Alignment of RVU Targets With Operating Room Block Time

Saieesh A Rao; Nikita G Deshpande; Douglas W Richardson; Jon Brickman; Mitchell C Posner; Jeffrey B Matthews; Kiran K Turaga

doi:10.1097/AS9.0000000000000260

Alignment of RVU Targets With Operating Room Block Time

Ann Surg Open. 2023 Feb 22;4(1):e260. doi: 10.1097/AS9.0000000000000260. eCollection 2023 Mar.

Authors

Saieesh A Rao¹, Nikita G Deshpande², Douglas W Richardson³, Jon Brickman³, Mitchell C Posner³, Jeffrey B Matthews³, Kiran K Turaga³

Affiliations

¹ From the Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
² Division of Biological Sciences, Department of Medicine, University of Chicago, Chicago, IL.
³ Division of Biological Sciences, Department of Surgery, University of Chicago, Chicago, IL.

Abstract

Background: Surgeon productivity is measured in relative value units (RVUs). The feasibility of attaining RVU productivity targets requires surgeons to have enough allocated block time to generate RVUs. However, it is unknown how much block time is required for surgeons to attain specific RVU targets. We aimed to estimate the effect of surgeon and practice environment characteristics (SPECs) on block time needed to attain fixed RVU targets.

Methods: We computationally simulated individual surgeons' annual caseloads under a variety of SPECs in the following way. First, empirical case data were sampled from ACS NSQIP in accordance with surgeon specialty, case-mix complexity, and RVU target. Surgeons' operating schedules were then constructed according to the block length, turnover time, and scheduling flexibility of the practice environment. These 6 SPECs were concurrently varied over their ranges for a 6-way sensitivity analysis.

Results: Annual operating schedules for 60,000,000 surgeons were simulated. The number of blocks required to attain RVU targets varied significantly with surgeon specialty and increased with increased case-mix complexity, increased turnover time, and decreased scheduling flexibility. Intraspecialty variation in block requirement with variation in environmental characteristics exceeded interspecialty variation with fixed environmental characteristics. Multivariate linear models predicted block utilization across surgical specialties with consideration for the stated factors. An online tool is shared with which to apply these results to one's particular practice.

Conclusions: Block time required to attain RVU targets varies widely with SPECs; intraspecialty variation exceeds interspecialty variation. The feasibility of attaining RVU targets requires alignment between targets and allocated operating time with consideration for surgical specialty and other practice conditions.

Keywords: Monte Carlo; NSQIP; OR; RVU; burnout; finance; health economics; operating room; relative value unit; scheduling; simulation; surgeon.