RVUs?

[suckstobeme]

What are they? What do I need to know about them? I hear the term a lot, and I just politely nod.

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[deleted77919]

Here's a pretty good answer.

http://www.texmed.org/Template.aspx?id=1531

 

[docB]

The site Dakota linked is pretty good. A simpler explaination is that the RVU or Relative Value Unit is a way to standardize and compare the amount of work bone by docs. It's especially important for EPs because the volume and complexity of our patient load changes every shift. We need a way to compare and fairly pay docs who see these changing patient loads. You can't just use number of patients seen because they bill differently.

Here's what you need to know. After you finish a chart the work you did, based only on your documentation so document well, the chart will have an RVU assigned. This is usually done by whoever does your billing. You will then be paid based on however your group pays you which may or may not be based on the RVUs.

 

[deleted109597]

Dollar bill y'all.

 

[pseudoknot]

The site Dakota linked is pretty good. A simpler explaination is that the RVU or Relative Value Unit is a way to standardize and compare the amount of work bone by docs. It's especially important for EPs because the volume and complexity of our patient load changes every shift. We need a way to compare and fairly pay docs who see these changing patient loads. You can't just use number of patients seen because they bill differently.

Here's what you need to know. After you finish a chart the work you did, based only on your documentation so document well, the chart will have an RVU assigned. This is usually done by whoever does your billing. You will then be paid based on however your group pays you which may or may not be based on the RVUs.

I remember reading somewhere recently the fact that the committee that actually decides what the RVUs are for everything is composed of a disproportionately high number of physicians from the procedural specialties. Has anyone else heard or thought about this? The implications were fascinating.

OK, found it:
http://allbleedingstops.blogspot.com/2007/11/ranting-on-ruc.html

 

[supercut]

I remember reading somewhere recently the fact that the committee that actually decides what the RVUs are for everything is composed of a disproportionately high number of physicians from the procedural specialties. Has anyone else heard or thought about this? The implications were fascinating.

OK, found it:
http://allbleedingstops.blogspot.com/2007/11/ranting-on-ruc.html

Which is exactly why you can compare RVU for various procedures and wind up scratching your head. From my general surgery days, I learned that placement of a mediport is worth more RVU than either a mastectomy or a splenectomy.

Mediport placment:The RVU include: 30 min (max) procedure, quick preop visit and simple wound check POD 1. Usually you use absorbable suture so no need to remove sutures/staples

Mastectomy:The RVU include: Long (min 1hr) preop visit with lots of crying (newly dx Ca pt), surgery can take a couple hours, needs drain placement and management (unless simlutaneous reconstrution by plastics...then they do that). Pts generally spend 1-2 nights in hospital, rounded on, followed up in the office and have the final pathology report explained to them.

Splenectomy: The RVU include: Can be complicated when done for splenomegaly from a bone marrow disorder or if there is bleeding risk from ITP. Huge spleen isn't so easy to get out without some blood loss and a BIG incision. Pts with a marrow disorder aren't the healthiest and can take 5 days to recover enough from surgery to go home. Must be rounded on, post op visit and staple removal.

So why is the mediport worth more RVU than either a mastectomy or splenectomy? Becuase the IR guys on the committee that decides RVUs do mediports!

 

[NinerNiner999]

docB - for an EM physician, what is a good average RVU/hr?

 

[docB]

docB - for an EM physician, what is a good average RVU/hr?

Interesting question. And here's the answer everyone hates: it depends.

Seriously it depends on the set up you use. If your ED has poor ancillary services, low volumes, you have to run around findng lab results and xrays it will be less. If you don't it will be more. Some paradigms use scribes, hire "admission coordinators," put all chest pain to CP obs immediately on presentation and so on. They have high RVUs but their overhead is higher to pay all those extra people.

My group does not use scribes, we use paper T sheets, have PAs for part of the day, no admission coordinator and we actually write the admission orders (don't ask), high acuity and admission rates and we run in the neighborhood of 8-10 RVU/hr.

 

[Apollyon]

There is indeed some bias in RVUs, just as stated above (the winners write the history books).

You want one of the biggest tricks? Use a scalpel or blade to remove a foreign body. If you document forceps, say it's "x". Using a blade, however, increases the RVU to 4.5 or 5x. I'm not kidding - I couldn't believe it.

I became curious after I tried to find out how many RVUs came from a chest tube I put in for a spontaneous tension pneumo. All I could find was that chest tubes are bundled with CT surgery. Coding and billing seems kind of sketchy, flooded by microscopic details (it pays more to diagnose what part of the abdomen hurts instead of just "abdominal pain" - put in the RLQ or periumbilical or diffuse).

 

[crewmaster1]

It seems like if we could spend another year just studying billing and coding we could increase our pay by 50%, mostly because we leave stuff out. We get some GR teaching (mostly about how stuff is codeded), but little tricks like using a blade pretty cool. However, you do have to keep patient care in mind because I assume they are billed based on RVU as well (?) and using a scapel when one isn't necessary just to increase billing isn't good! If they have RUQ pain, call it as it is!

 

[Apollyon]

It seems like if we could spend another year just studying billing and coding we could increase our pay by 50%, mostly because we leave stuff out. We get some GR teaching (mostly about how stuff is codeded), but little tricks like using a blade pretty cool. However, you do have to keep patient care in mind because I assume they are billed based on RVU as well (?) and using a scapel when one isn't necessary just to increase billing isn't good! If they have RUQ pain, call it as it is!

To my knowledge, patients are not billed by RVU - there's the flat rate service level (1-5), or critical care, then the procedures, which are heavily protocolized - know what the most important thing in suturing lacs is (for billing)? How long was the lac.

And I think that if you spent a year studying billing and coding, you'd end up inpatient psych, because you'd barely be a quarter into it and would be spinning in your seat, and wish you'd never gotten into it.

 

[deleted77919]

and using a scapel when one isn't necessary just to increase billing isn't good! If they have RUQ pain, call it as it is!

Oh come on, using the blunt end of two scalpels instead of forceps for a foreign body removal is perfectly legitimate. Just be careful not to cut your hand.

 

[leviathan]

Dollar bill y'all.

CREAM, amirite???