Hematology / Oncology RVU comp

[onconc]

Wanted to get a general feel of the numbers.

I am getting reimbursed at $84 per RVU. Location is in non-metro part of California. Compensation is RVU based only, i.e. there is no base salary. I get $84 for all the RVUs. I total between 7000 and 11000 RVUs in a year depending on various factors.

Recently, I heard from another colleague in one of the top 2 CA metros that they are reimbursing at $105. I was taken aback since I assumed metros will pay less than non-metros.

I want to ensure that I am not being taken advantage of by my employer.

What are your numbers if you don't mind sharing ?

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[solidonc2020]

Wanted to get a general feel of the numbers.

I am getting reimbursed at $84 per RVU. Location is in non-metro part of California. Compensation is RVU based only, i.e. there is no base salary. I get $84 for all the RVUs. I total between 7000 and 11000 RVUs in a year depending on various factors.

Recently, I heard from another colleague in one of the top 2 CA metros that they are reimbursing at $105. I was taken aback since I assumed metros will pay less than non-metros.

I want to ensure that I am not being taken advantage of by my employer.

What are your numbers if you don't mind sharing ?

I don’t have the data you’re looking for, but out of curiosity how many patients are you seeing roughly to get to that many RVUs?

 

[HemeOncHopeful19]

Based on most posts in this forum I’d say you’re being taken advantage of by your employer.

You’re also being taken advantage of by your state (taxes) to be fair.

 

[onconc]

Based on most posts in this forum I’d say you’re being taken advantage of by your employer.

Could you please elaborate on that ? What are the numbers you think is fair ?

Thanks

 

[onconc]

I don’t have the data you’re looking for, but out of curiosity how many patients are you seeing roughly to get to that many RVUs?

varies between 20 to 35 per day

 

[HemeOncHopeful19]

Could you please elaborate on that ? What are the numbers you think is fair ?

Thanks

I just meant that I feel like most people who post their offers in other threads get offered closer to what your colleague mentioned

 

[gutonc]

I mean, that seems on the low side for an RVU only gig. That said, you're still grossing $6-900K/y so while more is certainly more, you're already well beyond the "sh**load" level IMO.

 

[solidonc2020]

varies between 20 to 35 per day

That's impressive (and maybe a little terrifying). Thanks for the reply.

 

[gutonc]

That's impressive (and maybe a little terrifying). Thanks for the reply.

I am not allergic to hard work but I am personally not interested in working that hard.

 

[onconc]

I am not allergic to hard work but I am personally not interested in working that hard.

Thanks for your responses. Curious to know what sort of work arrangement do you have ? I see in your posts you have mentioned you do some admin work as well .

 

[Ubba]

I'm just a starting fellow, but based on what I've seen on threads here, that productivity rate seems low for this environment, especially with that base. Look forward to reading from those with more valuable input. Also... competitive location? Partnership track?

 

[HemeOncHopeful19]

Hospital-employed position. No partnership.

$100 an RVU or bust

 

[gutonc]

Competitive-ish location.

Hospital-employed position. No partnership.

Doesn't seem unreasonable for that kind of a position. Can't hurt to ask for more but unlikely to get it in a hospital employed situation.

$100 an RVU or bust

I mean, that's nice and everything, but not always practical. The post-tax difference between $90 and $100/wRVU is a rounding error for most of us.

 

[HemeOncHopeful19]

I mean, that's nice and everything, but not always practical. The post-tax difference between $90 and $100/wRVU is a rounding error for most of us.

I don’t disagree but it should be a much, much smaller rounding error for admin.

 

[gutonc]

How many RVUs can someone expect to earn in a 4.5 day work week?

Let's say I build to 15-20 patients per day. Is 2-2.5 wRVUs per encounter a reasonable estimate?

That would give me a range of 6210-10350 wRVUs per year with 46 weeks of work and 4.5 day work week (excluding weekends/inpatient responsibilities). At $90 per RVU that would be $558,900 - $931,500. The high end of that range seems too high, or am I missing something?

I typically tell people to assume 2wRVU/visit as a good baseline. I just looked at my productivity last month and it averaged out to 1.97 wRVU/visit.

Using your formula above, 20pts/d, 2wRVU/pt, 4.5d/w, 46w at $90/wRVU does come out to $750-ish.

I would personally not want to work that hard (20/d for 4.5d a week is a lot in oncology) but that kind of compensation is out there (and roughly what you'd make working in my group if you worked that hard)...I can't get anyone in my group to even try to work that hard, but that's a different issue.

 

[MD46]

How many RVUs can someone expect to earn in a 4.5 day work week?

Let's say I build to 15-20 patients per day. Is 2-2.5 wRVUs per encounter a reasonable estimate?

