The AMA / RUC Physician Work Survey



The AMA / RUC Physician Work Survey

Please email your completed survey to: RUCsurvey@

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For 2015, the CPT Editorial Panel has approved new and revised codes to report negative pressure wound therapy. These new / revised CPT codes require review of physician work. The American College of Surgeons, American Academy of Orthopaedic Surgeons, American Society of Plastic Surgeons, and American Podiatric Medical Association need your help to complete this survey to assure relative values will be accurately and fairly presented to CMS during this review process.

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Survey Codes

976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment, including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters

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START HERE

Please Complete Survey Areas Shaded in Green

Financial Disclosure: Do you or a family member have a direct financial interest in the procedure(s) shown above, other than providing these procedure(s) in the course of patient care?

|For purposes of this survey “direct financial interest” means: |For each question |

| |Check Yes or No |

|A financial ownership interest in an organization of 5% or more? |Yes | |No | |

|A financial ownership interest in an organization which contributes materially to your income? |Yes | |No | |

|Ownership of stock options in an organization? |Yes | |No | |

|A position as proprietor, director, managing partner, or key employee in an organization? |Yes | |No | |

|Serve as a consultant, researcher, expert witness (excluding professional liability testimony), speaker or writer |Yes | |No | |

|for an organization, where payment contributes materially to your income? | | | | |

• Family member means spouse, domestic partner, parent, child, brother, or sister. Disclosure of family member’s interest applies to the extent known by you.

• Organization means any entity that makes or distributes the product that is utilized in performing the procedure/service and NOT the physician group or facility in which you work or perform the procedure/service.

• Materially means income of $10,000 or more (excluding any reimbursement for expenses) for the past 24 months.

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Demographic information will be kept confidential.

|Physician's NAME |Last: First: |

|Physician’s Primary Office (STATE) | |

|E-mail address | |

|SPECIALTY | |General Surgery |

|(check ALL that apply) | | |

| | |Orthopaedic Surgery |

| | |Plastic Surgery |

| | |Podiatry |

| | |Other (specify) ( | |

|YEARS Practicing Specialty( | |

|Primary Geographic Practice Setting: | |Rural |

|(check ONE) | | |

| | |Suburban |

| | |Urban |

|Primary Type of Practice: | |Solo Practice |

|(check ONE) | | |

| | |Single Specialty Group |

| | |Multispecialty Group |

| | |Medical School Faculty Practice Plan |

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Please consider these “typical patients” when completing this survey

|Survey Code |976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including|

| |topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or |

| |equal to 50 square centimeters |

|Global |XXX |

|Typical Patient|The patient is a male with a diabetic foot ulcer of the heel that measures 3.5 x 3.8 x 1.2 cm. The base of the wound is clean and |

| |red, but with significant serous drainage. Negative pressure wound therapy using an electrically powered vacuum assisted closure |

| |device (eg, VACTM) is applied. |

Is your typical patient for 976A1 similar to the typical patient described above?

|Yes? |No? |If "No," please describe your typical patient below: |

| | | |

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|Survey Code |976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical |

| |equipment, including provision of exudate management collection system, topical application(s), wound assessment, and instructions |

| |for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters |

|Global |XXX |

|Typical Patient|The patient is a male with a diabetic foot ulcer of the heel that measures 2.0 x 1.8 x 0.8 cm. The base of the wound is clean and red|

| |and has minimal necrotic tissue. Negative pressure wound therapy using a disposable mechanical wound care system (eg, SNaPTM) is |

| |applied. |

Is your typical patient for 976A3 similar to the typical patient described above?

|Yes? |No? |If "No," please describe your typical patient below: |

| | | |

Introduction

"Physician work" includes the following elements:

1. Physician time it takes to perform the service

2. Physician mental effort and judgment

3. Physician technical skill and physical effort, and

4. Physician psychological stress that occurs when an adverse outcome has serious consequences

All of these elements will be explained in greater detail as you complete this survey.

"Physician work" does not include the services provided by support staff who are employed by your practice and cannot bill separately, including registered nurses, licensed practical nurses, medical secretaries, receptionists, and technicians; these services are included in the practice expense relative values, a different component of the RBRVS.

Background for Question 1

The Table in Question 1 presents reference services that have been selected for use as comparison services for this survey because their relative values are sufficiently accurate and stable to compare with other services. The “work RVU” column presents current Medicare fee schedule work RVUs (relative value units). In Question 1 you will be asked to select one code from this list which is most similar to the survey code descriptor and typical patient/service.

It is very important to consider the global period when you are comparing the survey code to the reference services.

