791–5 Physician Profiles of Coronary Revascularization in the Emory Angioplasty vs Surgery Trial: Understanding Physician Differences Using Resource-based Relative Values

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Understanding the reasons for variations in physician resource utilization in coronary angioplasty (PTCA) and coronary surgery (CABG) is essential to efficiently organizing, managing, and paying for these procedures. To evaluate the extent of variations in physician resource utilization for CABGs and PTCAs and the reasons for these variations, the resource-based relative value scale (RBRVS), an index of relative weights for physician work and practice costs, is used to evaluate physician practice patterns. Given their extensive clinical review, RBRVS weights represent new, unique, comprehensive measures of physician resource utilization where 1 unit value is equivalent to an intermediate office visit for an established patient. Our investigation uses 3 years of clinical and financial data on 392 randomized patients with multivessel coronary artery disease (EAST data). receiving the initial therapy of either CABG or PTCA. RBRVS weights are assigned to each procedure code (CPT) and the distribution of RBRVS units and their allocation among different types of services are analyzed. Results show significant differences in physician resources for both CABGs and PTCAs. Among CABG patients, nearly a ninefold variation in physician resource units is evident (108 ± 46) and, for PTCA, a 29-fold variation exists (66 ± 54). At three years, the average physician resource utilization for CABG is 64% greater than PTCA. Significant differences are also evident in surgical, laboratory, imaging, and consult resources even after accounting for casemix. The findings demonstrate that the RBRVS is a viable and useful analytical tool for managerial and clinical personnel.