That would give me a range of 6210-10350 wRVUs per year with 46 weeks of work and 4.5 day work week (excluding weekends/inpatient responsibilities). At $90 per RVU that would be $558,900 - $931,500. The high end of that range seems too high, or am I missing something?

Last year did 9k RVUs, numbers seem legit.

 

[Mehena]

Last year did 9k RVUs, numbers seem legit.

Any efficiency tips to make this many RVU while keeping your sanity year on year?
I'm hospital employed and working with a bunch of slowa$$ MAs and usless NPs.

 

[gutonc]

Any efficiency tips to make this many RVU while keeping your sanity year on year?
I'm hospital employed and working with a bunch of slowa$$ MAs and usless NPs.

My MAs are mediocre at best, 1/3 of my NPs is stellar, the others I choose not to work on the days they're there. The rest of my support staff is excellent.

My productivity (normalized to a 1.0 cFTE...I have a fair amount of administrative FTE) is ~9K a year as well and I don't sweat it all that often TBH. I find the efficiencies in my own workflow to route around the obstructions that come from elsewhere.

 

[MD46]

Any efficiency tips to make this many RVU while keeping your sanity year on year?
I'm hospital employed and working with a bunch of slowa$$ MAs and usless NPs.

I look at new onc patients night prior, takes maybe 15 mins now

Heme new patients are relatively quick.

Off load lvl3 followups to NP and see chemo patients regularly. If still building practice can see things like folfox alternating with NP.

My NP doesn’t provide any RVUs, hence no direct financial benefit.
She is usually on the messages and nurse related issue and I focus on direct patient care.

24-27 patients on avg clinic
2 avg new consults inpatient
Plus 4-5 followup patients , some times less some times more

That’s an average day
4.5 days a week

I dictate pretty quickly with dragon, helps a lot.

In by 8am out before 5 most days.

Plan to continue like this till at least 50yrs of age then dial back

 

[bigboyonc]

Given the CMS changes, can’t you bill level 5 even for FOLFOX q2 weeks if you’re actually seeing them and clearing for chemo? Why give them to NP?

 

[gutonc]

Given the CMS changes, can’t you bill level 5 even for FOLFOX q2 weeks if you’re actually seeing them and clearing for chemo? Why give them to NP?

The CMS coding changes were more related to time based billing and the fact that you can omit BS from your note that we were all copy/pastaing or just making up anyway. The big benefit I find from the CMS changes (and the way Epic tracks things now) is that you can bill for all the time you spend on a case on the day of service, not just F2F or the ">50% F2F" (which...again...we all made up anyway). So I now routinely schedule all of my lung and head and neck patients on Mondays (which is when those tumor boards are), breast on Tuesday and GI on Friday. I open up the charts during the tumor board discussions and typically add 5-20 minutes of time spent on those cases, doing things I'm doing anyway. I legitimately bill prolonged service about 25% of the time now on new or treatment change patients when I probably billed that 2 or 3 times a year in the past.

A stable FOLFOX without any SEs from tx is hard to bill a 99215 on, but not impossible. My chemo follow ups who are sailing through are 99214s and the whole visit, including the note is usually 5-10 minutes.

A lot of people will turf their long-term "survivorship" patients to the NP/PA in the clinic. I find those folks (usually breast cancer) to be the ones to make the biggest stink about not seeing their doctor and to bitch to their surgeon about it...so I just take care of them.

 

[gutonc]

I look at new onc patients night prior, takes maybe 15 mins now

Heme new patients are relatively quick.

Off load lvl3 followups to NP and see chemo patients regularly. If still building practice can see things like folfox alternating with NP.

My NP doesn’t provide any RVUs, hence no direct financial benefit.
She is usually on the messages and nurse related issue and I focus on direct patient care.

24-27 patients on avg clinic
2 avg new consults inpatient
Plus 4-5 followup patients , some times less some times more

That’s an average day
4.5 days a week

I dictate pretty quickly with dragon, helps a lot.

In by 8am out before 5 most days.

Plan to continue like this till at least 50yrs of age then dial back

Are you saying you see 30-35 patients a day on average? Because that sounds terrible.

 

[HemeOncHopeful19]

A stable FOLFOX without any SEs from tx is hard to bill a 99215 on, but not impossible. My chemo follow ups who are sailing through are 99214s and the whole visit, including the note is usually 5-10 minutes.

To bill a 5 it seems like you need side effects bad enough to consider hospitalization? Or are any significant side effects enough?

I feel like I see some attendings bill under side effects while others bill under the “threat to life or bodily function” which seems pretty vague and of course CMS doesn’t give any examples for Onc.

