The goal of the study was to illustrate the influence of differences between operational times in the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Project) and self-reported operative time from the American Medical Association’s Relative Value Scale Update Committee (RUC) on RVU calculation. The ACS NSQIP 2016 Participant User File and the Centers for Medicare & Medicaid Services physician procedure time file for 2018 were used in this cross-sectional evaluation of registry data. Adjusted for patient comorbidities, age, duration of stay, and ACS NSQIP mortality and morbidity probability, a multivariate regression analysis was performed. The surgeon’s self-reported surgical times from the Centers for Medicare & Medicaid Services were compared to operative times recorded in the ACS NSQIP, with extra time from RUC estimations referred to as “overreported time.” The median RVU per hour varied greatly amongst specialties, according to an analysis of 901,917 operations. The highest RVU per hour was in orthopedics, neurosurgery, and general surgery, while the lowest was in gynecology, plastic surgery, and otolaryngology. Multivariate regression analysis yielded the same results. The most overreported operational time was in general surgery, followed by neurosurgery and urology. Overreporting of operating time was substantially associated with increased RVU per hour.
Despite the availability of trustworthy electronic records, the AMA-RUC continues to rely on erroneous self-reported RUC surveys to determine operative timeframes. As a result, there are differences in RVU per hour among specialties, as well as a continuing imbalance for women-specific operations in gynecology.
