MP47-05 PHYSICIAN AND HOSPITAL MISALIGNMENT IN THE ERA OF WRVU: CAN THIS MODEL HURT THE CORE OF ACADEMIC MEDICINE?

Abstract

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-05 PHYSICIAN AND HOSPITAL MISALIGNMENT IN THE ERA OF WRVU: CAN THIS MODEL HURT THE CORE OF ACADEMIC MEDICINE? Patrick Curtin, Philip Latham, Hailey Silverii, and Shumyle Alam Patrick CurtinPatrick Curtin More articles by this author , Philip LathamPhilip Latham More articles by this author , Hailey SilveriiHailey Silverii More articles by this author , and Shumyle AlamShumyle Alam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The work relative value unit or wRVU is an often controversial measurement of productivity used in many academic medical centers (AMC). The interests at AMCs including care of complex patients, resident education, and effective hospital utilization are not necessarily aligned with physician compensation. To test this hypothesis, we sought to determine the difference in wRVUs per minute of operative time before and after the development of our center for complex urologic reconstruction. METHODS: A retrospective review was performed for patients undergoing reconstructive urologic procedures using CPT codes. A second population of patients undergoing urologic procedures prior to the creation of our reconstructive urology center were identified for comparison. Hospital length of stay, operative time, and wRVUs generated were determined for both populations. RESULTS: 44 patients were identified who underwent reconstructive urologic procedures. For comparison, 29 operative days were identified during which a total of 50 patients had undergone a variety of general urologic surgeries during the same time frame in the prior year. An average of 84 wRVUs were per case for reconstructive surgery versus 34 wRVU per case for the general urology population (p<0.0001). The wRVU generated per minute of operative time was 0.176 vs 0.241 respectively (p=0.014). Average hospital length of stay was 11.6 days versus 2.4 days (p<0.0001). CONCLUSIONS: Complex cases exemplify the spirit of the AMC in many ways. Firstly, these surgeries serve at risk populations whose needs can not be addressed in the community hospital setting. Second, the operative and post operative periods allow for training of residents and staff. Lastly, they lead to increased utilization of hospital services helping to make the pediatric multidisciplinary team more financially viable. As demonstrated in the above analysis, non-reconstructive cases are more productive from a financial perspective for the physician, yet this stands contrary to the best interests of the hospital and AMC. The wRVU system, therefore, may create a disincentive for pediatric urologists performing complex reconstructive surgeries. Fewer complex cases performed a year may diminish quality outcomes. Additionally, decreasing exposure of trainees to this patient population negatively impacts education, leaving future generations less well prepared to treat complex disease processes. Source of Funding: Not applicable © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e824-e824 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Curtin More articles by this author Philip Latham More articles by this author Hailey Silverii More articles by this author Shumyle Alam More articles by this author Expand All Advertisement Loading ...