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89th Annual Meeting Abstracts

Contribution of Plastic Surgery to a Healthcare System: Our Economic Value to Hospital Bottom Line
Theresa Y. Wang, M.D.1, Jonas Nelson, B.S.1, Diane Corrigan, M.B.A.2, Joseph M. Serletti, M.D.1.
1University of Pennsylvania, Philadelphia, PA, USA, 2Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

With the current economic downturn and the inevitability of healthcare reform in the United States, it is critical for plastic surgeons to be aware of not only our clinical contributions but also our financial value to healthcare and hospital systems. We frequently assist with reconstruction following cancer extirpation or loss of parts due to trauma, flap closure of a wound due to infection and dehiscence and provide our intraoperative expertise for complex soft tissue problems. Are we appropriately valued and given credit, both operative and financial, for our important role? We aim to evaluate surgeon productivity, collaborative cases with other surgical specialties and financial contributions made to our healthcare system by the division of plastic surgery. This is the first in-depth economic analysis of the contribution of plastic surgery to a healthcare system in the literature.
Review of data was conducted at the University of Pennsylvania Healthcare System of operative case logs for the departments of surgery (10 divisions including plastic surgery), neurosurgery, orthopedics and gynecology for fiscal year 2009, from July 1, 2008 to June 30, 2009. Margins, revenue data were provided by the hospital finance department. Surgeon total relative value units (RVUs), a measure of productivity, were calculated. For each specialty, average RVU/surgeon, RVU/case, revenue/RVU were analyzed.
Average RVU for all surgical specialties was 94,595 (range 25,205 to 183,415), whereas, the plastic surgery division was 54,288. Average RVU per surgeon for the health system was 12,149 (range 4,001 to 15,590). For plastic surgery average RVU/surgeon was 14,272 and the division was ranked 4th highest among all surgical services within the hospital. The mean number of RVUs per case was 24.5 among all services, for plastic surgery, it was 31.2. The average net revenue for primary inpatient admissions per RVU was $304.26 for all surgical services while plastic surgery was $113.49 per RVU. Total joint operative cases with plastic surgery and other surgical specialties was 601 or 34.5% of all cases logged by the division. Overall reimbursement rate by insurance of total surgeon fees billed by the plastic surgery division was 38.9%.
Plastic surgery contribute significantly to hospital bottom line in performing many joint cases and salvaging complications that reduce patient morbidity and mortality for the hospital in the long term. Our division logs a high volume of collaborative cases and outperforms in surgeon productivity than most other surgical services. However, it lags behind the average in reimbursements of inpatient admissions and surgeon’s fees. The aim is to provide more leverage to negotiate contracts with managed care companies for better reimbursement rates as well as within our health system for recruiting new faculty members, equipment and research resources given our higher productivity. In this current economic environment, it is crucial for plastic surgeons to be fully cognizant of our positive influence and economic impact to the hospital margin.


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