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Article ; Online: When 1 Plus 1 Equals 3-The Art, Not Science, of RVU Valuations.

Childers, Christopher P / Maggard-Gibbons, Melinda

2022 Volume 157, Issue 5, Page(s) e220107

MeSH term(s)	Current Procedural Terminology ; Humans ; Relative Value Scales
Language	English
Publishing date	2022-05-11
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.0107
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Article ; Online: Replication Studies for Database Research.

Childers, Christopher P / Maggard-Gibbons, Melinda

JAMA surgery

2021 Volume 156, Issue 12, Page(s) 1081–1082

MeSH term(s)	Databases, Factual ; Humans
Language	English
Publishing date	2021-08-27
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2021.4132
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Article ; Online: A Systematic Review of Filtering Facepiece Respirator Reprocessing-Reply.

Schumm, Max A / Maggard-Gibbons, Melinda

JAMA

2021 Volume 326, Issue 7, Page(s) 677

MeSH term(s)	Respiratory Protective Devices ; Ventilators, Mechanical
Language	English
Publishing date	2021-08-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2021.8941
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Article ; Online: Refining Assumptions About Specialty Compensation Rates-Reply.

Childers, Christopher P / Maggard-Gibbons, Melinda

JAMA surgery

2020 Volume 155, Issue 11, Page(s) 1085–1086

MeSH term(s)	Compensation and Redress ; Humans ; Medicine ; Physicians ; Specialties, Surgical
Language	English
Publishing date	2020-11-18
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2020.3028
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Article ; Online: Assessment of the Contribution of the Work Relative Value Unit Scale to Differences in Physician Compensation Across Medical and Surgical Specialties.

Childers, Christopher P / Maggard-Gibbons, Melinda

JAMA surgery

2020 Volume 155, Issue 6, Page(s) 493–501

Abstract: Importance: The work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures ...

Abstract	Importance: The work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures have been blamed for pay differences across specialties, but to our knowledge, a comprehensive assessment is lacking. Objective: To assess how compensation rates built into work RVUs contribute to differences in physician compensation across specialties. Design, setting, and participants: This cross-sectional analysis examined 2017 Part B fee-for-service Medicare data. The data were analyzed from May 1 to May 30, 2019. Main outcomes and measures: A specialty-wide compensation rate (wRVUs/min) was generated for 42 medical and surgical specialties defined as the sum of wRVUs for all billed current procedural terminology codes divided by the presumed time to perform those services. This measure accounted for the volume and diversity of services each specialty provides. Sensitivity analyses were performed to assess the association of errors in wRVU time estimates with average compensation rates. Results: The final sample included 42 specialties and 6587 distinct Current Procedual Terminology (CPT) codes. The number of CPT codes attributed to a specialty ranged from 575 (medical oncology) to 4346 (general surgery). Compensation rates ranged from 0.029 wRVUs/min (pathology) to 0.057 wRVUs/min (emergency medicine). Most specialties (34/42 [81.0%]) had compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant. This narrow range reflects the fact that most specialties had more than 60% of time allocated to activities outside the intraservice period. Assuming that time values for surgical procedures are significantly overestimated increased the difference in average compensation between surgical and medical specialties to 23.4%. Conclusions and relevance: Compensation rates assumed in wRVU valuations are small contributors to differences in physician compensation. Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.
MeSH term(s)	Cross-Sectional Studies ; Economics, Medical ; Fee-for-Service Plans ; Income ; Medicare ; Relative Value Scales ; Specialties, Surgical/economics ; United States
Language	English
Publishing date	2020-04-29
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2020.0422
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Article ; Online: Same Data, Opposite Results?: A Call to Improve Surgical Database Research.

Childers, Christopher P / Maggard-Gibbons, Melinda

JAMA surgery

2020 Volume 156, Issue 3, Page(s) 219–220

MeSH term(s)	Data Accuracy ; Data Science ; Databases, Factual ; Humans ; Research ; Surgical Procedures, Operative/statistics & numerical data
Language	English
Publishing date	2020-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2020.4991
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Article ; Online: Inaccuracies in Postoperative Inpatient Stays Assumed in the Valuation of Surgical RVUs.

