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Relative value units per Total Care Time hour in Complex Head and Neck Reconstruction: Assessment of Surgeon Valuation
Benjamin D. Smith, B.S., Khang T. Nguyen, M.D., Anthony Brawell, M.D., Denis Knobel, M.D., Nicholas Bastidas, M.D., Brian T. Andrews, M.D., James P. Bradley, M.D., Armen K. Kasabian, M.D., Neil Tanna, M.D., M.B.A..
North Shore - LIJ Health System, New York, NY, USA.

BACKGROUND:
Work relative value units (wRVUs) are supposed to account for the time and complexity of a medical procedure in order to appropriately reimburse a physician for services rendered.
METHODS:
The operative time, coding, and perioperative course for fifty consecutive patients undergoing complex head & neck reconstructive surgery was prospectively evaluated. Total care time (TCT) was determined by adding 15 minutes to the operative time for each post-operative hospital day and each post-operative follow-up appointment within the 90 day global period. Patients were then separated into groups based on reconstruction type: pedicled flap (PF), soft tissue free flap (STFF), or bone free flap (BFF). Authors calculated TCT hours per wRVU to determine the number of wRVUs a physician effectively "earned" per hour spent during the global period for each procedure.
RESULTS:
For the all patients, mean operative time was 10.6 hours and mean post-operative hospital days were 15.1. The mean wRVUs earned per TCT hour for PF, STFF, and BFF was 1.56, 2.57, and 3.07 respectively, p=0.00006 (ANOVA).
CONCLUSIONS:
If reimbursement were based solely on time spent, there would be little need for further analysis of physician reimbursement. However, fair compensation dictates that complexity also be considered. This analysis shows that, while holding time constant, wRVUs do rise as complexity rises in head and neck reconstruction (assuming BFF>STFF>PF). While this study demonstrates some qualitative success of the wRVU concept, further analysis is warranted in determining the quantitative degree to which certain procedures are more complex than others.


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