Question regarding pay structure and reimbursement as an Attending in a group

[otacon88]

I had a question regarding reimbursement when working out in the community. Say a group offers $200/hr as base pay, + RVU bonus for more patients that you see. Are there any other variables that come into play with your paycheck? For example, does a person who sees 2pt/hr who only completes charts to level 3 make the same as a person who completes all their charts, with 5's, 4's, 3' etc? I know the group/hospital will be able to bill more for higher level of charting and care, but will the physician get more money for more complex patients, or is it all the same, in essence seeing many lower acuity patients will make you more money than seeing a few critically ill patients?

This would be in a democratic, employee model (not being a partner or owner of the group)

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[Birdstrike]

If paid with any RVU component, higher billing = greater RVUs = greater amount of money paid.

Each procedure code, and E&M code (ie "level 3") has a fixed RVU value set every year by the AMA RUC.

At the end of the month they add up your total rvu's and use that to calculate whatever portion of your pay is at risk on an RVU basis. Every group could be a little different. Some may base all your pay on RVUS, some base none on RVUs (all "$ per hour") and others may have varying mixes of both.

 

[Apollyon]

I had a question regarding reimbursement when working out in the community. Say a group offers $200/hr as base pay, + RVU bonus for more patients that you see. Are there any other variables that come into play with your paycheck? For example, does a person who sees 2pt/hr who only completes charts to level 3 make the same as a person who completes all their charts, with 5's, 4's, 3' etc? I know the group/hospital will be able to bill more for higher level of charting and care, but will the physician get more money for more complex patients, or is it all the same, in essence seeing many lower acuity patients will make you more money than seeing a few critically ill patients?

This would be in a democratic, employee model (not being a partner or owner of the group)

First, think of what IS an "RVU" - it is a "relative value unit", which is a means to make apples equal apples. Think of this example: if one person sells Rolex, and the second Timex, the Rolex person sells 10, and the Timex person sells 300, and the profit is equal. If you see 5 level 3 patients in the same time as I see 2 level 5's, the RVUs are meant to equal them out. That is how urgent cares clean up - massive amounts of level 3 patients (and level 2's - that is VERY low hanging fruit). As such, that is why people learn tricks to maximize RVUs - such as, if you are removing a foreign body, use a blade. That is worth something like 7 RVU's (or, at least, was), versus using forceps. That is how surgeons and cards & GI do it - the visit is a level 3, but the procedure is RVU heavy (kind of like side quests in a game being really rich, but the main gameplay is somewhat bland).

Billing "critical care" is like ringing the "Big Bonus Bell!!!!!". That's like Double Jeopardy, when the dollars can really add up.

 

[hoot504]

Billing "critical care" is like ringing the "Big Bonus Bell!!!!!". That's like Double Jeopardy, when the dollars can really add up.

 

[The White Coat Investor]

I had a question regarding reimbursement when working out in the community. Say a group offers $200/hr as base pay, + RVU bonus for more patients that you see. Are there any other variables that come into play with your paycheck? For example, does a person who sees 2pt/hr who only completes charts to level 3 make the same as a person who completes all their charts, with 5's, 4's, 3' etc? I know the group/hospital will be able to bill more for higher level of charting and care, but will the physician get more money for more complex patients, or is it all the same, in essence seeing many lower acuity patients will make you more money than seeing a few critically ill patients?

This would be in a democratic, employee model (not being a partner or owner of the group)

The answer is it depends.

If you're an employee in my group, you don't get any RVU bonus no matter how many patients you see. If you're a partner, you get your share of the overall revenues minus expenses divided by the number of shifts you work adjusted for a shift differential.

Some groups are "eat what you kill" and you get some percentage of what you bill.

As explained by others, RVUs are RVUs and if your pay depends on them, whether directly in an eat what you kill model, or indirectly like in ours, you'd best learn how to maximize them.

 

[otacon88]

thanks for the replies guys! for some reason I was having tunnel vision in that I thought an RVU only referred the number of patients you see. but makes sense now it's everything, including procedures and charting, so it would benefit me to complete all my charts in a couple months!

 

[Apollyon]

Did you see the "April Fool's Day" episode? Bob was on it! He looks OLD, and with a tremor, but still has it!

 

[TheBlueBlazer]

thanks for the replies guys! for some reason I was having tunnel vision in that I thought an RVU only referred the number of patients you see. but makes sense now it's everything, including procedures and charting, so it would benefit me to complete all my charts in a couple months!

If your program hasn't had someone sit down and go through all of this stuff with you, I would push them to. In fact, if they haven't already, they really dropped the ball because this is stuff you should have learned about before the job search started. I've also gotten a number of emails from people from EmCare and other CMGs trying to do dinner talks about this and other transitioning to being an attending talks

 

[TPBC]

First, think of what IS an "RVU" - it is a "relative value unit", which is a means to make apples equal apples. Think of this example: if one person sells Rolex, and the second Timex, the Rolex person sells 10, and the Timex person sells 300, and the profit is equal. If you see 5 level 3 patients in the same time as I see 2 level 5's, the RVUs are meant to equal them out. That is how urgent cares clean up - massive amounts of level 3 patients (and level 2's - that is VERY low hanging fruit). As such, that is why people learn tricks to maximize RVUs - such as, if you are removing a foreign body, use a blade. That is worth something like 7 RVU's (or, at least, was), versus using forceps. That is how surgeons and cards & GI do it - the visit is a level 3, but the procedure is RVU heavy (kind of like side quests in a game being really rich, but the main gameplay is somewhat bland).

Billing "critical care" is like ringing the "Big Bonus Bell!!!!!". That's like Double Jeopardy, when the dollars can really add up.

How do you differentiate with billing if you use a blade or pickups to remove a foreign body? I assume you enter a CPT code for each? I also heard if your remove cerumen using a curret rather than just lavage, it codes higher. Is that right?

 

[Apollyon]

How do you differentiate with billing if you use a blade or pickups to remove a foreign body? I assume you enter a CPT code for each? I also heard if your remove cerumen using a curret rather than just lavage, it codes higher. Is that right?

I just put it in my note. "Wooden foreign body extracted with #11 blade", that sort of thing.

As for the curette vs lavage, I do not know. Sorry.

 

[Janders]

Lavage alone does not allow for the CPT code for cerumen removal. The billing is moderately complex. Here is a good overview--
http://www.priorityhealth.com/provider/manual/billing-and-payment/services/cerumen