Childers, Christopher P / Maggard-Gibbons, Melinda

Annals of surgery

2020 Volume 273, Issue 1, Page(s) 13–18

Abstract: Objective: The aim of this study was to assess the accuracy of inpatient postoperative visits assumed in the valuation of surgical relative value units (RVUs).: Summary background data: Medicare reimburses physicians based on the number of RVUs ... ...

Abstract	Objective: The aim of this study was to assess the accuracy of inpatient postoperative visits assumed in the valuation of surgical relative value units (RVUs). Summary background data: Medicare reimburses physicians based on the number of RVUs assigned to a service. For surgical procedures with a 10- or 90-day global period, the RVU valuation is based, in part, on a presumed number of inpatient postoperative visits whether or not those visits occur. The Centers for Medicare and Medicaid Services (CMS) have recently proposed changing all surgical procedures to a 0-day global period. Methods: We combined 2017 National Surgical Quality Improvement (NSQIP) data with physician time and RVU files from CMS. We then compared the number of inpatient postoperative visits assumed in the valuation to actual length of stay (LOS) information from the surgical registry. Results: The analysis included 10 specialties and 601 distinct current procedural terminology codes. The number of patient observations underlying NSQIP LOS estimates ranged from 50 to 57,904. Eighty-three percent of procedures had median NSQIP LOS values that were shorter than the values assumed in the global period. These differences varied by specialty, with the largest discrepancy in neurosurgery. Procedures in this sample were last reviewed, on average, in 2000, with procedures reviewed more recently having more accurate valuations with respect to LOS. Conclusions: The number of postoperative visits assumed in the valuation of surgical RVUs is grossly inaccurate. Holding all else equal, removing global periods from surgical RVUs would dramatically reduce surgeon compensation.
MeSH term(s)	Humans ; Length of Stay/statistics & numerical data ; Postoperative Care/statistics & numerical data ; Relative Value Scales ; Surgical Procedures, Operative/statistics & numerical data
Language	English
Publishing date	2020-05-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000003918
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Article ; Online: Symptomatic Cholelithiasis: Do Minority Patients Experience Delays to Surgery?

Shenoy, Rivfka / Kirkland, Patrick / Maggard-Gibbons, Melinda / Russell, Marcia M

The Journal of surgical research

2021 Volume 272, Page(s) 88–95

Abstract: Background: Cholecystectomy is one of the most common surgeries and the majority are performed to treat symptomatic cholelithiasis (SC). While surgery is often elective, poor access or delays in care may lead to urgent cases, which are potentially ... ...

Abstract	Background: Cholecystectomy is one of the most common surgeries and the majority are performed to treat symptomatic cholelithiasis (SC). While surgery is often elective, poor access or delays in care may lead to urgent cases, which are potentially associated with higher complication rates. This study aims to determine if minority patients with SC have higher rates of urgent cholecystectomy and postoperative complications. Materials and methods: Analysis of patients undergoing cholecystectomy for SC utilizing American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2017 to 2019. Primary outcome was acuity of cholecystectomy (i.e., urgent versus elective). Secondary outcomes were any post-operative complication and length of stay. Results: Patients who underwent cholecystectomy for SC between 2017 to 2019 (N: 13,390) were analyzed. Hispanic and non-Hispanic Black patients had higher odds of undergoing urgent surgery as compared to non-Hispanic White patients, and Hispanics had over twice the odds (adjusted odds ratio (aOR), 2.16; 95% CI 1.93-2.43), adjusting for age, sex, and comorbidities. Having urgent surgery was associated with higher odds for developing any postoperative complication and experiencing longer length of stay. After adjusting for urgency of surgery, Non-Hispanic Black and Asian patients were at risk for higher postoperative length of stay. Conclusions: Hispanic and non-Hispanic Black patients were more likely to undergo urgent cholecystectomy as compared to non-Hispanic White patients for SC. Urgent surgery was independently associated with a higher complication rate and longer length of stay. Further characterization of the delays to surgery that lead to these differences are critical to prevent further treatment disparities.
MeSH term(s)	Cholecystectomy/adverse effects ; Cholelithiasis/surgery ; Hispanic or Latino ; Humans ; Length of Stay ; Minority Groups ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies
Language	English
Publishing date	2021-12-22
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.11.003
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Article ; Online: The Association of Frailty With Outcomes for Older Adults Undergoing Appendectomy.

