When Benchmarks Fail Us: A Case Study in Cytoreductive Surgery

Ann Surg Oncol. 2025 Jan;32(1):19-23. doi: 10.1245/s10434-024-16191-y. Epub 2024 Oct 26.

Abstract

Introduction: Relative Value Units (RVUs) are utilized to measure physician work effort and create national benchmarks. Physicians are often measured against national benchmarks to determine compensation. Using a case study in cytoreductive surgery, we explored variability in coding that can impact national benchmarks.

Methods: A survey was conducted amongst surgeons in the peritoneal surface malignancies consortium (PSM). Data was collected on clinical experience, clinical full time equivalent, wRVUS and institutional coding practice.

Results: Coding of the same procedure resulted in significantly varying RVUs (IQR 60-101) across institutions. Higher volume (> 50% practice) appeared to have better coding practices with higher wRVU/case (Median 102 vs 62, p = 0.04).

Conclusions: There is significant variability in the measurement of similar effort across institutions due to coding variability. Such variability creates flaws in measurement necessary for benchmarks.

Keywords: Cytoreductive surgical procedures; Organization and administration; Peritoneal neoplasms; Peritoneal surface malignancies.

Publication types

  • Editorial

MeSH terms

  • Benchmarking*
  • Clinical Coding / standards
  • Cytoreduction Surgical Procedures* / standards
  • Humans
  • Peritoneal Neoplasms* / surgery
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data
  • Prognosis
  • Relative Value Scales
  • Surgeons / standards
  • Surveys and Questionnaires