Landscape of outpatient dermatology work relative value units (wRVUs) at a tertiary cancer center

Abstract

Background

Specialized dermatology services including cutaneous oncology (CO), cutaneous lymphoma (CL), and oncodermatology (OD) are increasingly central to cancer care. However, data on the financial sustainability and complexity of care provided by these subspecialties is limited.

Objective

Evaluate outpatient work relative value unit (wRVU) generation, including visit complexity, across CO, CL, and OD subspecialties at a tertiary cancer center.

Methods

Retrospective review of work relative value units (wRVUs) assigned to 13,534 outpatient visits between April 1, 2022, and April 1, 2023. Visits were categorized into CO, CL, or OD visits and inpatient and procedure-only visits were excluded. wRVUs for each visit were assigned according to evaluation and management (E/M) levels and associated current procedural terminology (CPT) procedure codes for each visit. Geometric mean wRVUs per visit and sources of wRVUs were compared between CL, CO, and OD subspecialties.

Results

Among 7,589 patients (mean age 58.7 years), all three subspecialties demonstrated high geometric mean wRVUs per visit (1.76, 95% CI 1.73–1.77). Most wRVUs were derived from codes for evaluation and management, rather than procedures. Most visits were level 3 (51.6%) and 4 (39.9%) complexity with OD visits exhibiting the highest proportion of Level 4 (53.7%) and Level 5 (10.7%) visits.

Conclusions

CO, CL, and OD services demonstrate high billing intensity, which may reflect high-complexity, cognitively intensive care. These findings support further investigation into the financial sustainability of these subspecialties to support broader institutional investment.