 

[gutonc]

To bill a 5 it seems like you need side effects bad enough to consider hospitalization? Or are any significant side effects enough?

I feel like I see some attendings bill under side effects while others bill under the “threat to life or bodily function” which seems pretty vague and of course CMS doesn’t give any examples for Onc.

If I address and/or manage it, I add it to my list and let the complexity add up. Once you're at 3 items that you're actively addressing/managing you're at a 99215 so no need to go overboard unless it's germane to the actual care of the patient at that moment.

 

[MD46]

Are you saying you see 30-35 patients a day on average? Because that sounds terrible.

Averages out to be in high 20s as i have a half day a week off or “admin” time.

 

[HemeOncHopeful19]

If I address and/or manage it, I add it to my list and let the complexity add up. Once you're at 3 items that you're actively addressing/managing you're at a 99215 so no need to go overboard unless it's germane to the actual care of the patient at that moment.

Sorry to keep asking about this but I'm trying to think about some of this stuff before graduating so I'm less clueless starting out.

I thought for 99215 (based on problems addressed - I know you could theoretically do it without but seems difficult based on the "data reviewed" requirements) you needed either

1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment; or
1 acute or chronic illness or injury that poses a threat to life or bodily function

But you're saying you can bill 99215 as long as you are actively addressing 3 items?

 

[gutonc]

Sorry to keep asking about this but I'm trying to think about some of this stuff before graduating so I'm less clueless starting out.

I thought for 99215 (based on problems addressed - I know you could theoretically do it without but seems difficult based on the "data reviewed" requirements) you needed either

1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment; or
1 acute or chronic illness or injury that poses a threat to life or bodily function

But you're saying you can bill 99215 as long as you are actively addressing 3 items?

Yes. Either of those things can be accounted for by what the average oncologist sees on an active treatment patient.

 

[HemeOncHopeful19]

Yes. Either of those things can be accounted for by what the average oncologist sees on an active treatment patient.

But where does it come in “once you're at 3 items that you're actively addressing/managing you're at a 99215 so no need to go overboard”?

 

[forchinet121]

varies between 20 to 35 per day

35 cancer patients a day seem a **** ton? Or am I wrong?

 

[gutonc]

35 cancer patients a day seem a **** ton? Or am I wrong?

It’s a f***ton. My typical day is 18-22 which, if everything flows well, is a perfect number. Keeps me busy and brings in the bacon.

35 is far more work than I’m interested in doing, regardless of the compensation.

 

[Mehena]

What is a healthy first and second quarter total RVUs for a fresh Hem-Onc community attending to aim for when starting to build new panel ? I think i may be leaving money on the table from under billing/coding.

 

[gutonc]

What is a healthy first and second quarter total RVUs for a fresh Hem-Onc community attending to aim for when starting to build new panel ? I think i may be leaving money on the table from under billing/coding.

Not really an answerable question without knowing your volume/case mix/etc. As a new doc in the group, your panel is probably smaller and composed of more new patients that are often kind of soft/boring consults. Once you're up and running and your schedule is full-ish with a typical mix of new/follow-ups a day, you should be seeing roughly 2wRVUs/patient encounter, on average.

ETA: What makes you think you're under coding? Other than the fact you're not making @HOIV money?

 

[HOIV]

Not really an answerable question without knowing your volume/case mix/etc. As a new doc in the group, your panel is probably smaller and composed of more new patients that are often kind of soft/boring consults. Once you're up and running and your schedule is full-ish with a typical mix of new/follow-ups a day, you should be seeing roughly 2wRVUs/patient encounter, on average.

ETA: What makes you think you're under coding? Other than the fact you're not making @HOIV money?

Ouch

 

[gutonc]

Ouch

You hustle your a** off. No shade intended.

 

[Mehena]

Not really an answerable question without knowing your volume/case mix/etc. As a new doc in the group, your panel is probably smaller and composed of more new patients that are often kind of soft/boring consults. Once you're up and running and your schedule is full-ish with a typical mix of new/follow-ups a day, you should be seeing roughly 2wRVUs/patient encounter, on average.

Exactly! Soft & boring consults but still time consuming- not due to complexity but reassuring anxious and worried patients in a cancer clinic takes time. Don't want be that jerk/curt doctor and tranish my reputation along the way.

ETA: What makes you think you're under coding? Other than the fact you're not making @HOIV money?

Touche.
It's just that, if the wRVU generated so far is predictive of my total annual productivity then may not reach/surpass mean wRVU per MGMA 2021 survey. Not my first rodeo with E/M coding and billing but Hem-Onc side of things takes considerable time & effort with less to show for, at least for the time being. I enjoy the job immensely compared to my previous clinical gig. Time will tell.
I got hustle, though, ambition flow inside my DNA

 

[Oncology08]

Pls anyone could comment on RVU generated in private practice model: how is it different than RVU generated by hospital employed oncologist?

