medicare compensation rates for hand and shoulder/ elbow surgery by operative time: a comparative analysis

Background: there is a high demand for shoulder/elbow experience among hand-fellowship trainees due to the perception that this exposure will improve their professional “marketability” in a subspecialty they perceive as having higher compensation. methods: using medicare data, we investigated the most common surgeries from these fields and determined which have the highest compensation [work relative value unit (wrvu), payment, charge, and reimbursement (payment-to-charge percentage] rates per operative time. we then determined whether the overall non-weighted and weighted (by surgical frequency/volume) compensation rates of shoulder/elbow surgery are greater than that of hand surgery. results: among 30 shoulder/elbow procedures, arthroplasty and arthroscopic rotator cuff repair had the highest payment and wrvu assignments. among 83 hand procedures, upper-extremity flaps, carpal stabilization, distal radius open reduction internal fixation (orif), both-bone orif, and interposition arthroplasty had the greatest wrvu assignments with correspondingly high payments. a non-weighted comparison of the two subspecialties showed that hand surgery has a higher mean payment/min ($10.46±3.22 vs. $7.52±2.89), charge/min ($51.02±17.11 vs. $41.96±11.32), and reimbursement (21±4.7% vs. 18±5.1%) compared with shoulder/elbow surgery (all, p<0.01). non-weighted mean wrvus/min were similar (0.12±0.03 vs. 0.13±0.03, p = 0.12). when weighted by procedure frequency, hand surgery had greater wrvus/min (0.15±0.036 vs. 0.13±0.032), payments/min ($14.17±4.50 vs. $6.97±2.26), charges/min ($75.68±30.47 vs. $42.61±7.83), and reimbursement (20±5.0% vs. 17±6.0%) (all, p<0.01). conclusion: according to medicare compensation, and when weighted by procedure frequency, hand procedures are associated with greater overall mean wrvus/min, payments/min, charges/min, and reimbursement compared with shoulder and elbow procedures. hand-surgery fellowship applicants should be aware that subspecialty compensation is complex in nature but should seek shoulder/elbow elective experience to acquire an additional surgical skill-set as opposed to primarily monetary reason.