title: Capture of complexity of specialty care in pediatric cardiology by work RVU measures.
abstract: OBJECTIVE
  We sought to determine the relationship between relative value units (RVUs) and intended measures of work in catheterization for congenital heart disease.
  
  
  METHODS
  RVU was determined by matching RVU values to Current Procedural Terminology codes generated for cases performed at a single institution. Differences in median case duration, radiation exposure, adverse events, and RVU values by risk category and cases were assessed. Interventional case types were ranked from lowest to highest median RVU value, and correlations with case duration, radiation dose, and a cases-predicted probability of an adverse event were quantified with the Spearman rank correlation coefficient.
  
  
  RESULTS
  Between January 2008 and December 2010, 3557 of 4011 cases were identified with an RVU and risk category designation, of which 2982 were assigned a case type. Median RVU values, radiation dose, and case duration increased with procedure risk category. Although all diagnostic cases had similar RVU values (median 10), adverse event rates ranged from 6% to 21% by age group (P < .001). Median RVU values ranged from 9 to 54 with the lowest in diagnostic and biopsy cases and increasing with isolated and then multiple interventions. Among interventional cases, no correlation existed between ranked RVU value and case duration, radiation dose, or adverse event probability (P = .13, P = .62, and P = .43, respectively).
  
  
  CONCLUSIONS
  Time, skill, and stress inherent to performing catheterization procedures for congenital heart disease are not captured by measurement of RVU alone.
authors: Department of Cardiology, The Children's Hospital, 300 Longwood Ave, Boston, MA, USA. lisa.bergersen@cardio.chboston.org
authors: Lisa
authors: L
authors: Bergersen
authors: Kimberlee
authors: K
authors: Gauvreau
authors: Doff
authors: D
authors: McElhinney
authors: Sandra
authors: S
authors: Fenwick
authors: David
authors: D
authors: Kirshner
authors: Julie
authors: J
authors: Harding
authors: Patricia
authors: P
authors: Hickey
authors: John
authors: J
authors: Mayer
authors: Audrey
authors: A
authors: Marshall
mesh_terms: D000293:Adolescent; D001900:Boston; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000145:classification* / Q000706:statistics & numerical data*; D002309:Cardiology / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D039702:Current Procedural Terminology; D005245:Fee Schedules / Q000145:classification / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D006751:Hospital Information Systems; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010372:Pediatrics / Q000706:statistics & numerical data*; D011336:Probability; D011829:Radiation Dosage; D015642:Radiology, Interventional / Q000145:classification / Q000706:statistics & numerical data; D015895:Relative Value Scales; D018570:Risk Assessment; D013038:Specialization / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States