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Health Care Economics, Insurance, Payment

Assessment of the Contribution of the Work Relative Value Unit Scale to Differences in Physician Compensation Across Medical and Surgical Specialties

Educational Objective To identify how work relative value units contribute to differences in physician compensation across specialties.

1 Credit CME

JAMA Surgery

Published Online: April 15, 2020

Original Investigation

Article Information and Disclosures

Christopher P. Childers, MD, PhD¹;

Melinda Maggard-Gibbons, MD, MSHS¹

Author Affiliations

¹David Geffen School of Medicine, Department of Surgery, University of California, Los Angeles, Los Angeles

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Key Points

Question How do work relative value unit (wRVU) compensation rates vary across medical and surgical specialties?

Findings In this cross-sectional study, most specialties had wRVU compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant.

Meaning Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.

Abstract

Importance The work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures have been blamed for pay differences across specialties, but to our knowledge, a comprehensive assessment is lacking.

Objective To assess how compensation rates built into work RVUs contribute to differences in physician compensation across specialties.

Design, Setting, and Participants This cross-sectional analysis examined 2017 Part B fee-for-service Medicare data. The data were analyzed from May 1 to May 30, 2019.

Main Outcomes and Measures A specialty-wide compensation rate (wRVUs/min) was generated for 42 medical and surgical specialties defined as the sum of wRVUs for all billed current procedural terminology codes divided by the presumed time to perform those services. This measure accounted for the volume and diversity of services each specialty provides. Sensitivity analyses were performed to assess the association of errors in wRVU time estimates with average compensation rates.

Results The final sample included 42 specialties and 6587 distinct Current Procedual Terminology (CPT) codes. The number of CPT codes attributed to a specialty ranged from 575 (medical oncology) to 4346 (general surgery). Compensation rates ranged from 0.029 wRVUs/min (pathology) to 0.057 wRVUs/min (emergency medicine). Most specialties (34/42 [81.0%]) had compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant. This narrow range reflects the fact that most specialties had more than 60% of time allocated to activities outside the intraservice period. Assuming that time values for surgical procedures are significantly overestimated increased the difference in average compensation between surgical and medical specialties to 23.4%.

Conclusions and Relevance Compensation rates assumed in wRVU valuations are small contributors to differences in physician compensation. Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.

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Article Information

Accepted for Publication: February 11, 2020.

Corresponding Author: Christopher P. Childers, MD, PhD, David Geffen School of Medicine, Department of Surgery, UCLA, 10833 Le Conte Ave, CHS 72-247, Los Angeles, CA 90095 (cchilders@mednet.ucla.edu).

Published Online: April 15, 2020. doi:10.1001/jamasurg.2020.0422

Author Contributions: Dr Childers had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Childers.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Childers.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Childers.

Obtained funding: Childers.

Supervision: Maggard-Gibbons.

Conflict of Interest Disclosures: None reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.