Average RVUs/hr

[CreoleDoc]

Hey all,

I've searched this topic already and haven't seen any GOOD answers to my question.

I'm considering a job that's RVU with a base salary. I've done my research but still have a lot to learn about RVUs as my residency hasn't offered much in regards to this topic. I know all docs have different charting abilities and see patients at different speeds but I am curious on average how many RVUs per hour most docs are able to bill for. Lets assume charting is equal and the patient population is mixed acuity. Prospective job director says most at their shop get ~6RVUs/hr.

1. Is this (6RVUs/hr) pretty doable? Low? High?
2. What would this equate to roughly in patient/hr in a lower acuity/fast track setting.
3. What about patients/hr in high acuity setting?

2pph in a high acuity area with level 5 coding is 7.6rvu/hr - right? - then add EKG interp, CC time etc... so at 2 per hour in a 30% admission area could yield more than 7.6?

I just want to be able to compare the RVU job to a pure hourly rate job as best I can.

My residency does not give us these these numbers so I dont know where I will fall at once out. Its hard to feel great about taking a job thats RVU based not knowing what I am capable of. Thoughts and/or advice would be appreciated .

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[BoardingDoc]

Hey all,

I've searched this topic already and haven't seen any GOOD answers to my question.

I'm considering a job that's RVU with a base salary. I've done my research but still have a lot to learn about RVUs as my residency hasn't offered much in regards to this topic. I know all docs have different charting abilities and see patients at different speeds but I am curious on average how many RVUs per hour most docs are able to bill for. Lets assume charting is equal and the patient population is mixed acuity. Prospective job director says most at their shop get ~6RVUs/hr.

1. Is this (6RVUs/hr) pretty doable? Low? High?
2. What would this equate to roughly in patient/hr in a lower acuity/fast track setting.
3. What about patients/hr in high acuity setting?

2pph in a high acuity area with level 5 coding is 7.6rvu/hr - right? - then add EKG interp, CC time etc... so at 2 per hour in a 30% admission area could yield more than 7.6?

I just want to be able to compare the RVU job to a pure hourly rate job as best I can.

My residency does not give us these these numbers so I dont know where I will fall at once out. Its hard to feel great about taking a job thats RVU based not knowing what I am capable of. Thoughts and/or advice would be appreciated .

1: Is this doable? Yes. Low/High? Depends entirely on your dept.
2: If you assume all your fast track is an equal mix of lvl 2 and lvl 3 charts on everything(this is being conservative, it's probably more 3s than 2s), that's approx 1.4 RVU/pt, so 6rvu/hr is 4 pts an hr. Doable in fast track for sure, but you need the volume.
3: You literally already stated the math for this. High acuity area with 2 pph where both are lvl 5 charts = 7.6 rvu.

Short answer: yes, 6RVU/hr is probably a reasonable average in a decently busy shop.

 

[GeneralVeers]

6 RVU would be very low, and you would get paid nothing. Most places I've worked at 2.5 pts/hour and ~ 4 RVU/pt you are easily at 10-12 RVU/hour.

 

[CreoleDoc]

6 RVU would be very low, and you would get paid nothing. Most places I've worked at 2.5 pts/hour and ~ 4 RVU/pt you are easily at 10-12 RVU/hour.

From what I understand in our current practice environment, at least in my state, each RVU is worth ~$40 currently so 6/hr is $240/hr. This is considered low? 10-12/hr @ $40 per is alot of $$$

 

[goodoldalky]

From what I understand in our current practice environment, at least in my state, each RVU is worth ~$40 currently so 6/hr is $240/hr. This is considered low? 10-12/hr @ $40 per is alot of $$$

Here's the questions: what do you get paid per RVU? (What does your contract say?) Are you paid a relative proportion from a pool of what is paid in or do you only keep RVUs that are subsequently collected?

 

[BoardingDoc]

6 RVU would be very low, and you would get paid nothing. Most places I've worked at 2.5 pts/hour and ~ 4 RVU/pt you are easily at 10-12 RVU/hour.

Your shop sees no fast track traffic? In order to get an average 4 RVU/pt you need to be writing a 50/50 mix of lvl4 and lvl5 charts.

 

[carbonizedeyesockets]

6 RVU would be very low, and you would get paid nothing. Most places I've worked at 2.5 pts/hour and ~ 4 RVU/pt you are easily at 10-12 RVU/hour.

