Relative value units and reimbursement for primary and revision total shoulder arthroplasty

Published on Jul 1, 2021in Seminars in Arthroplasty
· DOI :10.1053/J.SART.2020.11.016
Edward G. McFarland1
Estimated H-index: 1
(Johns Hopkins University)
Sources
Abstract
Abstract Background Relative value units (RVU), based on physician work and case expenses, are reimbursement and payment rates set by the Center for Medicare and Medicaid Services. Total shoulder arthroplasty (TSA) is performed less frequently than total hip and knee arthroplasty and may take longer to perform yet has a similar RVU assignment. The purpose of this study is to determine differences in RVU/minute and dollars/minute for primary and revision TSA and to compare the RVUs/minute and dollars/minute of shoulder arthroplasty to published reports of hip and knee arthroplasty. Methods In this retrospective cohort study, data were collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2006 to 2018. Current procedural terminology (CPT) code 23472 was used to identify all primary TSA cases (N = 16,719), and CPT codes 23473 and 23474 were used for revision TSA cases (N = 948). Work RVU, operation time, and RVU per minute were compared between the primary and revision shoulder cohorts. The conversion factor for RVU to dollar was provided by the U.S. Centers for Medicare and Medicaid Services, and dollars per minute calculations were performed for the 2 cohorts. Multiple regression analysis was performed to control for age, gender, race, BMI, and American Society of Anesthesiologists classification. Univariate and multivariate analyses with a significance set at P Results The mean operation times for primary and revision TSA were 109.42 minutes and 122.39 minutes, respectively (P Conclusion The RVU per minute and reimbursement in dollars per minute of operative time are higher for revision TSA than for primary TSA. Compared with published reports on total hip and knee arthroplasty, primary TSA has lower RVU/minute assignment and lower dollars/minute reimbursement. Level of evidence Level III
References22
Newest
#1Matthew J. Best (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 19
#2Keith T. Aziz (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 6
Last. Uma Srikumaran (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 14
view all 5 authors...
Abstract Background The purpose of this study was to determine the incidence of primary reverse and anatomic total shoulder arthroplasty in the United States and to examine changes in age and gender-based procedure rates. A secondary goal was to determine the incidence of hemiarthroplasty. Methods Using nationally representative data along with United States Census data, we identified over 508 thousand cases of primary reverse and anatomic total shoulder arthroplasty and shoulder hemiarthroplast...
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#1Cesar D. Lopez (Columbia University)H-Index: 3
#2Venkat Boddapati (Columbia University)H-Index: 14
Last. Charles M. JobinH-Index: 12
view all 6 authors...
BACKGROUND Recent efforts to contain health care costs and move toward value-based health care have intensified, with a continued focus on Medicare expenditures, especially for high-volume procedures. As total shoulder arthroplasty (TSA) volume continues to increase, especially within the Medicare population, it is important for orthopedic surgeons to understand recent trends in the allocation of health care expenditures and potential effects on reimbursements. The purpose of this study was to e...
Source
#1Barrie Sugarman (Duke University)H-Index: 2
#2Elshaday S. Belay (Duke University)H-Index: 4
Last. Christopher S. Klifto (Duke University)H-Index: 8
view all 7 authors...
Abstract Background Relative Value Units (RVU) are an essential component of reimbursement calculations from the Center for Medicare and Medicaid Services (CMS). RVU are calculated based on physician work, practice expense, and professional liability insurance. Procedures that are more complex, such as revision arthroplasty, require greater levels of physician work and should therefore be assigned a greater RVU. The purpose of this study is to compare RVU assigned for primary and revision total ...
Source
#1Matthew J. Best (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 19
#2Edward G. McFarland (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 22
Last. Uma Srikumaran (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 14
view all 4 authors...
