Abstract PO5-10-10: Disparities in Work RVUs for Breast and Prostate Cancer Operations

Abstract

Abstract Introduction: In a vast array of different methods used to quantify healthcare processes, the Relative Value Unit (RVUs) has become the federal precedent set by the Centers for Medicare and Medicaid Services (CMS) to assign value to different procedures and processes. The current RVU conversion factor in 2023 is $33.06 per unit. Physician work RVUs, malpractice RVUs (MP RVUs) and practice expense RVUs (PE RVUs) were first implemented in 1992 as a system for assigning payment to physicians while providing administrative budgeting based on clinical and liability expenditures. These values are subject to reevaluation every 5 years at minimum, or as new services become available. The CMS updates it’s RVU model by consulting the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC), which controversially sets higher values in certain fields of medicine than others. This article will objectively analyze the RVUs provided by the CMS to surgical oncologists treating breast cancer and compare them to the RVUs compensated to urologists treating prostate cancer, across multiple modalities. Methods: Work RVUs, practice expense RVUs, and malpractice RVUs were obtained from the CMS 2023 physician fee schedule, using the HCPCS codes to identify the services from their database. Estimated pre-evaluation times, intra-procedure times, immediate post service times, and total procedural times were gathered from the CY 2023 Final Rule Physician Work Time database provided by CMS. The HCPCS codes used for mastectomy variations were 19301 for partial mastectomy, 19302 for partial mastectomy with lymph node removal, 19303 for a simple complete mastectomy, 19305 for a radical mastectomy, 19306 for an urban type radical mastectomy, and 19307 for a modified radical mastectomy. The HCPCS codes used for armpit lymph nodes were 38740 and 38745 for axillary lymph node dissections. The HCPCS codes used for prostatectomy variations were 55810 and 55812 for a radical perineal prostatectomy, 55840 and 55845 for a radical retropubic prostatectomy, and 55866 for a laparoscopic retropubic radical prostatectomy. The HCPCS codes used for pelvic lymph nodes were 38571-38573 for laparoscopic lymphadenectomies. Work RVUs were compared between mastectomy and prostatectomy procedures, and axillary node procedures were compared to those of pelvic lymph nodes. To further asses any true disparities in the values assigned to the operations, a second analysis of work RVUs divided by total operation times were compared between their surgical counterparts. Conclusion: Values collected from CMS indicate 59% more RVUs are provided to urologists for prostatectomies than breast surgeons for mastectomies per procedure, and 12% more per hour of total procedure time. Additionally, the CMS indicates on average 29% more work RVUs are provided to urologists for pelvic lymph node removals than breast surgeons for axillary lymph node removals, and 3.4% more per hour of total procedure time (appendix 1). Breast cancer and prostate cancer have similar incidence and mortality rates, but one affects mostly women and the other only men. The decision by the Center of Medicare and Medicaid Services to place a higher value in prostate cancer management is unknown, and elicits future analysis with surveyed procedural data across the nation for statistical significance determination. Appendix 1 allocated work RVUs, practice expense RVUs, malpractice RVUs, and median operative times for prostate cancer and breast cancer operations. Citation Format: Noah Khosrowzadeh, Kyle Chambers, Matthew Gompels, Cyrus Washington, Jessica Meshman. Disparities in Work RVUs for Breast and Prostate Cancer Operations [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-10-10.