18 vs 0.11) were higher for distal radius fracture cases than for complex carpal trauma cases (percent difference: mean 34%, median 62%). Lastly, the mean ($378.85) and median reimbursement ($383.29) per surgical case for complex carpal trauma was lower than that of the mean ($447.19) and median reimbursement ($516.08) of distal radius fractures.
Conclusions: Despite longer operative times and increased procedural complexity, surgical treatment of complex carpal trauma is reimbursed significantly less than surgical treatment of distal radius fractures. The authors advocate a threefold plan. First, the ACS may consider developing more clear guidelines on the definition of a hand surgeon. Second, hand surgeons must insert themselves into hospital policy making, particularly with call and consult management discussions. Finally, considering the three components of the RVU calculation (physician work, physician expertise, and liability), the management of complex carpal trauma is under-recognized and reimbursed. As such, the authors recommend consideration of these injuries to be recompensed commiserate with arthroplasty and orthopaedic trauma.
Level of Evidence: IV; Economic Analysis
Keywords: Complex carpal trauma, relative value unit, wRVU, reimbursement, distal radius fracture
(J Ortho Business 2022; Volume 1, Issue 1:pages 19-23)
References
Dunn J, Koehler L, Kusnezov N, et al. Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military. J Wrist Surg. 2018;07(01):057-065. doi:10.1055/s-0037-1603932
Jupiter JB, Nunex Jr FA, Nunex Sr F, et al. Current Perspectives on Complex Wrist Fracture-Dislocations - PubMed. Instr Course Lect. 2018;67:155-174. https://pubmed.ncbi.nlm.nih.gov/31411409/. Accessed November 20, 2020.
Scarborough JE, Pietrobon R, Tuttle-Newhall JE, et al. Relationship between provider volume and outcomes for orthotopic liver transplantation. J Gastrointest Surg. 2008;12(9):1527-1533. doi:10.1007/s11605-008-0589-5
Weller WE, Hannan EL. Relationship Between Provider Volume and Postoperative Complications for Bariatric Procedures in New York State. J Am Coll Surg. 2006;202(5):753-761. doi:10.1016/j.jamcollsurg.2006.02.002
Cole T, Veeravagu A, Zhang M, et al. Surgeon procedure volume and complication rates in anterior cervical discectomy and fusions. Clin Spine Surg. 2017;30(5):E633-E639. doi:10.1097/BSD.0000000000000238
Koltsov JCB, Marx RG, Bachner E, et al. Risk-based hospital and surgeon-volume categories for total hip arthroplasty. J Bone Jt Surg - Am Vol. 2018;100(14):1203-1208. doi:10.2106/JBJS.17.00967
Malik AT, Panni UY, Masri BA, et al. The impact of surgeon volume and hospital volume on postoperative mortality and morbidity after hip fractures: A systematic review. Int J Surg. 2018;54(Pt B):316-327. doi:10.1016/j.ijsu.2017.10.072
Jacobs JP, Lahey SJ, Nichols FC, et al. How Is Physician Work Valued? Ann Thorac Surg. 2017;103(2):373-380. doi:10.1016/j.athoracsur.2016.11.059
Hsiao WC, Braun P, Dunn DL, et al. An overview of the development and refinement of the resource-based relative value scale: The foundation for reform of U.S. Physician payment. Med Care. 1992;30(11):NS1-NS12. doi:10.1097/00005650-199211001-00001
Laugesen MJ. The resource-based relative value scale and physician reimbursement policy. Chest. 2014;146(5):1413-1419. doi:10.1378/chest.13-2367
RBRVS overview | American Medical Association. https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrvs-overview. Accessed November 1, 2020.
