Traditional Metrics Used To Measure The Value Of A Vascular Surgeon Do Not Adequately Capture The Value Of A Vascular Surgeon To A Health Care System
Francesco A. Aiello, M.D., M.B.A.1, Zachary Fang, M.D.1, Matthew Sideman, M.D.2, Edward Arous, M.D., M.P.H.1, Dejah Judelson, M.D.1, Robert Steppacher, M.D.1, Jessica Simons, M.D., M.P.H.1, Andres Schanzer, M.D.1.
1University of Massachusetts, Worcester, MA, USA, 2University of Texas at San Antonio, San Antonio, TX, USA.
OBJECTIVES: Reimbursements for professional services performed by clinicians are under constant scrutiny and Vascular Surgery is no exception. The value of a vascular surgeon's services as measured by work relative value units (wRVU) and professional reimbursement has decreased for many common procedures. Hospital reimbursements, however, often remain stable or increase. We sought to evaluate diagnostic fistulagrams as a case study and hypothesized that while wRVU and professional reimbursements decrease, hospital reimbursements increase.
METHODS: Medicare 5% claims data were reviewed to identify all diagnostic fistulagrams performed between 2015-2018 using current procedural terminology codes (CPT 36147 and 36901). Diagnostic fistulagrams were stratified by specialty and by site of service: physician office, hospital outpatient, and hospital inpatient. Reimbursements and wRVU were analyzed for both professional and hospital outpatient settings to determine the financial impact across all sites of service. Medicare’s physician fee schedule, by year of service, were used for wRVU and professional reimbursement. Medicare’s national ambulatory payment classification (APC) were used for hospital outpatient reimbursement.
RESULTS: We identified 259,161 diagnostic fistulagrams. Over the study period, vascular surgeons experienced a 28% increase in total volume and a 24% increase in market share for diagnostic fistulagrams. Concurrently, physician office-based reimbursements decreased by 28.5% ($855 to $611) while both vascular surgeon wRVU (3.72 to 3.36) and professional reimbursement ($195 to $176) decreased by 9.7%. During the same period, hospital outpatient reimbursement decreased by 26% ($827 to $612). However, in 2019, hospital outpatient reimbursement for diagnostic fistulagrams increased by 79% ($612 to $1,094) while vascular surgeon wRVU and professional reimbursement remained unchanged. Physician office-based reimbursements increased slightly by 7.9% ($611 to $660).
CONCLUSIONS: Vascular Surgeons contribution to a hospital may not be accurately reflected through traditional metrics. Vascular surgeons performed an increasing volume of diagnostic fistulagrams while experiencing marked reductions in wRVU and reimbursement. Hospitals, on the other hand, initially experienced a decline in reimbursement but then benefited from a marked increase in payment. This study demonstrates that wRVU and professional reimbursements, taken in isolation and without consideration of hospital reimbursement, undervalues the service and contribution provided by a vascular surgeon.
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