Work Relative Value Units for Total Hip Replacement Performed for Osteoarthritis Compared to Fracture

Abstract

Total hip arthroplasty (THA) performed in the setting of fracture is associated with greater case complexity, worse outcomes, and increased costs when compared with THA performed for osteoarthritis. Despite the increased complexity, the work relative value units (wRVUs) assigned to THA may not adequately compensate for this difference in surgical effort and time. The purpose of this study was to determine the wRVU per minute rates and reimbursement in dollars per minute for THA performed for fracture compared with THA performed for osteoarthritis. Data were collected through the National Surgical Quality Improvement Program database from 2006 to 2018 to identify all patients who underwent primary THA for osteoarthritis or for fractures. Total wRVU, operation time, wRVU per minute, and dollars per minute were assessed between the osteoarthritis and fracture cohorts. Bivariate and multivariate analyses were utilized for the study. The mean operation times for primary THA for osteoarthritis and for fractures were 91.96 and 99.43 minutes, respectively (p < 0.001), resulting in 0.26 versus 0.25 wRVU/min (p < 0.001). THA for osteoarthritis was also valued higher at $9.22/min versus $8.83/min for fracture (p < 0.001). This study shows that wRVU rates and reimbursement in dollars per minute for THA performed in the setting of fracture were lower than THA performed for osteoarthritis. Although patient care remains the number one priority, these findings have important implications in establishing adequate compensation for more complex cases. Level of evidence is III.