title: Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.
abstract: BACKGROUND
  The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement.
  
  
  METHODS
  Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time.
  
  
  RESULTS
  Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30).
  
  
  CONCLUSIONS
  The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Dartmouth-Hitchcock Medical Center, Dartmouth, NH, USA. abhishek.chatterjee@hitchcock.org
authors.forename: Abhishek
authors.initials: A
authors.lastname: Chatterjee
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
authors.forename: Sean
authors.initials: S
authors.lastname: Figy
authors.forename: Lilian
authors.initials: L
authors.lastname: Chen
authors.forename: Shirley A
authors.initials: SA
authors.lastname: Montagne
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Rosen
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Desimone
mesh_terms: D005102:Health Expenditures; D006801:Humans; D010820:Physicians / Q000191:economics*; D011216:Practice Management, Medical / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics*; D015895:Relative Value Scales; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics*; D014481:United States; D016526:Workload / Q000191:economics