wRVUs: Do They Really Measure the Workload and Complexity of What We Do?

Posted by Raj S. Pruthi, MD, MHA, FACS | Aug 2022

Raj S. Pruthi, MD, MHA, FACS, presented “wRVUs: Do They Really Measure the Workload and Complexity of What We Do?” during the 41st Annual Ralph E. Hopkins Urology Seminar on February 5, 2022, in Jackson Hole, Wyoming.

How to cite: Pruthi, Raj S. “wRVUs: Do They Really Measure the Workload and Complexity of What We Do?.” February 5, 2022. Accessed Apr 2024. https://grandroundsinurology.com/wrvus-do-they-really-measure-the-workload-and-complexity-of-what-we-do/

wRVUs: Do They Really Measure the Workload and Complexity of What We Do?

In this 13-minute presentation, Raj S. Pruthi, MD, MHA, FACS, Professor in the Department of Urology at the University of California San Francisco, discusses how work Relative Value Units (wRVUs) correlate with the work urologists perform. Recently, there has been an increasing use of wRVUs in employment compensation models, from 16% in 2007 to 60% in 2016. Productivity-based compensation models including wRVU use benchmark data to determine the compensation and productivity rates for each type of treatment. He explains that resource-based relative value scale is a method that aims to measure the time and skill for each treatment. The current system measures work, practice expense, and professional liability, then final payments incorporating budget constraints and geographic location. Dr. Pruthi continues to explain how the AUA and AMA worked with urologists to determine the most important 22 urological services. He states that they surveyed 115 urologists to rate pre-service, inter-service, and post-service work for these codes. For these surveys, each component measured time and intensity to determine work. He explains that they then set a reference service for urologists worth 100 units. Dr. Pruthi explains that for urology, the reference service was an ambulatory diagnostic cystoscopy for a man with microhematuria. He explained that they can change these, but if they increase the code for one specialty, the units have to be detracted from another specialty due to budget constraints. This brings the question of if wRVUs are an accurate measure. He then explains that he analyzed data from 190,000 urologic procedures from 2012-2016 regarding indirect measures of urologists’ efforts, including operation time, length of stay, morbidity, mortality, serious adverse events, and readmissions. He states that wRVUs in urology correlate well with operation time, length of stay, and morbidity, but they only moderately correlate with mortality, serious adverse events, and readmissions. He also stated that it is important to measure fairly and actively reflect the work that physicians do, including quality of care and cost of care. He states that there should be objective measures and may need to include quality and cost of care. Lastly, Dr. Pruthi compares urology to other surgical specialties and explains that it would need to be consistent within specialty and across specialties.

About The 41st Annual Ralph E. Hopkins Urology Seminar:

The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Pruthi presented this lecture during the 41st iteration of the meeting on February 5th, 2022 in Jackson Hole, Wyoming.

For further educational activities from this conference, visit our collection page.

About The Author

Raj S. Pruthi, MD, MHA, FACS

Dr. Pruthi is a Professor in the Department of Urology at the University of California, San Francisco. He previously served as chair of the Department of Urology at the University of North Carolina at Chapel Hill, where he was on faculty for nineteen years. Serving first as its Chief and then as its inaugural chair, he took the UNC Department of Urology from an unranked program to one of the best in the nation. Dr. Pruthi was a member of the ABU/AUA Examination Committee and serves as an examiner for the Certifying Exam for the ABU. He is also on the Executive Committee for the Society of Academic Urology, as well as the Chair of the Advisory Council for Urology of the American College of Surgeons. Dr. Pruthi helped to develop the American Urological Association’s Guidelines on the Management of Non-muscle Invasive Bladder Cancer. He also served on the Bladder Cancer Guidelines Committee of the International Consultation on Urological Diseases. He is an elected member of the Urologic Research Society, the Society of Pelvic surgeons, the American Association of Genitourinary Surgeons, and the Clinical Society of Genitourinary Surgeons. Dr. Pruthi is a graduate of Stanford University, where he double majored in economics and in biology and became interested in health economics. He received his MD from Duke University School of Medicine. Following medical school, he completed his residency and post-graduate training at Stanford University. Most recently, he completed the executive MHA program at UNC. Dr. Pruthi’s area of clinical expertise is urologic oncology, including prostate and bladder cancer. He is committed to a multi-disciplinary, holistic, and patient-centric approach to care. Dr. Pruthi is a recognized expert in minimally-invasive, robotic surgery for prostate and bladder cancer. He incorporates nerve-sparing techniques to improve recovery and long-term quality of life. He is committed to compassionate, comprehensive, innovative, and patient-centered care that balances long-term survivorship with a high-level of functioning and an optimal quality of life. Dr. Pruthi’s research is focused on surgical innovation, care pathways, and quality of care. Most recently, this primary research has addressed topics related to health economics, including characterizing the urologic workforce, understanding compensation, productivity, and burnout. Dr. Pruthi has been tackling health economic issues to better understand the drivers of faculty productivity, compensation, and burnout. He has explored urologic workforce, projections, gender disparity issues, factors impacting career earnings, predictors of dissatisfaction and burnout, and understanding the impact of workflow initiatives, including the implementation of scribes. His work in these areas has been recognized nationally and has had an impact on the understanding of the practice of urology.

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