Correlation of Relative Value Units with Surgical Complexity and Physician Workload in Pediatric Urology
Case Wood, MD, Allison Deal, MS, Raj Pruthi, MD, Zoe Gan, MD, Solomon Hayon, MD, Angela Smith, MD, Hung-Jui Tan, MD, Sherry Ross, MD.
University of North Carolina, Chapel Hill, NC, USA.
BACKGROUND: Relative value units (RVUs) are assigned to all patient-physician interactions and are more increasing used as a metric of physician productivity. The correlation between procedure RVUs and objective measures of surgical complexity and physician workload remains poorly understood. This study seeks to better define the correlation of RVUs with surgical complexity and physician workload, as measured by variables such as operative time, length of hospital stay (LOS), morbidity, and readmission rates.
METHODS: We examined the 2017 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database and identified 45 current procedural terminology (CPT) codes in pediatric urology with a frequency of > 100. We then analyzed 35,941 pediatric urologic procedures using linear regression to correlate RVUs with measures of surgical complexity and overall physician workload such as operative time, LOS, morbidity, and readmissions.
RESULTS: On average, total RVUs poorly correlated with readmissions (R2 = 0.13) and morbidity (R2 = 0.13), with a higher number of low RVU CPTs requiring readmission and in many cases, low RVU CPTs having a higher morbidity. There was a moderate correlation between RVUs and LOS (R2 = 0.60). RVUs were significant predictors of operative time (R2 = 0.89).
CONCLUSIONS: In the field of pediatric urology, operative time appears to correlate with RVUs. However, other measures for surgical complexity and overall physician workload do not correlate appropriately. Efforts to improve RVU metrics for individual CPT codes used in pediatric urology should be based on correlative data with the overall goal that RVU assignments reflect case and patient complexity. 
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