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The Impact of an Acute Care Surgery Model on the General Surgery Service Revenue Stream
*Adam N. Paine, Edward C. Borrazzo, *Bradley L. Krompf, Ajai K. Malhotra, Mitchell C. Norotsky, *Mitchell H. Tsai
University of Vermont Medical Center, Burlington, VT

Objective: To determine whether the implementation of an Acute Care Surgery (ACS) service model enables general surgeons to reduce their afterhours caseload while simultaneously maintaining a stable revenue stream. Design: Using WiseOR® (Palo Alto, CA), we extracted surgical cases for the General Surgery (GS) service one year before and after implementation of the ACS service at the University of Vermont Medical Center. Using billing data from the Department of Surgery, we obtained work Relative Value Units (wRVUs) and full time equivalent (FTE) data for the GS service during the two-year study period. Setting: Single center, academic medical center. Participants: Surgeons covering our institution’s GS service, which includes colorectal, bariatric, and minimally invasive subspecialties. Interventions: Implementation of an ACS service. Main Outcome Measure: The wRVU/FTE ratio for the GS service the year before and after implementation of an ACS service. Results: The year prior to the implementation of the ACS service, the GS service performed an average of 35.6 afterhours cases per month. The year following implementation of the ACS service, the GS service had a significant (p<.01) reduction in the number of afterhours cases to an average of 16.1 per month. The GS service generated 6,911 wRVU/FTE the year prior to ACS implementation and 6,759 wRVU/FTE the year following ACS implementation. This -2.2% change is well within the range observed between recent fiscal years, prior to ACS implementation (-4.0% to +7.0%). Conclusions: The GS service maintained a stable revenue stream despite a significant reduction in afterhours cases that followed the implementation of an ACS service. This reduction in afterhours cases may improve job satisfaction while allowing surgeons to concentrate on their subspecialty and academic pursuits.


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