Shah DR, Bold RJ, Yang AD, et al. Relative value units poorly correlate with measures of surgical effort and complexity. J Surg Res. 2014;190(2):465-470. doi:10.1016/j.jss.2014.05.052
Schwartz DA, Hui X, Velopulos CG, et al. Does relative value unitYbased compensation shortchange the acute care surgeon? In: Journal of Trauma and Acute Care Surgery. Vol 76. J Trauma Acute Care Surg; 2014:84-94. doi:10.1097/TA.0b013e3182ab1ae3
Frank C, Kondrashov D, Craig Meyer S, et al. Work intensity in sacroiliac joint fusion and lumbar microdiscectomy. Clin Outcomes Res. 2016;8:367-376. doi:10.2147/CEOR.S112006
Nayar SK, Aziz KT, Zimmerman RM, et al. Misvaluation of Hospital-Based Upper Extremity Surgery Across Payment, Relative Value Units, and Operative Time. Iowa Orthop J. 2020;40(1):173-183. doi:10.1097/01.gox.0000584772.32518.f6
Malik AT, Scharschmidt TJ, Li M, et al. Are Joint Surgeons Being Adequately Compensated for Single-Component versus Double-Component Revision TKA An Analysis of Relative Value Units. J Knee Surg. 2020;33(6):593-596. doi:10.1055/s-0039-1681094
Sodhi N, Piuzzi NS, Khlopas A, et al. Are We Appropriately Compensated by Relative Value Units for Primary vs Revision Total Hip Arthroplasty? J Arthroplasty. 2018;33(2):340-344. doi:10.1016/j.arth.2017.09.019
Peterson J, Sodhi N, Khlopas A, et al. A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty. J Arthroplasty. 2018;33(7):S39-S42. doi:10.1016/j.arth.2017.11.070
Sodhi N, Dalton SE, Garbarino LJ, et al. Not all primary total hip arthroplasties are equal—so is there a difference in reimbursement? Ann Transl Med. 2019;7(4):74-74. doi:10.21037/atm.2018.08.14
Malik AT, Quatman CE, Phieffer LS, et al. Are Orthopaedic Trauma Surgeons Being Adequately Compensated for Treating Nonunions of the Femoral Shaft?: An Analysis of Relative Value Units. JAAOS Glob Res Rev. 2020;4(10):e20.00163. doi:10.5435/jaaosglobal-d-20-00163
American College of Surgeons National Surgical Quality Improvement Program. User Guide for the 2018 ACS NSQIP Participant Use Data FIle.; 2019.
Buntin MB, Escarce J, Goldman D, et al. Payment for Physicians’ Services Under the Resource Based Relative Value Scale. 2003. https://www.ncbi.nlm.nih.gov/books/NBK43875/. Accessed March 10, 2021.
Hand Trauma Center Network. https://www.assh.org/s/hand-trauma-center-network. Accessed March 10, 2021.
Gittings DJ, Mendenhall SD, Levin LS. A Decade of Progress Toward Establishing Regional Hand Trauma Centers in the United States. Hand Clin. 2019;35(2):103-108. doi:10.1016/j.hcl.2018.12.001
American College of Surgeons. Resources for Optimal Care of the Injured Patient. https://www.facs.org/~/media/files/quality programs/trauma/vrc resources/1_chapter_23 new criteria reference guide v1.ashx11. Accessed November 19, 2020.
Mattila VM, Huttunen TT, Sillanpää P, et al. Significant change in the surgical treatment of distal radius fractures: A nationwide study between 1998 and 2008 in Finland. J Trauma - Inj Infect Crit Care. 2011;71(4):939-942. doi:10.1097/TA.0b013e3182231af9
Knirk J, Jupiter J. Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg. 1986;68(5):647-659.
Waljee JF, Zhong L, Shauver MJ, et al. The influence of surgeon age on distal radius fracture treatment in the United States: A population-based study. J Hand Surg Am. 2014;39(5):844-851. doi:10.1016/j.jhsa.2013.12.035
Childs S, Mann T, Dahl J, et al. Differences in the Treatment of Distal Radius Fractures by Hand Fellowship Trained Surgeons: A Study of ABOS Candidate Data. J Hand Surg Am. 2017;42(2):e91-e97. doi:10.1016/j.jhsa.2016.11.015
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