Advertisement

Reoperative Cervical Endocrine Surgery: Appropriate Valuation for the Time and Effort?

Published:February 27, 2021DOI:https://doi.org/10.1016/j.jss.2021.01.034

      Abstract

      Background

      Controversies currently exist regarding the best way to appropriately quantify complexity and to benchmark reimbursement for surgeons. This study aims to analyze surgeon reimbursement in primary and redo-thyroidectomy and parathyroidectomy using operative time as a surrogate for complexity.

      Methods

      A retrospective analysis using the National Surgical Quality Improvement Program database was performed to identify patients who underwent primary and redo-thyroidectomy and parathyroidectomy. Calculations of median operative time work relative value units per minute and dollars per minute were compared between primary and redo procedures.

      Results

      Thyroidectomy cases represented 53.5% (22,521 cases), and the other 46.5% (19,596 cases) were parathyroidectomy cases. The median dollars per minute in primary thyroidectomy was $4.97 and for redo-thyroidectomy was $8.12 (P < 0.0001). By the same token, dollars per minute were higher in the redo cases with $15.40 when compared with primary parathyroidectomy cases with $13.14 dollars per minute (P < 0.0001).

      Conclusions

      By Current Procedural Terminology codes, surgeons appear to be appropriately reimbursed for redo-thyroid and parathyroid procedures indexed to first time parathyroidectomy based on the compensated operative time of these procedures calculated using a nationally representative sample.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Maxwell S.
        • Zuckerman S.
        Impact of resource-based practice expenses on the medicare physician volume.
        Health Care Financ Rev. 2007; 29: 65-79
        • Childers C.P.
        • Dworsky J.Q.
        • Russell M.M.
        • Maggard-Gibbons M.
        Association of work measures and specialty with assigned work relative value units among surgeons.
        JAMA Surg. 2019; 154: 915-921
        • Orr R.D.
        • Sodhi N.
        • Dalton S.E.
        • et al.
        What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments.
        Spine J. 2018; 18: 1727-1732
        • Chan D.C.
        • Huynh J.
        • Studdert D.M.
        Accuracy of valuations of surgical procedures in the medicare fee schedule.
        N Engl J Med. 2019; 380: 1546-1554
        • Sodhi N.
        • Piuzzi N.S.
        • Khlopas A.
        • et al.
        Are we appropriately compensated by relative value units for primary vs revision total hip arthroplasty?.
        J Arthroplasty. 2018; 33: 340-344
        • Samuel L.T.
        • Grits D.
        • Acuña A.J.
        • Piuzzi N.S.
        • Higuera-Rueda C.A.
        • Kamath A.F.
        Work relative value units do not adequately support the burden of infection management in revision knee arthroplasty.
        J Bone Joint Surg Am. 2020; 102: 230-236
        • Martin J.D.
        • Warble P.B.
        • Hupp J.A.
        • et al.
        A real world analysis of payment per unit time in a Maryland Vascular Practice.
        J Vasc Surg. 2010; 52: 1094-1098
        • Proczko M.
        • Stefaniak T.
        • Sworczak K.
        • et al.
        Completion thyroidectomy of well-differentiated thyroid cancer - a prospective, miserandomised study.
        Endokrynol Pol. 2013; 64: 335-339
        • Khan M.
        • Ali Syed A.
        • Khan A.I.
        • Raza Hussain S.
        • Zafar W.
        Morbidity comparison of Primary and Completion Total thyroidectomy for differentiated thyroid cancer in relation to the extent of Redo surgery.
        Int J Surg Open. 2015; 1: 14-17
        • American College of Surgeons
        American College of surgeons-national surgical quality improvement Program.
        (Available at:)
        • Fuchshuber P.R.
        • Greif W.
        • Tidwell C.R.
        • et al.
        The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.
        Perm J. 2012; 16: 39-45
        • Lee P.
        • Chin K.
        • Liew D.
        • et al.
        Economic evaluation of clinical quality registries: a systematic review.
        BMJ Open. 2019; 9: 1-10
        • Thanh N.X.
        • Baron T.
        • Litvinchuk S.
        An economic evaluation of the national surgical quality improvement Program (NSQIP) in alberta, Canada.
        Ann Surg. 2019; 269: 866-872
        • Seidenwurm D.J.
        • Burleson J.H.
        The medicare conversion factor.
        Am J Neuroradiol. 2014; 35: 242-243
        • Chakedis J.M.
        • Maser C.
        • Brumund K.T.
        • Bouvet M.
        Indocyanine green fluorescence-guided redo parathyroidectomy.
        BMJ Case Rep. 2015; 2015: 1-3
        • Abboud B.
        • Sleilaty G.
        • Eid T.
        Morbidity of redo surgery for thyroid disease.
        Acta Chir Belg. 2014; 114: 381-387
        • Doval A.F.
        • Nguyen-Lee J.J.
        • Beal L.L.
        • Zheng F.
        • Echo A.
        Does complexity relate to compensation? A comparison of relative value units in initial versus recurrent inguinal hernia repair.
        Hernia. 2019; 24: 245-250
        • Little D.C.
        • Peter SD St.
        • Calkins C.M.
        • et al.
        Relative value units correlate with pediatric surgeons’ operating time: when perceived myth becomes reality.
        J Pediatr Surg. 2006; 41: 234-238
        • Chan D.C.
        • Huynh J.
        • Studdert D.M.
        Accuracy of valuations of surgical procedures in the medicare fee schedule.
        N Engl J Med. 2019; 380: 1546-1554
        • Chakiryan N.H.
        • Jiang D.D.
        • Gillis K.A.
        • Chen Y.
        • Martinez Acevedo A.
        • Sajadi K.P.
        Relative value units do not adequately account for operative time in urologic surgery.
        J Urol. 2019; 203: 1003-1007
        • Shah D.R.
        • Bold R.J.
        • Yang A.D.
        • Khatri V.P.
        • Martinez S.R.
        • Canter R.J.
        Relative value units poorly correlate with measures of surgical effort and complexity.
        J Surg Res. 2014; 190: 465-470