Citation? One source put it between 6&7 RVUs per hour. (http://www.best-practices.com/wp-content/uploads/2015/08/Staffing-Your-ED_White-Paper.pdf)

 

[coachB]

Your shop sees no fast track traffic? In order to get an average 4 RVU/pt you need to be writing a 50/50 mix of lvl4 and lvl5 charts.

With EmCare doing the billing, fast track patients will be at least a 4.

 

[RustedFox]

Your shop sees no fast track traffic? In order to get an average 4 RVU/pt you need to be writing a 50/50 mix of lvl4 and lvl5 charts.

Pretty sure he's talking about just his share of the patients; the acute side of things.

On a tangentially related note (and Veers will appreciate this); my "Go the Hell Home" game is reaching major-league level. I just had a string of 6 nightshifts in a row. Every shift when I walked in, there were 3-5 patients in the WR, mostly level 4s. I had those suckers dispo'd in 10 minute each, thus effectively clearing the backload. We also get a "just prior to midnight" bolus of level-4 bull$hit, which are also very "go the hell home"-able.

Veers is right about some people doing ridiculous workups. It's THESE people that the subspecialty folks love to rip on, and that give the rest of us a bad name. I don't care if they're MD/DO/NP/PA... some people just don't get it. I actually read an NP chart that said this the other night... verbatim.

"Patient (8-year old kid) has a plantars (sic) wart, but mom is concerned about infection because she says it smells bad. I do not see anything malodorous, but I will prescribe anitbiotics."

Rx: Clindamycin 300mg TID.

Seriously. Clindamycin for a Plantar's wart and smelly feet. I called mom and told her to stop. Thanks for making more work for me, MLP!

 

[GeneralVeers]

Pretty sure he's talking about just his share of the patients; the acute side of things.

On a tangentially related note (and Veers will appreciate this); my "Go the Hell Home" game is reaching major-league level. I just had a string of 6 nightshifts in a row. Every shift when I walked in, there were 3-5 patients in the WR, mostly level 4s. I had those suckers dispo'd in 10 minute each, thus effectively clearing the backload. We also get a "just prior to midnight" bolus of level-4 bull$hit, which are also very "go the hell home"-able.

Veers is right about some people doing ridiculous workups. It's THESE people that the subspecialty folks love to rip on, and that give the rest of us a bad name. I don't care if they're MD/DO/NP/PA... some people just don't get it. I actually read an NP chart that said this the other night... verbatim.

I like it "Go the Hell Home" but I say it in a minimally sarcastic way that doesn't sound bad if they quote me in a complaint letter.

Towards 6AM I make the night shift nurses a deal. If they can get the few labs/meds/X-rays I have ordered done by 5:45, I can discharge the "go the hell home" patients before Dr. Painmed McTesty comes on and starts his million dollar workups/bogus admissions. Surprisingly I have very few patient turnovers at 6AM, and few who need to be seen.

Really, most of the stuff that comes in between 4AM and 6AM is absolute non-medical garbage.

 

[Groove]

Hey all,

I've searched this topic already and haven't seen any GOOD answers to my question.

I'm considering a job that's RVU with a base salary. I've done my research but still have a lot to learn about RVUs as my residency hasn't offered much in regards to this topic. I know all docs have different charting abilities and see patients at different speeds but I am curious on average how many RVUs per hour most docs are able to bill for. Lets assume charting is equal and the patient population is mixed acuity. Prospective job director says most at their shop get ~6RVUs/hr.

1. Is this (6RVUs/hr) pretty doable? Low? High?
2. What would this equate to roughly in patient/hr in a lower acuity/fast track setting.
3. What about patients/hr in high acuity setting?

2pph in a high acuity area with level 5 coding is 7.6rvu/hr - right? - then add EKG interp, CC time etc... so at 2 per hour in a 30% admission area could yield more than 7.6?

I just want to be able to compare the RVU job to a pure hourly rate job as best I can.

My residency does not give us these these numbers so I dont know where I will fall at once out. Its hard to feel great about taking a job thats RVU based not knowing what I am capable of. Thoughts and/or advice would be appreciated .

