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Disparities Between Operative Time and Relative Value Units for Plastic Surgery Procedures
Jared Blau, BS, MEd, Brett T. Phillips, MD, MBA, Scott T. Hollenbeck, MD FACS.
Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.

Purpose
Plastic surgeons are evaluated not only by the number of patients served but also by relative value, quantified by the Medicare Relative Value Unit (RVU) system, which can affect advancement and compensation. Procedures that demand a longer operative time without an increase in RVUs are, by definition, inefficient. The purpose of this study is to determine if the number of RVUs actually corresponds to operative time.
Methods
NSQIP datasets from 2005-2013 were queried for plastic surgery operations and the Time to RVU Ratio (TRR) was calculated for each operation. The primary CPT codes representing the 100 most common surgeries were compared for operative time, total RVUs, and TRR.
Results
Inclusion criteria yielded 53,696 patients. There was a high degree of correlation between operative time and number of RVUs (r2=0.82, Figure 1). Excisions of sacral pressure ulcers had the lowest TRR, indicating the highest level of surgical efficiency. Infected skin debridement had the highest TRR, indicating the lowest efficiency. The average TRR was 8.54 minutes per RVU. A selected list of procedures is included in Table 1.
Conclusions
As a general trend, the most common plastic surgical procedures requiring longer operative times are associated with more RVUs. The cases with lower TRRs tended to have higher operative times and RVUs, implying that surgeons selecting more involved cases were rewarded with an increase in relative value.


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