Evidence map›Paper›PMID 33747382›Full record

ArticleClinics in orthopedic surgery2021

Reassessment of Relative Value in Shoulder and Elbow Surgery: Do Payment and Relative Value Units Reflect Reality?

Suresh K Nayar, Richard L Skolasky, Dawn M LaPorte, Ryan M Zimmerman, Aviram M Giladi, Umasuthan Srikumaran

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinics in orthopedic surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Suresh K NayarDepartment of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Richard L SkolaskyDepartment of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Dawn M LaPorteDepartment of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Ryan M ZimmermanCurtis National Hand Center, Union Memorial, Baltimore, MD, USA.
Aviram M GiladiCurtis National Hand Center, Union Memorial, Baltimore, MD, USA.
Umasuthan SrikumaranDepartment of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroudMany U.S. health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. A major determinant of payment and wRVU assignments is operative time. We sought to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common shoulder/elbow procedures.

methodsWe collected data on wRVUs, payments, and operative times from CMS for 29 types of isolated arthroscopic and open shoulder/elbow procedures. Using regression analysis, we compared relationships between these variables, in addition to median operative times reported by NSQIP (2013-2016). We then determined the relative valuation of each procedure based on operative time.

resultsSeventy-nine percent of CMS operative time were longer than NSQIP time (

conclusionsCMS may overestimate operative times compared to actual operative times as recorded by NSQIP. Shorter operative times may render certain procedures more highly valued than others. Case examples show that this can potentially affect patient care and incentivize higher compensating procedures per operative time when less-involved, shorter operations have similar patient-reported outcomes.

Indexed as

Operative TimeAgedElbow JointHumansMedicareOrthopedic ProceduresShoulder JointUnited StatesOperative timePaymentRelative value unitShoulder arthroplastyShoulder arthroscopy

Identifiers

PMID33747382
PMCPMC7948050

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.