Mismatch in productivity calculated from wRVU metric and the actual number of images in musculoskeletal radiographic studies.

Abstract

The work relative value unit (wRVU) measures the physician's work involved in performing a service and is commonly used to quantify physician productivity. A critical component factored in wRVUs is the time required to perform a service. In musculoskeletal radiology, this time correlates directly with the number of images produced per radiograph. The purpose of this project was to evaluate whether the actual number of acquired images matches the number of views indicated in musculoskeletal radiographs CPT code descriptions. A query of our internal database returned 76,204 musculoskeletal radiograph reports. 440 random radiographs were reviewed to evaluate variability in the number of images obtained. This sample consisted of ten studies from each of the forty-four musculoskeletal codes. We recorded the number of actual images obtained. 242 studies from the safety net health care system and 198 studies from the university associated hospitals and clinics were evaluated. Seventy-five studies (31 %) were found to have mismatched number of images among the 242 studies from the safety net health care system. Sixty-six studies (33 %) were found to have mismatched number of images among the 198 studies sample from university associated tertiary care system. There was significant difference between the extra images obtained at two different health care systems (p < 0.001). There were more studies with extra images in the safety net system compared to the university hospital. The commonly used wRVU metric has broad variability in the assessment of work productivity for musculoskeletal radiographs given the variance in the number of images obtained.