Abstract Background In order to help control the COVID-19 pandemic, elective procedures have been cancelled in most US hospitals by government order. The purpose of this study is to estimate national hospital reimbursement and net income losses due to elective surgical procedure cancellation during the COVID-19 pandemic. Methods The National Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) were used to identify all elective surgical procedures performed in the inpatient...
Source
#1Cesar D. Lopez (Columbia University)H-Index: 3
#2Venkat Boddapati (Columbia University)H-Index: 14
Last. Jeffrey A. Geller (Columbia University)H-Index: 25
view all 6 authors...
Abstract Background Over 1 million total joint arthroplasties (TJAs) are performed every year in the United States, creating Medicare cost concerns for policy makers. The purpose of this study is to evaluate recent trends in Medicare utilization and reimbursements to hospitals/surgeons for TJAs between 2012 and 2017. Methods We tracked annual Medicare claims and payments to TJA surgeons using publicly available Medicare databases and aggregated data at the county level. Descriptive statistics an...
Source
#1Matthew J. Best (Johns Hopkins University)H-Index: 19
#2Keith T. Aziz (Johns Hopkins University)H-Index: 6
Last. Uma Srikumaran (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 14
view all 5 authors...
PURPOSE In order to reduce viral spread, elective surgery was cancelled in most US hospitals for an extended period during the COVID-19 pandemic. The purpose of this study was to estimate national hospital reimbursement and net income losses due to elective orthopaedic surgery cancellation during the COVID-19 pandemic. METHODS The National Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) were used to identify all elective orthopaedic and musculoskeletal (MSK) surgery pe...
Source
#1Aaron J. Casp (University of Virginia Health System)H-Index: 6
#2J. Michael Smith (University of Virginia Health System)H-Index: 2
Last. Brian C. Werner (University of Virginia Health System)H-Index: 39
view all 4 authors...
Background The relationship between surgeon and hospital charges and payments for total shoulder arthroplasty (TSA) has not been well examined. The goal of this study was to report trends and variation in hospital charges and payments compared with surgeon charges and payments for TSA. Methods The 5% Medicare sample was used to capture hospital and surgeon charges and payments for TSA from 2005 to 2014. Two values were calculated: (1) the charge multiplier (CM), which is the ratio of hospital to...
Source
#1Alex Gu (GW: George Washington University)H-Index: 14
#2Michael-Alexander Malahias (HSS: Hospital for Special Surgery)H-Index: 14
Last. Peter K. Sculco (HSS: Hospital for Special Surgery)H-Index: 29
view all 15 authors...
AIMS: The aim of this study was to determine the impact of the severity of anaemia on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database. All patients who underwent primary TKA or THA between January 2012 and December 2017 were identified and stratified based upon hematocrit level. In this analysis,...
Source
#1Suresh K. NayarH-Index: 10
#2Samir Sabharwal (Johns Hopkins University)H-Index: 3
Last. Dawn M. LaPorte (Johns Hopkins University)H-Index: 16
view all 6 authors...
Background: There is a high demand for shoulder/elbow experience among hand-fellowship trainees due to the perception that this exposure will improve their professional “marketability” in a subspecialty they perceive as having higher compensation. Methods: Using Medicare data, we investigated the most common surgeries from these fields and determined which have the highest compensation [work relative value unit (wRVU), payment, charge, and reimbursement (payment-to-charge percentage] rates per o...
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#1Nicole D. Quinlan (UVA: University of Virginia)H-Index: 4
#2Dennis Q. Chen (UVA: University of Virginia)H-Index: 5
Last. Brian C. Werner (UVA: University of Virginia)H-Index: 39
view all 4 authors...
Abstract Background Despite increasing demands on physicians and hospitals to increase value and reduce unnecessary costs, reimbursement for healthcare services has been under downward pressure for several years. This study aimed to analyze the trend in hospital charges and payments relative to corresponding surgeon charges and payments in a Medicare population for total hip (THA) and knee arthroplasty (TKA). Methods The 5% Medicare sample database was used to capture hospital and surgeon charge...
Source
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