Are primary and revision shoulder arthroplasty appropriately reimbursed based on relative value units?

Abstract

BackgroundThe number of primary and revision shoulder arthroplasties performed each year continues to increase. Relative value units (RVUs) are currently used by the Centers for Medicare and Medicaid Services (CMS) to determine physician reimbursement based on time, effort, and complexity of services rendered. Compared to primary shoulder arthroplasty, revision shoulder arthroplasties are often more technically challenging, have longer operative times, and pose a greater risk of intraoperative and postoperative complications. This study aims to compare surgeon reimbursement between primary and revision shoulder arthroplasty. MethodsUtilizing a single institution shoulder arthroplasty database, we identified patients who underwent primary or revision shoulder arthroplasty between February 2011 and December 2013 by a single shoulder and elbow fellowship trained surgeon with over 20 years of experience at the time of data collection. The RVUs for primary and revision shoulder arthroplasty were obtained from the CMS Physician Fee schedule. Physician reimbursement for primary and revision shoulder arthroplasty was calculated using the CMS RVU to dollar conversion factor of $34.8921 per RVU. The RVU was divided by operative time to calculate an RVU/min for primary and revision shoulder arthroplasty. Monetary reimbursement per minute, case, day, and year was subsequently calculated. ResultsA total of 190 primary and 100 revision shoulder arthroplasties were performed during the study period. Mean RVU for primary shoulder arthroplasty was 22.13 ± 0.00 vs. 26.24 ± 1.10 for revision shoulder arthroplasty (P < .001). Mean operative time for primary shoulder arthroplasty was 111.17 ± 29.26 minutes vs. 145.12 ± 38.56 minutes for revision shoulder arthroplasty (P <.001). The RVU per minute for primary shoulder arthroplasty was 0.21 ± 0.05 and revision shoulder arthroplasty was 0.19 ± 0.04 (P < .001). The reimbursement for primary shoulder arthroplasty was $7.39/min ($772.16/case) and revision shoulder arthroplasty was $6.69/min ($915.92/case). With an estimated surgeon volume of 6 primary shoulder arthroplasties or 4 revision shoulder arthroplasties per day, reimbursement favors primary shoulder arthroplasty by a difference of $969.29 per day or $155,086.15 per year. ConclusionWhile the RVU/case is higher for revision shoulder arthroplasty, the difference does not account for the additional operative time and complexity compared to primary shoulder arthroplasty. In light of this data, the current RVU reimbursement model should be reevaluated to account for these differences between primary and revision shoulder arthroplasty. Level of EvidenceLevel III; Retrospective Comparative Study