Salzman, Garrett A / Saliba, Debra / Ko, Clifford Y / Maggard-Gibbons, Melinda / Russell, Marcia M

The American surgeon

2022 Volume 88, Issue 10, Page(s) 2456–2463

Abstract: Background: Frailty is a potential modifiable predictor of surgical outcomes in older adults. The impact of frailty following appendectomy, a common urgent operation, is unknown for older adults. The study aim was to assess if frailty is associated with ...

Abstract	Background: Frailty is a potential modifiable predictor of surgical outcomes in older adults. The impact of frailty following appendectomy, a common urgent operation, is unknown for older adults. The study aim was to assess if frailty is associated with worse perioperative outcomes after appendectomy in older adults. Methods: We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2016 to 2018 and identified patients 65 and older who underwent appendectomy for acute appendicitis. We identified frailty as a Modified Frailty Index (MFI) score ≥2. Multivariate logistic regression was used to assess the association of frailty with 30-day mortality, serious complications, readmission, and discharge to facility. Results: Five thousand seven hundred twenty-eight older adults underwent appendectomy, of which 29.1% were 75 or older, 53.3% female, 74.9% non-Hispanic White, and 17.1% frail. Frail patients experienced worse outcomes: mortality (frail: 1.0% vs non-frail: .3%, Conclusions: Frailty is associated with worse postoperative outcomes following appendectomy in older adults. As frailty is potentially modifiable, it should be routinely assessed and utilized in perioperative optimization and counseling, especially with respect to patient-centered outcomes.
MeSH term(s)	Aged ; Appendectomy/adverse effects ; Appendicitis/complications ; Appendicitis/surgery ; Female ; Frailty/complications ; Humans ; Male ; Patient Discharge ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2022-05-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221101493
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Article ; Online: Comparing Quality of Surgical Care Between the US Department of Veterans Affairs and Non-Veterans Affairs Settings: A Systematic Review.

Blegen, Mariah / Ko, Jamie / Salzman, Garrett / Begashaw, Meron M / Ulloa, Jesus G / Girgis, Mark / Shekelle, Paul / Maggard-Gibbons, Melinda

Journal of the American College of Surgeons

2023 Volume 237, Issue 2, Page(s) 352–361

Abstract: In response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of ...

Abstract	In response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 to create a program for patients to receive care in non-VA sites of care, paid by VA. Questions remain about the quality of surgical care between these sites in specific and between VA and non-VA care in general. This review synthesizes recent evidence comparing surgical care between VA and non-VA delivered care across the domains of quality and safety, access, patient experience, and comparative cost/efficiency (2015 to 2021). Eighteen studies met the inclusion criteria. Of 13 studies reporting quality and safety outcomes, 11 reported that quality and safety of VA surgical care were as good as or better than non-VA sites of care. Six studies of access did not have a preponderance of evidence favoring care in either setting. One study of patient experience reported VA care as about equal to non-VA care. All 4 studies of cost/efficiency outcomes favored non-VA care. Based on limited data, these findings suggest that expanding eligibility for veterans to get care in the community may not provide benefits in terms of increasing access to surgical procedures, will not result in better quality, and may result in worse quality of care, but may reduce inpatient length of stay and perhaps cost less.
MeSH term(s)	Humans ; United States ; Health Services Accessibility ; Hospitals, Veterans ; United States Department of Veterans Affairs
Language	English
Publishing date	2023-05-08
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000720
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