Our Summary

This research paper is about how surgeons are paid for their work. The payment is calculated based on something called work relative value units (wRVUs), which is supposed to measure how much effort, skill, and time a surgeon puts into a procedure. In this study, the researchers looked at two types of surgery for inguinal hernia repair: one that is done with small incisions and a camera (laparoscopic), and another that is done with a larger, open incision.

The researchers found that, according to the wRVUs, the laparoscopic surgery is worth less than the open surgery. This was true for all patient cases they looked at, whether the hernia was on one side or both, whether it was a first-time or repeat surgery, and whether the hernia was blocking the intestine or not. This is despite the fact that the laparoscopic surgery is becoming more popular and is often more complex to perform.

The researchers argue that the current wRVUs system is not fair to surgeons who perform laparoscopic surgeries, because it doesn’t accurately reflect the complexity of the surgery or the condition of the patient. They suggest that the system should be changed to take these factors into account.

FAQs

  1. What are work relative value units (wRVUs) and how do they impact surgeons’ payment?
  2. According to the study, how does the wRVUs system value laparoscopic hernia repair surgeries compared to open surgeries?
  3. Why do the researchers believe the current wRVUs system is unfair to surgeons who perform laparoscopic surgeries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic hernia repair is that it is a minimally invasive procedure that typically results in less pain and a quicker recovery compared to open surgery. Additionally, patients may experience less scarring and a lower risk of complications with laparoscopic hernia repair. It is important to follow your doctor’s post-operative instructions for a successful recovery.

Suitable For

Patients who are typically recommended for laparoscopic hernia repair include those with inguinal hernias, especially those with smaller hernias or recurrent hernias. Laparoscopic surgery is also often recommended for patients who may have a higher risk of complications with open surgery, such as those with obesity or other underlying health conditions. Additionally, laparoscopic hernia repair may be recommended for patients who prefer a minimally invasive approach and a quicker recovery time.

Timeline

Before laparoscopic hernia repair:

  1. Patient experiences symptoms of a hernia, such as a bulge in the abdomen or groin, pain or discomfort, and difficulty lifting heavy objects.
  2. Patient consults with a healthcare provider who diagnoses the hernia and recommends surgery.
  3. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for surgery.

During laparoscopic hernia repair:

  1. Patient is given anesthesia to ensure they are comfortable and pain-free during the procedure.
  2. Surgeon makes small incisions in the abdomen and inserts a camera to view the hernia and surrounding tissues.
  3. Surgeon uses specialized instruments to repair the hernia, typically by placing a mesh patch over the weakened area.
  4. Procedure typically lasts 1-2 hours, depending on the complexity of the hernia and the patient’s overall health.

After laparoscopic hernia repair:

  1. Patient is monitored in the recovery room until they are awake and stable.
  2. Patient may experience some pain, swelling, and discomfort at the incision sites, which can be managed with pain medication.
  3. Patient is typically discharged the same day or within a few days, depending on their recovery progress.
  4. Patient is advised to avoid heavy lifting and strenuous activities for a few weeks to allow the incisions to heal properly.
  5. Patient follows up with their surgeon for post-operative care and monitoring to ensure the hernia has been successfully repaired.

What to Ask Your Doctor

  1. How does the wRVU system currently value laparoscopic hernia repair compared to open hernia repair?
  2. Why is laparoscopic hernia repair valued lower than open hernia repair under the wRVU system?
  3. How does the complexity of laparoscopic hernia repair compare to open hernia repair?
  4. What factors should be considered when determining the value of a surgical procedure like laparoscopic hernia repair?
  5. Are there any potential consequences for patients if surgeons are not fairly compensated for performing laparoscopic hernia repair?
  6. Are there any alternative payment systems that could better account for the complexity and skill required for laparoscopic hernia repair?
  7. How can patients advocate for fair compensation for surgeons who perform laparoscopic hernia repair?
  8. What are the potential implications of the current payment disparities between laparoscopic and open hernia repair for the future of surgical care?
  9. Are there any ongoing efforts or initiatives to address the disparities in payment for laparoscopic hernia repair?

Reference

Authors: Kapadia S, Ozao-Choy J, de Virgilio C, Kim D, Moazzez A. Journal: Am Surg. 2020 Oct;86(10):1324-1329. doi: 10.1177/0003134820964441. Epub 2020 Oct 30. PMID: 33125258