RVU productivity as a component of your compensation formula is fairly common these days so I wouldn't encourage you to avoid jobs that utilize it as an incentive for productivity. However, if you work for a CMG (and most of us do), the RVU/hr number given to you at the end of a month after an audit of your patients billed, in my experience, is not usually technically accurate. I've worked for different CMG/locums and the number always seems to change whereas my pph/documentation/efficiency has stayed the same. There's a lot of site specific number averaging (average $$/hr compensation for specific sites) that is applied on top of existing complicated compensation formulas with base salary components and it all gets very complicated when I've asked the powers that be to explain in detail how the number is specifically derived. Suffice to say, my compensation seems to be reasonably reflective of my productivity for the month..and fair.

Honestly, I think it's probably a terrible way for this director to allay your fears about being under compensated. You should just ask him for the bell curve and forget the RVU stuff. You'll figure out RVUs soon enough. What's the average $$/hr most docs are getting paid? What's the lowest? What's the highest? If you can see 2pph and do a decent chart then you're bound to at the very least hit the middle or a little bit above on the bell curve.

I think the guys that know exactly how many RVU/hr they generate are probably SDG with transparent billing/collections. So far, I haven't had that luxury yet.

 

[CreoleDoc]

RVU productivity as a component of your compensation formula is fairly common these days so I wouldn't encourage you to avoid jobs that utilize it as an incentive for productivity. However, if you work for a CMG (and most of us do), the RVU/hr number given to you at the end of a month after an audit of your patients billed, in my experience, is not usually technically accurate. I've worked for different CMG/locums and the number always seems to change whereas my pph/documentation/efficiency has stayed the same. There's a lot of site specific number averaging (average $$/hr compensation for specific sites) that is applied on top of existing complicated compensation formulas with base salary components and it all gets very complicated when I've asked the powers that be to explain in detail how the number is specifically derived. Suffice to say, my compensation seems to be reasonably reflective of my productivity for the month..and fair.

Honestly, I think it's probably a terrible way for this director to allay your fears about being under compensated. You should just ask him for the bell curve and forget the RVU stuff. You'll figure out RVUs soon enough. What's the average $$/hr most docs are getting paid? What's the lowest? What's the highest? If you can see 2pph and do a decent chart then you're bound to at the very least hit the middle or a little bit above on the bell curve.

I think the guys that know exactly how many RVU/hr they generate are probably SDG with transparent billing/collections. So far, I haven't had that luxury yet.

Wow... thank you. Your comment is incredibly helpful. I can only imagine how 'creative' some of these CMGs get.

I would be an employee of the hospital at the hospital that I referenced above and from what I understand they send weekly reports with various metrics including patient/hr and rvus/hr. No punishment for those underperforming. Just incentive to do better. I will reach out to see if I can get a view of this bell shaped curve you speak of. I'm sure with time my efficiency will improve and with it my profits.

Thanks again for the response Groove. Same to those above.

 

[Redrox]

Average for my site for last month was 6.5 RVU per hour with one doc over 8 and another just under 4/hour to give you an idea of the spread. I could dig up some prior month's data but that seems about par for the course. We average a little less than 2 patients an hour. Compensated 100% by RVU and I've been happyish with the salary

Work at two other places but we don't keep that kinda records there.

 

[HooliganSnail]

RVU productivity as a component of your compensation formula is fairly common these days so I wouldn't encourage you to avoid jobs that utilize it as an incentive for productivity. However, if you work for a CMG (and most of us do), the RVU/hr number given to you at the end of a month after an audit of your patients billed, in my experience, is not usually technically accurate. I've worked for different CMG/locums and the number always seems to change whereas my pph/documentation/efficiency has stayed the same. There's a lot of site specific number averaging (average $$/hr compensation for specific sites) that is applied on top of existing complicated compensation formulas with base salary components and it all gets very complicated when I've asked the powers that be to explain in detail how the number is specifically derived. Suffice to say, my compensation seems to be reasonably reflective of my productivity for the month..and fair.

Honestly, I think it's probably a terrible way for this director to allay your fears about being under compensated. You should just ask him for the bell curve and forget the RVU stuff. You'll figure out RVUs soon enough. What's the average $$/hr most docs are getting paid? What's the lowest? What's the highest? If you can see 2pph and do a decent chart then you're bound to at the very least hit the middle or a little bit above on the bell curve.

