Since I have been an attending for a year, RVU's is something that I have focused on. I started the first three months with an average RVU/patient at 3.5 and gradually increased to 4.45 - 4.5/patient. In all honesty the same type of patients, just better documentation. In my 3rd year of residency I went to the ACEP RVU stuff and this year I went to a couple of RVU things...
First, remember the basics. It's been said here, but let me reiterate. Always have PMH, surgical, and social. When a patient has pain, do your PQRST crap...we learned it in medical school...now we can bill for it. Always remember all of the HPI and review of systems. I have a set, memorized review of systems that I ask everyone so I don't have to worry about not hitting the 10 systems on one that ended up admitted or something. Unless it is a toothache that is obvious, I ask my memorized crap. For physical exam, document everything you do and make sure you do eight systems. Remember, just looking at them when you talk you can tell there's no d/c or erythema from the eyes, CN II - XII are grossly intact, if they are in distress or not (that's 3 systems right there).
Crit Care makes a huge difference. Using the mantra of "if I left the patient alone, they could die" is a great way to determine if crit care can be billed. We all understand the obvious intubated, hypotensive patient. Don't forget you can't bill crit care and for a procedure so you have to time it differently. If you spent 10 minutes intubating someone, it's not crit care...but the 10 minutes in the room listening to the patient, watching the vitals, having the resp therapist come down, the nurses getting the crash cart and meds do...We usually get those but the problem is the ones that aren't too sick but aren't great either. A pyelo in a young girl that has a HR of 120 on arrival with temp of 101 but after a bolus or two, tylenol, abx her HR is now 80, BP is normal, temp is normal and she is healthy and you d/c home she is still crit care. If you left her alone she could've crumped (wouldn't have been right away because young and healthy but definitely would've). An asthma patient that has O2 sat 93%, RR 24 and wheezing like crazy but after 3 nebs, steroids and such...and now they are at their baseline and everything normalized, it is still crit care even if you d/c home. If I left that person alone for another hour or two they wouldn't have made it. We do a horrible job billing for crit care and miss so many opportunities.
Procedures are easy ways to get RVU's but we all knew that already and it usually isn't a problem when it comes to billing since we usually remember to document those.