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Comment & Response
November 20, 2019

Varying Estimations of Surgical Work Value Units

Author Affiliations
  • 1Mayo Clinic, Surgery, Rochester, Minnesota
  • 2Department of Surgery, University of Connecticut Health Center, Farmington
  • 3Physicians’ Clinic of Iowa, St. Luke’s Unity Point Hospital, Cedar Rapids, Iowa
JAMA Surg. Published online November 20, 2019. doi:https://doi.org/10.1001/jamasurg.2019.4635

To the Editor We read with interest the Childers et al article1 advocating National Surgical Quality Improvement Program (NSQIP) registry use for calculating surgical work relative value units (WRVU). The Society of Thoracic Surgeons (STS) advocates using objective verified data (eg, STS National Database) rather than survey estimates to most accurately value surgeon work.2,3 This is the second article in the last 5 months4 using NSQIP for physician reimbursement. Both authors used different methods, arriving at diametrically opposed payment conclusions. Childers et al1 concluded cardiac and neurosurgery have overvalued procedures, while orthopedics and urology undervalued procedures. In contrast, Chan et al4 found cardiothoracic and neurosurgeons were underpaid ($130 and $60 million, respectively) while orthopedic surgeons and urologists were overpaid ($160 and $40 million, respectively).4

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