Background
Unbalanced work relative value unit (wRVU) payments can create value-based disparities, especially against female and racial/ethnic minority patients. We examined associations between wRVU and patient demographics for cleft/craniofacial procedural encounters.
Methods
The 2012-2021 National Surgical Quality Improvement Program Pediatric databases were queried for patient cases with primary CPT code pertaining to a cleft/craniofacial procedure. Primary CPT codes were categorized (Table 1). Total wRVU per patient encounter is calculated by adding the primary CPT wRVU and wRVUs of concurrent procedures under the same anesthetic. We determined the association between total wRVU and patient demographics by primary CPT code and by category using multivariable regression.
Results
A total of 107,906 patient cases across 69 primary CPT codes were included in the analysis. For 21 of the 69 CPT codes (representing 50.2% of all patient cases), females and/or racial/ethnic minorities were significantly associated with decreased total encounter wRVU relative to their male, white, or non-Hispanic counterparts (reference groups) (p<0.05). The five most prevalent CPT codes with wRVU disparity against female and/or racial/ethnic minority patients were: 42200, 61559, 14040, 11442, and 40720. When stratifying by procedure category, total wRVU disparities against female, Black, and Hispanic patients were found in Excision, Palatoplasty, and Reconstruction procedural encounters (all p<0.001) (Table 2).
Conclusion
A majority of pediatric cleft and craniofacial procedural encounters are associated with fewer wRVUs for female and URM patients compared to their male, white, and non-Hispanic counterparts. These differences should be further investigated to examine their possible role in exacerbating existing disparities in craniofacial care across gender and racial/ethnic lines.
Table 1. List of Primary CPT Codes for Pediatric Cleft and Craniofacial Procedures Utilized in Study by Category
Table 2. Multivariate Linear Regression Analysis of Total Work Relative Value Units (total wRVU) against Sex and Race/Ethnicity for Pediatric Cleft/Craniofacial Procedural Encounters
