The time spent by a physician conducting a procedure is not accurately reflected by the physician work expressed in relative value units, according to a speaker at the American Orthopedic Foot and Ankle Society Annual Meeting.

“Physician substitution varies substantially by procedure,” Apurva S. Shah, MD, MBA, said during his presentation. “There are high variations in [relative value unit] rates, and this varies by orthopedic specialty.”

Investigators evaluated 41 different orthopedic surgical procedures at a single institution between 2009 and 2012 using relevant CPT codes, identifying a total of 5,737 procedures. Process maps were created for each procedure showing 90-day care pathways based on either medical record data or results from a blind survey of 37 clinical providers. The process maps allowed for evaluation of operative time, length of stay, and the amount of pre- and postoperative visits. Ratio of estimated time-to-work relative value units (RVU) and Pearson correlation coefficient were also calculated.

Although a moderate correlation between RVU and total time for all cases was observed, a stronger correlation was seen between RVU and time in foot/ankle procedures.

Increases in the complexity of the procedure were proportional to RVU increases. Pediatrics had the lowest subspecialty time-to-RVU ratio (25.6 minutes/RVU), whereas foot/ankle had the highest (47.1 minutes/RVU). Other specialties studied included hand, sports medicine, shoulder, arthroplasty, trauma, tumor and spine.

High- and low-volume cases also exhibited a correlation with time-to-RVU ratio (25.9 and 37.7 minutes/RVU, respectively) Of all the procedures evaluated, amputation below the knee had the highest such ratio at 64.5 minutes/RVU, whereas single-level anterior cervical discectomy and fusion had the lowest at 10.5 minutes/RVU.