XXX A global period does not apply to the code and evaluation and management and other diagnostic tests or minor services performed, may be reported separately on the same day

000 0 days of post-service care are included in the work RVU:

5. visits and other physician services provided within 24 hours prior to the service;

6. provision of the service; and

7. visits and other physician services on the day of the service

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QUESTION 1: Which reference code below is most similar to the physician work for each survey code / typical patient described above?

|Reference Service List - Choose only ONE reference code for each survey code. |

|Only one "X" per column |CPT |DESCRIPTOR |work |global |

| |Code | |RVU |period |

|976A1 |976A3 | | | | |

| |

|976A1 |976A3 |CPT |DESCRIPTOR |work |global |

| | |Code | |RVU |period |

| | |11042 |

| Pre-service time: | | |minutes |

| Intra-service time: | | |minutes |

| Post-service time | | |minutes |

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QUESTION 3: For each Survey CPT code and for each reference service you chose in Question 1, rate the AVERAGE pre-, intra-, and post service complexity/intensity on a scale of 1 to 5 (1 = low; 3 =medium; 5 = high). Please base your rankings on the universe of codes your specialty performs. (Reference codes were chosen in Question 1 above.)

| |INSERT Complexity |

| |Rating of 1, 2, 3, 4, or 5 |

| |in each green cell |

| |(rating scale: 1=low; 5=high) |

| |Rate |Rate |Rate |Rate |

| |976A1 |Ref Code |976A3 |Ref Code |

| | | | | |

|PRE-service complexity | | | | |

| | | | | |

|INTRA-service complexity | | | | |

| | | | | |

|POST-service complexity | | | | |

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Discussion of Physician Work Complexity and Intensity

In evaluating the work of a service, it is helpful to identify and think about each of the components of a particular service. Focus only on the work that you perform during each of the identified components. The descriptions below are general in nature. Within the broad outlines presented, please think about the specific services that you provide.

Physician work includes the following:

Time it takes to perform the service.

Mental Effort and Judgment necessary with respect to the amount of clinical data that needs to be considered, the fund of knowledge required, the range of possible decisions, the number of factors considered in making a decision, and the degree of complexity of the interaction of these factors.

Technical Skill required with respect to knowledge, training and actual experience necessary to perform the service.

Physical Effort can be compared by dividing services into tasks and making the direct comparison of tasks. In making the comparison, it is necessary to show that the differences in physical effort are not reflected accurately by differences in the time involved; if they are, considerations of physical effort amount to double counting of physician work in the service.

Psychological Stress – Two kinds of psychological stress are usually associated with physician work. The first is the pressure involved when the outcome is heavily dependent upon skill and judgment and an adverse outcome has serious consequences. The second is related to unpleasant conditions connected with the work that are not affected by skill or judgment. These circumstances would include situations with high rates of mortality or morbidity regardless of the physician’s skill or judgment, difficult patients or families, or physician physical discomfort. Of the two forms of stress, only the former is fully accepted as an aspect of work; many consider the latter to be a highly variable function of physician personality.

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QUESTION 4: For each Survey CPT code and for each reference service you chose in Question 1, rate the intensity for each component listed on a scale of 1 to 5. (1= low; 3=medium; 5 = high). Please base your rankings on the universe of codes your specialty performs. (Reference codes were chosen in Question 1 above.)

| |INSERT Intensity |

| |Rating of 1, 2, 3, 4, or 5 |

| |in each green cell |

| |(rating scale: 1=low; 5=high) |

| |Rate |Rate |Rate |Rate |

| |976A1 |Ref Code |976A3 |Ref Code |

|Mental Effort and Judgment | | | | |

|The range of possible diagnoses and/or management options that must be considered | | | | |

|The amount and/or complexity of medical records, diagnostic tests, and/or other | | | | |

|information that must be analyzed | | | | |

|Urgency of medical decision making | | | | |

|Technical Skill/Physical Effort | | | | |

|Technical skill required | | | | |

|Physical effort required | | | | |

|Psychological Stress | | | | |

|The risk of significant complications, morbidity and/or mortality | | | | |

|Outcome depends on skill and judgment of physician | | | | |

|Estimated risk of malpractice suit with poor outcome | | | | |

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QUESTION 5: Experience - How many times in the past 12 months have you performed each survey code procedure and each reference code procedure you chose in Question 1?

|In the past 12 months, how many times |976A1 Experience |Ref Code |976A3 Experience |Ref Code |

|have you performed each survey code and | |Experience | |Experience |

|how many times have you performed each reference code that you chose in | | | | |

|Question 1? | | | | |

| | | | | |

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******************************VERY IMPORTANT******************************

QUESTION 6:

Based on your review of all previous steps, please provide your estimated work RVU for the survey CPT codes. Please indicate value to two decimal places (eg, 0.25, 0.64, 1.12)

For example, if the new/revised code involves the same amount of physician work as the reference service you choose in Question 1, you would assign the same work RVU. If the new or revised code involves less or more work than the reference service you would estimate a work RVU that is less or more than the work RVU of the reference service. This methodology attempts to set the work RVU of the survey service “relative” to the work RVU of comparable and established reference services. Please keep in mind the range of work RVUs for the reference codes listed in Question 1 above when providing your estimate.

|Estimated | |

|work RVU: | |

| |976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment|

| |(DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total |

| |wound(s) surface area less than or equal to 50 square centimeters |

| |976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable |

| |medical equipment, including provision of exudate management collection system, topical application(s), wound |

| |assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 |

| |square centimeters |

Please save you work and email your completed survey to:

RUCsurvey@

THANK YOU!

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