RVU math.. am i doing this right ?

[NeuroKlitch]

looking for my first job at the moment and i've been trying to make sure i dont end up getting suckered into a contract i dont fully understand. I will be interviewing at an academic facility in a major metropolitan area for an outpatient position with a mix of dual diagnosis patients. Pay for first 2 years is a gaurenteed base, however it then turns into pure RVU based system. So I want to be able to guage what my estimated salary would be once it turns to that.

so my understanding is that with two 30 min follow ups per hour, with 99214 + 90833 would be about 6 RVU's per hour. hoping that dual diagnosis would allow for the increase in complexity for billing. 9-5 is 48 per day.

so 48 x 5 days per week x 45 weeks worked = 1080 rvu's x conversion of 33 = 356k a year ? not including Rvu's for weekend call where we need to round the 20 bed inpatient unit. Is this how it works??

And if thats the case, i'm a little confused with how some posts are saying the average RVU value is 60ish dollars. If thats the case, would be closer to 700k. which seems an insane amount for 16 patients per day, unless im just used to be at a work horse program. Any insight would be helpful, thanks

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[capacityconsult]

You're assuming a perfect world of no cancellations and all patients being 99214 + 90833 (neither of which is true). New evals? Stable one diagnosis (ie ADHD) patients? 8 hours a day of patient care is also a lot, most salaried outpatient jobs include an hour of admin time to catch up on notes/calls/etc. Most outpatient psychiatrists see about 12-14 patients per day. A new grad got an inpatient contract for 60ish dollars per RVU. They are taking advantage of you with that low RVU rate and then expecting you to cover a busy inpatient unit over the weekend. You could make a lot more than you realize billing the same number of RVUs in private practice.

 

[nexus73]

You’ve laid out the absolutely best possible scenario.

Super suspect to bill 90833 on everyone. Coders may push back on this. The stable ADHD patient questioning their bill and words like fraud being thrown around are not good.

You work 8 hours straight no admin time? Most work 7 hours with 1 hour for charting, so that’s only 14 followups per day. There will be no shows, so you’re at let’s say 11 per day. Estimate 6 therapy addons. Much fewer RVUs than you’re projecting.

That rvu rate should be $60 or more though, at $33 you’re getting screwed.

 

[NeuroKlitch]

thanks, the 33$ i used in the example was part of my confusion, since i read that RVU in 2023 is 33.09 or something about RVU conversion rates, was not a number that was given, second round interview is coming up and just wanted to be educated in case there was pressure to sign, and to be able to negotiate from a place of understanding during.

I'm between doing this , or just going straight locums at local correctional facilities which were offering about anywhere between 200-270 an hour 2 weeks on 2 weeks off. Figured if i dont burn out with that 2 week gap in place, could ideally grind it out and make somewhere close to 500, and then ideally stash around 150k or so of that into self directed 401k and a cash balance plan, and slowly try to build a telehealth PP during those 2 weeks off or just travel for a while and enjoy life and build some coin, then switch to a full time job like the one above or bounce out to puerto rico for a few years and take advantage of ACT 22. However, the allure of stability from having a employed job in the city a grew up in sounds nice after the last 12 years.

 

[splik]

If this is an academic position, would you be faculty? If so presumably you would have to attend various conferences/grand rounds etc, teach, supervise trainees, serve on committees etc. These activities may not be compensable unless they offer educational RVUs or other bonuses for academic activities. If it is a pseudo-academic position may be worst of both worlds. You should also have time set aside for all the admin crap you may have to do. All of that cuts into your time. Assume 30-32 clinical hours per week. You may be able to work additional hours about 40 however to make more. In these sorts of jobs you are almost always expected to see new patients on an ongoing basis, so it would also be wrong to assume you'd just be seeing follow ups. a new pt is 4.16 wRVUs per hour using 90792.

Conversion factor depends on institution. Academic facilities usually the deans office and department and possibly even division are taking big cuts of the money. At my last job, they were given an offensive $40/wRVU after all of these "taxes" to faculty as a "bonus" at the end of the academic yr.

 

[Bartelby]

I agree with splik, 32 hours of clinical time blocked out per week is a full-time job (and likely more than that if you have real academic duties beyond just taking care of patients).

You estimated 45 weeks per year, which is fair enough. That is basically two weeks worth of holidays, a few weeks of vacation, and 1-2 weeks of sick or other leave time (remember everything subtracts from your bottom line in an RVU model).

