Relative value units and reimbursement for primary and revision total shoulder arthroplasty

Background: Relative value units (RVU), based on physician work and case expenses, are reimbursement and payment rates set by the Center for Medicare and Medicaid Services. Total shoulder arthroplasty (TSA) is performed less frequently than total hip and knee arthroplasty and may take longer to perform yet has a similar RVU assignment. The purpose of this study is to determine differences in RVU/minute and dollars/minute for primary and revision TSA and to compare the RVUs/minute and dollars/minute of shoulder arthroplasty to published reports of hip and knee arthroplasty. Methods: In this retrospective cohort study, data were collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2006 to 2018. Current procedural terminology (CPT) code 23472 was used to identify all primary TSA cases (N = 16,719), and CPT codes 23473 and 23474 were used for revision TSA cases (N = 948). Work RVU, operation time, and RVU per minute were compared between the primary and revision shoulder cohorts. The conversion factor for RVU to dollar was provided by the U.S. Centers for Medicare and Medicaid Services, and dollars per minute calculations were performed for the 2 cohorts. Multiple regression analysis was performed to control for age, gender, race, BMI, and American Society of Anesthesiologists classification. Univariate and multivariate analyses with a significance set at P <.05 were utilized for the study. Results: The mean operation times for primary and revision TSA were 109.42 minutes and 122.39 minutes, respectively (P <.001). This resulted in an RVU per minute of 0.233 for the primary shoulder cohort compared to 0.265 for the revision cohort (P <.001). Revision shoulder cases were valued higher with a dollars per minute of $9.56, whereas the dollars per minute for primary shoulder cases was $8.39 (P <.001). Multiple regression analysis showed a positive correlation between revision total shoulder cases and dollars per minute. Conclusion: The RVU per minute and reimbursement in dollars per minute of operative time are higher for revision TSA than for primary TSA. Compared with published reports on total hip and knee arthroplasty, primary TSA has lower RVU/minute assignment and lower dollars/minute reimbursement.