Perioperative work in shoulder arthroplasty is undervalued by Relative Value Scale Update Committee methodology: quantifying shoulder arthroplasty workload in a single surgeon's practice

Academic Article


  • Background: The Center for Medicare and Medicaid Services (CMS) quantifies the total work associated with procedures based on recommendations from the Relative Value Scale Update Committee (RUC). To determine the amount of work for a procedure, the RUC relies on data gathered via surveys from practicing physicians. Investigation of the accuracy of the RUC's estimates of physician work has shown that there are discrepancies between the RUC times used to calculate work and times determined objectively. The purpose of this study was to determine the accuracy of the RUC and CMS's current times and work relative value units (wRVUs) for the perioperative work involved regarding shoulder arthroplasty. Methods: The RUC was contacted to obtain a list of perioperative tasks for shoulder arthroplasty surgeries. The tasks that occurred outside of the operating room were timed as the event occurred, whereas times for tasks performed inside the operating room were determined from the electronic medical record. Each task's time was then multiplied by its respective CMS-assigned intensity coefficient to calculate the wRVU. Results: The tasks timed in this study were allotted 105 minutes by the RUC and a total wRVU of 2.1. Our study found that these same tasks took 119.5 minutes and had a total wRVU of 2.4. The overall time it takes to perform perioperative tasks in shoulder arthroplasty surgeries is underestimated by 14.5 minutes, resulting in an undervaluation of the wRVU by 0.3. Conclusion: The perioperative work associated with shoulder arthroplasty surgeries is underestimated by the RUC and CMS's. The RUC and CMS should consider using prospective, empiric times when calculating physician work as it is a more accurate measurement than the current method used. This discrepancy is expected to be amplified with increased preoperative templating and utilization of technological advancements in arthroplasty. Further study is needed on a broader national or international level to determine if this discrepancy exists systemically.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Hughes AG; Paul KD; Smith WR; Elphingstone JW; Brabston EW; Momaya AM; Ponce BA