title: Revenue Generation and Plastic Surgery Training Programs: 1-Year Evaluation of a Plastic Surgery Consultation Service.
abstract: BACKGROUND
  In academic institutions, residents make substantial contributions to clinical productivity. However, billing cannot be generated unless there is direct attending physician supervision of these services. The purpose of this study was to quantify clinical services provided by residents at a large academic medical center.
  
  
  METHODS
  The authors performed a review of all consultations to the plastic surgery service between January 1 and December 31, 2014. Documentation was reviewed and hypothetical billing for services was generated using American Medical Association Current Procedural Terminology and evaluation and management codes.
  
  
  RESULTS
  A total of 2367 consultations were reviewed during the 1-year study period. Residents provided services under indirect supervision for the majority of consultations [n = 1940 (81.9 percent)]. If these services had been billed, evaluation and management would have resulted in 6970 physician work relative value units. More than half of the encounters (52.0 percent) involved at least one procedure, resulting in an additional 3316 work relative value units from 1339 Current Procedural Terminology codes. Using a conservative estimate (2014 Medicare reimbursement rates), charges from these services would total $368,496.
  
  
  CONCLUSIONS
  The plastic surgery consultation service is a potential source of uncaptured revenue for training programs using indirect supervision of residents. Greater than 10,000 work relative value units could have been generated from resident clinical services, which is considerably more than the national average productivity of a full-time, academic plastic surgeon. Capturing a portion of this revenue stream could improve the fiscal balance of training programs and improve the cost-effective use of resident productivity.
authors.affiliation: Providence, R.I.|From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Drolet
authors.affiliation: Providence, R.I.|From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
authors.forename: Vickram J
authors.initials: VJ
authors.lastname: Tandon
authors.affiliation: Providence, R.I.|From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sargent
authors.affiliation: Providence, R.I.|From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
authors.forename: Kamaris
authors.initials: K
authors.lastname: Loor
authors.affiliation: Providence, R.I.|From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Schmidt
authors.affiliation: Providence, R.I.|From the Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Liu
mesh_terms: D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D015895:Relative Value Scales; D013518:Surgery, Plastic / Q000193:education*; D014146:Training Support / Q000191:economics*; D014481:United States