The use of intraservice work per unit of time (IWPUT) and the building block method (BBM) for the calculation of surgical work

Charles D. Mabry, Barton C. McCann, Jean A. Harris, Janet Martin, John O. Gage, Josef E. Fischer, Frank G. Opelka, Robert Zwolak, Karen Borman, John T. Preskitt, Paul E. Collicott, LaMar McGinnis, Isidore Cohn, Edward M. Copeland, William Turner, Thomas R. Russell, A. Osama Gaber

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: We will review the contribution to the Medicare Fee Schedule (MFS) by the techniques of intensity of work per unit of time (IWPUT), the building block methodology (BBM), and the work accomplished by the American College of Surgeons General Surgery Coding & Reimbursement Committee (GSCRC) in using IWPUT/BBM to detect undervalued surgical procedures and recommend payment increases. Summary Background Data: The MFS has had a major impact on surgeons' income since its introduction in 1992 by the Centers for Medicare and Medicaid (CMS) and additionally has been adopted for use by many commercial insurers. A major component of MFS is physician work, measured as the relative value of work (RVW), which has 2 components: time and intensity. These components are incorporated by: RVW = time X intensity. Methods: This work formula can be rearranged to give the IWPUT, which has become a powerful tool to calculate the amount of RVW performed by physicians. Most procedures are valued by the total RVW in the global surgical package, which includes pre-, intra-, and postoperative care for a time after surgery. Summing these perioperative components into RVW is called the building block methodology (BBM). Results: Using these techniques, the GSCRC increased the values for 314 surgery procedures during a recent CMS 5-year review, resulting in an increase to general surgeons of roughly $76 million annually. Conclusions: The use of IWPUT/BBM has been instrumental to correct payment for undervalued surgical procedures. They are powerful methods to measure RVW across specialties and to solve reimbursement, compensation, and practice management problems facing surgeons.

Original languageEnglish (US)
Pages (from-to)929-940
Number of pages12
JournalAnnals of Surgery
Volume241
Issue number6
DOIs
StatePublished - Jun 2005

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Fee Schedules
Medicare
Intraoperative Care
Physicians
Insurance Carriers
Postoperative Care
Practice Management
Medicaid
Surgeons

ASJC Scopus subject areas

  • Surgery

Cite this

Mabry, C. D., McCann, B. C., Harris, J. A., Martin, J., Gage, J. O., Fischer, J. E., ... Gaber, A. O. (2005). The use of intraservice work per unit of time (IWPUT) and the building block method (BBM) for the calculation of surgical work. Annals of Surgery, 241(6), 929-940. https://doi.org/10.1097/01.sla.0000165201.06970.0e

The use of intraservice work per unit of time (IWPUT) and the building block method (BBM) for the calculation of surgical work. / Mabry, Charles D.; McCann, Barton C.; Harris, Jean A.; Martin, Janet; Gage, John O.; Fischer, Josef E.; Opelka, Frank G.; Zwolak, Robert; Borman, Karen; Preskitt, John T.; Collicott, Paul E.; McGinnis, LaMar; Cohn, Isidore; Copeland, Edward M.; Turner, William; Russell, Thomas R.; Gaber, A. Osama.

In: Annals of Surgery, Vol. 241, No. 6, 06.2005, p. 929-940.

Research output: Contribution to journalArticle

Mabry, CD, McCann, BC, Harris, JA, Martin, J, Gage, JO, Fischer, JE, Opelka, FG, Zwolak, R, Borman, K, Preskitt, JT, Collicott, PE, McGinnis, L, Cohn, I, Copeland, EM, Turner, W, Russell, TR & Gaber, AO 2005, 'The use of intraservice work per unit of time (IWPUT) and the building block method (BBM) for the calculation of surgical work', Annals of Surgery, vol. 241, no. 6, pp. 929-940. https://doi.org/10.1097/01.sla.0000165201.06970.0e
Mabry, Charles D. ; McCann, Barton C. ; Harris, Jean A. ; Martin, Janet ; Gage, John O. ; Fischer, Josef E. ; Opelka, Frank G. ; Zwolak, Robert ; Borman, Karen ; Preskitt, John T. ; Collicott, Paul E. ; McGinnis, LaMar ; Cohn, Isidore ; Copeland, Edward M. ; Turner, William ; Russell, Thomas R. ; Gaber, A. Osama. / The use of intraservice work per unit of time (IWPUT) and the building block method (BBM) for the calculation of surgical work. In: Annals of Surgery. 2005 ; Vol. 241, No. 6. pp. 929-940.
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AU - Martin, Janet

AU - Gage, John O.

AU - Fischer, Josef E.

AU - Opelka, Frank G.

AU - Zwolak, Robert

AU - Borman, Karen

AU - Preskitt, John T.

AU - Collicott, Paul E.

AU - McGinnis, LaMar

AU - Cohn, Isidore

AU - Copeland, Edward M.

AU - Turner, William

AU - Russell, Thomas R.

AU - Gaber, A. Osama

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N2 - Objective: We will review the contribution to the Medicare Fee Schedule (MFS) by the techniques of intensity of work per unit of time (IWPUT), the building block methodology (BBM), and the work accomplished by the American College of Surgeons General Surgery Coding & Reimbursement Committee (GSCRC) in using IWPUT/BBM to detect undervalued surgical procedures and recommend payment increases. Summary Background Data: The MFS has had a major impact on surgeons' income since its introduction in 1992 by the Centers for Medicare and Medicaid (CMS) and additionally has been adopted for use by many commercial insurers. A major component of MFS is physician work, measured as the relative value of work (RVW), which has 2 components: time and intensity. These components are incorporated by: RVW = time X intensity. Methods: This work formula can be rearranged to give the IWPUT, which has become a powerful tool to calculate the amount of RVW performed by physicians. Most procedures are valued by the total RVW in the global surgical package, which includes pre-, intra-, and postoperative care for a time after surgery. Summing these perioperative components into RVW is called the building block methodology (BBM). Results: Using these techniques, the GSCRC increased the values for 314 surgery procedures during a recent CMS 5-year review, resulting in an increase to general surgeons of roughly $76 million annually. Conclusions: The use of IWPUT/BBM has been instrumental to correct payment for undervalued surgical procedures. They are powerful methods to measure RVW across specialties and to solve reimbursement, compensation, and practice management problems facing surgeons.

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