I think the guys that know exactly how many RVU/hr they generate are probably SDG with transparent billing/collections. So far, I haven't had that luxury yet.

Place that pays you based on RVU's........generally equals "Going to hate my job in the next two years"

 

[shoal007]

my group is just over 4 rvus an hour. we dont get PA's RVUs added to ours even if u saw and wrote a note.

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[thorg12]

Group average of 4rvu/hr?
That's seems mighty low. Is this a cmg or private group.
We're averaging around 4rvu/pt and 7rvu/hr for a sdg
Also 40$/rvu seems kinda high for an average. Probably a well insured pt population.
Are others getting these approximate dollars/rvu?

 

[CreoleDoc]

Group average of 4rvu/hr?
That's seems mighty low. Is this a cmg or private group.
We're averaging around 4rvu/pt and 7rvu/hr for a sdg
Also 40$/rvu seems kinda high for an average. Probably a well insured pt population.
Are others getting these approximate dollars/rvu?

I wonder this as well. The $40 I referenced was from word of mouth only during my interview. I would imagine amount paid per RVU is something that should be explicitly written into the contract? Please advise

 

[shoal007]

Group average of 4rvu/hr?
That's seems mighty low. Is this a cmg or private group.
We're averaging around 4rvu/pt and 7rvu/hr for a sdg
Also 40$/rvu seems kinda high for an average. Probably a well insured pt population.
Are others getting these approximate dollars/rvu?

hospital owned. there certainly is a billing issue. average e and m critical care 4% 5 35% 4 %30. remainder 2s and 3s. our PA group takes off half the patients and we dont get rvu credit even if we're involved.

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[GeneralVeers]

4 RVU would be barely more than 1 pt/hour. Most docs average anywhere between 3.8 - 4.5 RVU/pt. If you are seeing 1 pt/hour and getting a good salary, I want to work there!

 

[thorg12]

I agree with veers.
If 35% are e/m level 5; meaning sicker pts compared to level 3. Then there is a big problem if your seeing more than 1pt/hr. I am also not counting PA charts that you see. Only pt solely seen by a doc.

Creoledoc- I wish all jobs showed how much you collected per rvu. It all depends on payer mix.

If all docs knew this they would be furious at the rates they are getting when they're seeing 2.5 pts/hr and getting paid 200$/hr

 

[bravotwozero]

At my shop, most docs are averaging between 9-11 rvus per hour, and 4-5 per patient.

As for the dollar amount per RVU, I am finding this to be difficult to determine. I can easily take my average RVUs per hour, multiply by hours worked that month, get my total RVUs for that month. I can also divide my rvu payment amount with the total rvus to get dollars per RVU.

I have noticed that the dollar per RVU amount varies per month - sometimes it's 7 others other months it's 9!

The other issue is how rvu payments are calculated at my shop - all the rvus are pooled at the end of the month with a multiplier, and each person gets a percentage of rvu payment based on their percent contribution to the pool, so if you contributed 29% of the rvus you get 29% of the rvu money.

So I don't know how this works. Does the percentage rvu payment formula cause the dollar per rvu amount to fluctuate?


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[shoal007]

This thread is very insightful. Apparently, we are way under billing. Avg rvu pp is 3 in my group. We get paid at market.
I see 1.6 pph, rvu/hr 4.5.

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[GeneralVeers]

At my shop, most docs are averaging between 9-11 rvus per hour, and 4-5 per patient.

As for the dollar amount per RVU, I am finding this to be difficult to determine. I can easily take my average RVUs per hour, multiply by hours worked that month, get my total RVUs for that month. I can also divide my rvu payment amount with the total rvus to get dollars per RVU.

I have noticed that the dollar per RVU amount varies per month - sometimes it's 7 others other months it's 9!

The other issue is how rvu payments are calculated at my shop - all the rvus are pooled at the end of the month with a multiplier, and each person gets a percentage of rvu payment based on their percent contribution to the pool, so if you contributed 29% of the rvus you get 29% of the rvu money.

So I don't know how this works. Does the percentage rvu payment formula cause the dollar per rvu amount to fluctuate?


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If you are being paid from an RVU pool the $/RVU will naturally fluctuate because all RVU aren't the same. If you see a self-pay patient you may generate 4 RVU, however they don't pay their bill so the actual $/RVU from that patient is zero. Your bonus pool will average things out somewhat, but there will be significant monthly variation based on volume, and payor mix.

