Clinical Fellow Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
Introduction: The Medicare Physician Fee Schedule (PFS) is the backbone for physician reimbursement by public and private payers. This fee schedule values physician services according to the estimated time and intensity required to perform them; intensity reflects the summation of technical skill, cognitive load, and risk-related stress. The fee schedule uses relative value units (RVUs) as a metric that permits comparison across procedures. Recent debate has focused on whether the methods by which the Centers for Medicare & Medicaid Services (CMS) estimates procedural intensity are valid. We therefore sought to investigate current CMS estimates of intensity (RVUs/minute) for surgical procedures performed by pediatric otolaryngologists.
Methods: We performed a retrospective, cross-sectional analysis of fiscal year 2021 PFS and publicly available Medicare Part B utilization data for pediatric otolaryngology key indicator procedures as specified by the Accreditation Council for Graduate Medical Education, as well as procedure codes for general procedures (e.g. adenotonsillectomy). Time estimates were obtained using the Medicare time file. We utilized the 2021 Medicare PFS conversion factor of $34.89 per RVU to convert intensity (RVUs/minute) to compensation rate ($/minute). Primary outcomes were 1) total compensation rate (TCR) and 2) intraservice (i.e., incision to closure) compensation rate (ICR) for each procedure.
Results: Our study sample included 167 unique procedures within 9 domains: congenital anomalies, head & neck surgery, otology, closed airway (i.e., tracheostomy Conclusion: Total and intraservice compensation rates under the Medicare PFS vary widely for surgical procedures performed by pediatric otolaryngologists. Further investigation is necessary to examine the validity of assumptions underlying these procedural intensity valuations.