Developing Relative Value of selected surgical services in Tabriz Teaching Hospitals

Abstract

Abstract

Background: The relative value unit is the main method of calculating physician reimbursements and a tool for measuring the work of surgeons. Existing evidence shows that work RVU does not accurately represent the surgeon's work, and there is criticism in calculating the amount of work done by surgeons. Therefore, the current study attempts to develop a local model to measure surgeons' work. Methods: This study was conducted in two main phases of determining the metrics and model development using quantitative and qualitative. The Literature review, focused group discussions, and interviews were used to collect data. Content analysis, Exploratory Data Analysis techniques, and AHP method were applied to analyze data and developed the local model. Results: In this study, eleven indicators were identified as effective indicators in the surgeon’s work. The indicators were grouped in three general categories which called patient's conditions (age, severity of disease at referring time, and comorbidities), disease specifications (surgery time, complexity, physical effort, and risk, pre and post-operation time), and provider characteristic (surgeon’s willingness, imposed stress, and surgeon’s skill); The priority of each group in the developed model was 17%, 51% and 32%, respectively. Conclusions: Determining a fixed value for each procedure does not accurately estimate the amount of required surgeon’s work for any procedure. Many factors, such as the patient's condition, surgeon's characteristics, and the disease specification affect surgeons' work in the operation room. Proper measurement of the surgeon's work is an important step towards establishing equity in payment, and better patient’s access in the health system.