Examining the Relationship Between Relative Value Units and Patient-reported Outcomes: Implications for Value-based Care.

Abstract

Compensation based on work relative value unit (wRVU) production is common among orthopaedic surgeons. With increased adoption of value-based payments, a greater portion of surgeon compensation will be linked to quality and outcome measures-including patient-reported outcomes. Therefore, we aimed to evaluate the relationship between wRVUs and changes in Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) scores to assess whether wRVUs could serve as a marker of patient-reported functional improvements. A retrospective review of 2,996 orthopaedic surgeries at a single institution was done. Patient characteristics, total wRVUs billed by the surgeon for the case, operating room (OR) time, and change in PROMIS-PF scores from baseline to 6 months postoperatively were compared across subspecialties. Pearson correlation and multivariable linear regression were used to assess the relationship between wRVUs, OR time, and PROMIS-PF change. Statistically significant differences in average wRVUs, OR times, and PROMIS-PF scores were observed across subspecialties. A strong positive correlation between wRVUs and OR time existed ( r = 0.732, P < 0.001) that explained approximately 54% of OR-time variability. A weak positive correlation between wRVUs and change in PROMIS-PF scores was observed ( r = 0.058, P = 0.002) that explained <1% of the variation. Each 1-point increase in wRVU was associated with a 3-minute increase in surgical duration (β = 3.04, P < 0.001) after controlling for demographics, comorbidities, and subspecialty, accounting for approximately 63% of OR-time variation. Each 1-point increase in wRVU was independently associated with a 0.02-point increase in PROMIS-PF change (β = 0.02, P = 0.036), explaining approximately 7% of the variation. Across orthopaedic subspecialties, notable variability in both wRVUs and physical function improvements at 6 months postoperatively exists. Although highly correlated with surgical time, wRVUs show little association with functional improvement across subspecialties. As the transition toward value-based payment models continues, measurement of and compensation for work complexity and functional outcomes must remain separate and distinct.