Are Joint Surgeons Being Adequately Compensated for Single-Component versus Double-Component Revision TKA? An Analysis of Relative Value Units.

Relative value units (RVUs) are used for ensuring that physicians are appropriately reimbursed based on case complexity. While past research has elucidated that surgeons are reimbursed at a higher rate for primary total knee arthroplasty (TKA) versus revision TKA, no study has explored differences in reimbursements between single-component and double-component revisions, considering a double-component revision is likely to require more effort/skill as compared with single-component revision.

The 2015 to 2016 American College of Surgeons National Surgical Quality Improvement Program files were queried using Current Procedural Terminology (CPT) codes for single-component revision TKA (CPT-27486) and double-component revision TKA (CPT-27487). A total of 1,962 single-component and 4,184 double component revisions were performed during this period. Total RVUs, RVU/min, and dollar amount/min were calculated for each case. The mean RVU was 21.12 and 27.11 for single-component and double-component revision TKAs, respectively. A statistically significant difference was noted in mean operative time (single component = 100.44 vs. double component = 144.29; p < 0.001) between the two groups. Single-component revision had a significantly higher mean RVU/min (0.267) versus double-component revision (0.223).

The reimbursement amounts calculated for single-component versus double-component revisions were per minute ($9.58/min vs. $8.00/min), per case ($962.22 vs. $1,154.32), and per day ($5,773.32 vs. $4,617.28) with a projected annualized cost difference of $184,966. Orthopedic surgeons are reimbursed at a higher rate for single-component revision TKAs as compared with double-component revision TKAs, despite the higher complexity and longer operative times required in the latter. The study highlights the need for a change in the RVUs for either double-component or single-component revision to ensure reimbursement per unit time is adequate for performing a complex case such as double-component revision TKA.