 

[EctopicFetus]

a "normal" ED should generate 4+RVU per patient.

Published numbers are 1.8-2.2 pph.

Top 20 ED Reimbursement Codes 2016 // ACEP

Level 5 is 4.9 RVU.. throw in an EKG interp and you are at 5.12 for that patient. 6.3 RVUs for a critical care plus EKGs and procedures.

If you see ab pain with any real work up you are at a level 5 chart.

Hard to believe there are EM docs not generating 8 RVU/hr.

On another note you have to have a real good payer mix to get $40/RVU. I imagine most are right around medicare rates of $36.

 

[emergentmd]

RVU only pay can create alot of animosity esp if its not busy.

If you are up to fighting for patients, board watching all day then great. You will really love it when your partner sitting next to you are board watching, you go to the bathroom and come back with him signing up for 3 patients that popped up in triage.

 

[BoardingDoc]

RVU only pay can create alot of animosity esp if its not busy.

If you are up to fighting for patients, board watching all day then great. You will really love it when your partner sitting next to you are board watching, you go to the bathroom and come back with him signing up for 3 patients that popped up in triage.

This shouldn't be an issue in general. If you're salary/hourly/whatever + RVU bonus, it doesn't matter that much anyway. If you're ENTIRELY RVU based, you must work for an SDG, in which case you control your staffing and can ensure that everyone is happy. You also get to make sure that everyone plays nice in the sandbox, because if they don't and everyone feels that way, you just fire them.

 

[Hercules]

a "normal" ED should generate 4+RVU per patient.

Published numbers are 1.8-2.2 pph.

Top 20 ED Reimbursement Codes 2016 // ACEP

Level 5 is 4.9 RVU.. throw in an EKG interp and you are at 5.12 for that patient. 6.3 RVUs for a critical care plus EKGs and procedures.

If you see ab pain with any real work up you are at a level 5 chart.

Hard to believe there are EM docs not generating 8 RVU/hr.
.

Completely agree with this though I will say it can be more dependent on the efficiencies of your ED than the doc at times. I work in an SDG ED where the average RVU/pt is 4.5 and the RVU/hr is 12-13 alone and up to 19 when adding the supervised midlevel charts. I have also worked places where the RVU/hr were half that but it felt like I had to work harder to accomplish it.


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[emergentmd]

This shouldn't be an issue in general. If you're salary/hourly/whatever + RVU bonus, it doesn't matter that much anyway. If you're ENTIRELY RVU based, you must work for an SDG, in which case you control your staffing and can ensure that everyone is happy. You also get to make sure that everyone plays nice in the sandbox, because if they don't and everyone feels that way, you just fire them.

In theory this makes alot of common sense. But there are always that one person who will jump on a chart like its their last meal. When its RVU only, it is a great difference between seeing 20 pts on your shift and seeing 16 pts. 4 charts doesn't sound like much.

That is 25% increase in income. Factor that over a year and you are making 100K less than the guy next to you who is chart watching. Add to the fact that docs will start to speed up their pace so they will be "available" for the next chart. It starts becoming a rat race.

Flat rate + RVU seems like a good medium. RVU only in a overstaffed shop creates undo stress.

 

[CreoleDoc]

a "normal" ED should generate 4+RVU per patient.

Published numbers are 1.8-2.2 pph.

Top 20 ED Reimbursement Codes 2016 // ACEP

Level 5 is 4.9 RVU.. throw in an EKG interp and you are at 5.12 for that patient. 6.3 RVUs for a critical care plus EKGs and procedures.

If you see ab pain with any real work up you are at a level 5 chart.

Hard to believe there are EM docs not generating 8 RVU/hr.

On another note you have to have a real good payer mix to get $40/RVU. I imagine most are right around medicare rates of $36.

I was under the impression that we got paid for only the wRVU portion of the total RVU for the CPT code. So on the TOP 20 RVU by ACEP page - Level 5 Exam shows 4.0 total RVU but only 3.8 are wRVUs. Someone clarify please?

 

[EctopicFetus]

Creole you are incorrect. As an ED doc we get it all. Keep in mind that the wRVU is only a part of the whole. You still have med mal etc.