Trends in reimbursement for primary and revision total elbow arthroplasty.

Journal Article (Journal Article)

BACKGROUND: Relative value units (RVUs) are an essential component of reimbursement calculations from the Centers for Medicare & Medicaid Services. RVUs 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 RVUs assigned for primary and revision total elbow arthroplasty (TEA). METHODS: The National Surgical Quality Improvement Program database was used to collect all primary and revision total elbow arthroplasties performed between January 2015 and December 2017. Variables collected included age at time of surgery, RVUs assigned for the procedure, and operative time. RESULTS: A total of 359 cases (282 primary TEA, 77 revision TEA) were included in this study. Mean RVUs for primary TEA was 21.4 (2.0 standard deviation [SD]) vs. 24.4 (1.7 SD) for revision arthroplasty (P < .001). Mean operative time for primary TEA was 137.9 minutes (24.4 SD) vs. 185.5 minutes (99.7 SD) for revision TEA (P < .001). The RVU per minute for primary TEA was 0.16 and revision TEA was 0.13 (P < .001). This amounts to a yearly reimbursement difference of $71,024 in favor of primary TEA over revision TEA. CONCLUSION: The current reimbursement model does not adequately account for increased operative time, technical demand, and pre- and postoperative care associated with revision elbow arthroplasty compared with primary TEA. This leads to a financial advantage on performing primary TEA.

Full Text

Duke Authors

Cited Authors

  • Sugarman, BS; Belay, ES; Saltzman, EB; Richard, MJ; Ruch, DS; Anakwenze, OA; Klifto, CS

Published Date

  • January 2021

Published In

Volume / Issue

  • 30 / 1

Start / End Page

  • 146 - 150

PubMed ID

  • 32610075

Electronic International Standard Serial Number (EISSN)

  • 1532-6500

Digital Object Identifier (DOI)

  • 10.1016/j.jse.2020.06.004

Language

  • eng

Conference Location

  • United States