LAUSR

BACKGROUND Relative Value Units (RVU) are an essential component of reimbursement calculations from the Center for Medicare and Medicaid Services (CMS). RVU are calculated based on physician work, practice expense, and professional liability insurance. Procedures that are more complex, such as revision arthroplasty, require greater levels of physician work and should therefore be assigned a greater RVU. The purpose of this study is to compare RVU assigned for primary and revision total elbow arthroplasty. METHODS The National Surgical Quality Improvement Program (NSQIP) database was used to collect all primary and revision total elbow arthroplasties performed between January 2015 and December 2017. Variables collected included age at time of surgery, RVU assigned for the procedure, and operative time. RESULTS A total of 359 cases were (282 primary TEA, 77 revision TEA) were included in this study. Mean RVU for primary total elbow arthroplasty was 21.4 (2.0 SD) versus 24.4 (1.7 SD) for revision arthroplasty (p=0.0001). Mean operative time for primary total elbow arthroplasty was 137.9 minutes (24.4 SD) versus 185.5 minutes (99.7 SD) for revision total elbow arthroplasty (p=0.0001). The RVU per minute for primary TEA was 0.16 and revision TEA was 0.13 (p=0.0001). This amounts to a yearly reimbursement difference of $71,024 in favor of primary total elbow arthroplasty over revision TEA. CONCLUSION The current reimbursement model does not adequately account for increased operative time, technical demand, and pre- and postoperative care associated with revision elbow arthroplasty compared to primary TEA. This leads to a financial advantage for performing primary total elbow arthroplasty.