Making Sense of Productivity - Using RVUs

QUESTION: I am considering taking a new job where I’d be paid based on productivity. They’ll measure my productivity based on relative value units (RVUs). Before I accept the position, I’d like to roughly figure out what I’d be making if I keep working about as hard as I am now. But I don’t have any real idea what an RVU is or how to figure out what I’m producing.

Isn’t there anywhere that I can find out the number of RVUs per billing code or procedure?

ANSWER: Let’s start with an RVU primer. RVUs are the key part of the Resource Based Relative Value Scale (RBRVS). Basically, under RBRVS, every procedure or service gets assigned a relative value unit. In other words, it gets a value that situates it relative to other procedures or services.

It’s easier with an example: A mid-level 99213 office visit had a relative value unit of 1.68 in 2008. The even less complicated process of removing ear wax had an RVU of 1.26. Total hip replacement? 37.66.

You see these are values that express what it takes to do each service, relative to other services. Removing ear wax involves less than replacing a hip. Medicare uses that as a basis for deciding what to pay for each service or procedure. Most commercial payers follow the same model.

Every CPT code - every imaginable kind of service or procedure listed in the Common Procedural Terminology manual put out by the American Medical Association - has an associated relative value unit. Medicare changes the RVUs every year and publishes the total list online.

To find out what RVUs are associated with the codes you use, you need to go to the annual Physician Fee Schedule.

The easiest way to get the file is to visit PhysiciansPractice.com and click on the tools section. A link there sends you straight to the file buried on Medicare’s site.

You’ll find the work RVUs - the piece that most practices use to measure productivity - in column F.

Now, the unstated but often-related question is why in the world practices measure productivity using a method that requires this much explanation. Suffice to say, assessing productivity can be a huge issue in group practices. Every physician is pretty much convinced that he works harder than anybody else. And, sure, you can compare the number of office visits each one does, or the number of procedures, or even collected revenue per physician.

But here’s the problem: If Dr. Slow sees fewer patients per day or per year, he’ll be quite sure it’s because he takes on the really hard patients, the ones that take a lot of diagnostic skill or hand holding, while Dr. Greedy over there just does quick procedures and gets his easy patients in and out. Or, if Dr. Rich collects more, that’s because he refuses to see Medicaid patients, the big meany. You can see how these conversations are not so good for group longevity.

RVUs offer a decent alternative. The work RVU is meant to capture the amount of work done. For example, if a physician sees a patient that is more critical or needs more help, she’d pick a code that reflects that greater intensity of service and, with it, the related, higher work RVU.

Plus, work RVUs let you compare even if the physicians are in different specialties.
Do the math and see if the job is what you want.

Pamela L. Moore is director of content and strategy for Physicians Practice. She can be reached for solutions at pam.moore@cmpmedica.com.

This article originally appeared in the September 2009 issue of Physicians Practice.