I also think ~4.5 RVUs per hour average might be closer to correct than 6. As mentioned above, 6 RVUs per hour is only for 99214 + 90833. When you consider intakes, sessions without a therapy add-on, or longer sessions (like doing a one-hour meds + therapy session) the average drops quickly. For instance, two 99214 on the old scale is 3 RVUs per hour.

I also totally agree that you should factor in no-shows and unfilled time in the schedule. So those 32 theoretical hours drop to, say, 26 hours actually billed.

So running those numbers: 26 hours billed per week x 4.5 RVUs per hour x 45 weeks per year x $33 per RVU = $173,745.

If we bump up to $60 per RVU, that's $315,900. Which, by the way, is right about what you would expect for a pure clinical job with a big system.

You can easily adjust around the assumptions, but the point is the RVU approach you describe doesn't sound overly generous, and I have to wonder how academic this job is (versus mainly a model of less expensive clinical labor). $33 per RVU with a pure outpatient clinical grind seems like an unnecessarily difficult way to make a living to me.

 

[Bartelby]

And I didn't factor in the weekend unit rounding, but personally I would not have much interest in doing that. It will bring up your bottom line, but you know better whether weekend rounding / call is something you would be fine with long-term.

 

[forchinet121]

33 dollars per wrvu is exploitative and disgusting

 

[WisNeuro]

33 dollars per wrvu is exploitative and disgusting

OP was not quoted that, he was using the CMS RVU conversion factor. But, this does get at why MH units in medicare/medicaid heavy systems are huge loss leaders and are getting shut down all across the country.

 

[Stagg737]

thanks, the 33$ i used in the example was part of my confusion, since i read that RVU in 2023 is 33.09 or something about RVU conversion rates, was not a number that was given, second round interview is coming up and just wanted to be educated in case there was pressure to sign, and to be able to negotiate from a place of understanding during.

I'm between doing this , or just going straight locums at local correctional facilities which were offering about anywhere between 200-270 an hour 2 weeks on 2 weeks off. Figured if i dont burn out with that 2 week gap in place, could ideally grind it out and make somewhere close to 500, and then ideally stash around 150k or so of that into self directed 401k and a cash balance plan, and slowly try to build a telehealth PP during those 2 weeks off or just travel for a while and enjoy life and build some coin, then switch to a full time job like the one above or bounce out to puerto rico for a few years and take advantage of ACT 22. However, the allure of stability from having a employed job in the city a grew up in sounds nice after the last 12 years.

As Wis said, that's the CMS conversion factor and is only a portion of the equation for how compensation for billable codes is calculated. You're correctly only using wRVUs for your compensation calculations, but not including potential geographic conversion factors. You're also assuming this is a 100% CMS population which is unrealistic. CMS is going to be the lowest payor for major health systems where the system has negotiated for insurance to reimburse multiples of what CMS would.

You may not get reimbursed at $60/RVU if this is an academic position, but like others said you should be making significantly more than $33 per hour.

 

[Sushirolls]

Here is my understanding of current wRVU values:
99204 2.6
99205 3.5
90792 4.16
99417 0.61
90833 1.5
99213 1.3
99214 1.92
99215 2.8
99406 0.24
96127 0.00

Here is my source:

RVU Calculator - AAPC Relative Value Units​

CPT® RVU calculator provides a quick analysis of the work relative value units associated with a certain volume of CPT or HCPCS codes.

www.aapc.com

 

[Bartelby]

Correct. Some systems, though, have kept using the old system and thus shortchange their providers. You want to clarify whether the system has started using the new wRVU values or whether they have remained on the old scale.

 

[J ROD]

To make better advantage of things if you are efficient and want to see more patients hence more wrvu and more money. You could see follow ups in 20 min. and new patients in 40 min. Typically, let's say I see 12 follow ups in the morning. I usually get 4-6 with add on 90833. Some are easy follows up just give me medications. Some requires more support. Generally it works out nice. I am able to chart while I see them mostly and finish up between no shows and lunch. But yeah do not expect 99214 + 90833 on all patients. Should bill 99214 most times but a simple depression, ADHD that takes 5 minutes is a 99213. Also, not everyone needs that supportive add on. But, this way can get you more money if you are efficient and can keep schedule and notes up. Also, expect about a 20% no show rate. And then there are bad weather days......

 

[NeuroKlitch]

I'm being told 63-68, this fair, average , or competitive?

 

[Merovinge]

I'm being told 63-68, this fair, average , or competitive?

Good if it's based on new RVU numbers for OP care.

 

[forchinet121]

Good if it's based on new RVU numbers for OP care.

Competitive