Is it true there is an RVU for chemo administration
RVU for procedures that nurses typically do in the infusion center?
What other RVUs could be granted to a private oncologist that a hospital employed one may not see or get?

In the thread the quoted average RVU is around 2 so you see 20 patients you would expect 40 RVU. Is this true in a pure private model where other RVUs may be added such the chemotherapy administrative one that o got to know about it today

Thanks

 

[HemeOncHopeful19]

Pls anyone could comment on RVU generated in private practice model: how is it different than RVU generated by hospital employed oncologist?

Is it true there is an RVU for chemo administration
RVU for procedures that nurses typically do in the infusion center?
What other RVUs could be granted to a private oncologist that a hospital employed one may not see or get?

In the thread the quoted average RVU is around 2 so you see 20 patients you would expect 40 RVU. Is this true in a pure private model where other RVUs may be added such the chemotherapy administrative one that o got to know about it today

Thanks

It is complicated but you can try searching around for “total RVU vs work RVU” to get an idea. Basically your hospital gets paid for your work component but also additional pay for “expenses” and to cover “malpractice”.

That is just for your work, then there is also fees on imaging, chemo money (average sales price +6%).

The real scam is that hospitals get paid more for this stuff than a private practice can. This is basically because they lobby the government although the official reason is “to help support advanced 24 hour services that our wonderful hospitals provide”. You can still come out ahead because in private practice you minimize your admin costs but it is supposedly getting worse by the year.

 

[Oncology08]

I did a second interview and this is what they offered: baseline 450k, RVU threshold 5000 K, 90 dollars per RVU after you meet your threshold, 50k performance incentive bonus based on achieving target metrics (like buying fish in the sea). Any comments in this offer? Does it sound reasonable

 

[MD46]

I did a second interview and this is what they offered: baseline 450k, RVU threshold 5000 K, 90 dollars per RVU after you meet your threshold, 50k performance incentive bonus based on achieving target metrics (like buying fish in the sea). Any comments in this offer? Does it sound reasonable

Decent offer, close to a metro area or suburban/rural?
If rural could as for a higher rvu value, otherwise seems reasonable.

 

[Oncology08]

Decent offer, close to a metro area or suburban/rural?
If rural could as for a higher rvu value, otherwise seems reasonable.

Inside a large metro area, I like this offer, I believe its decent and clear. I struggled with the first offer from another private group but this one was straightforward and decent given the large metropolitan area and the fierce competition in the city

 

[bobow98]

For a large metro if you see 18 pts a day x 4 days a week, and have about 45 weeks of clinic a year (6 weeks vacation + 1 week CME?) this would be a relatively decent offer - Assuming 6500 E/M RVU a year.

 

[Poor Applicant!]

For a large metro if you see 18 pts a day x 4 days a week, and have about 45 weeks of clinic a year (6 weeks vacation + 1 week CME?) this would be a relatively decent offer - Assuming 6500 E/M RVU a year.

Just curious, with the base 450K and all those numbers you mentioned (18 x 4 day a week), how much does it come to? like 650K? or less?

 

[gutonc]

Just curious, with the base 450K and all those numbers you mentioned (18 x 4 day a week), how much does it come to? like 650K? or less?

Sing along, you know the words...all together now!
"It depends!"

For the position that @Oncology08 described, 6500 wRVU/y, 450K base, $90/wRVU over 5K, you're looking at $585K. Add in that $50K quality bonus and you're at $635K which is close enough to spit at $650K from.

I can tell you that with my current position, those numbers get you in the $500-550K range (with a 12K citizenship bonus). In my new position which is in a "rural" area, that same productivity puts you in the $700-750K range. And that's before the $25K "quality" bonus and retention after years 3-7.

 

[Fpg1245]

Sing along, you know the words...all together now!
"It depends!"

For the position that @Oncology08 described, 6500 wRVU/y, 450K base, $90/wRVU over 5K, you're looking at $585K. Add in that $50K quality bonus and you're at $635K which is close enough to spit at $650K from.

I can tell you that with my current position, those numbers get you in the $500-550K range (with a 12K citizenship bonus). In my new position which is in a "rural" area, that same productivity puts you in the $700-750K range. And that's before the $25K "quality" bonus and retention after years 3-7.

What’s “rural” these days for med onc?

 

[gutonc]

What’s “rural” these days for med onc?

It's not med onc that defines rural, it's CMS (and you can look that up yourself). In my particular case it's a town of ~8K in a county of 25K with a regional population of ~60K. It's 65 miles outside of major metro downtown and <1h to international airport (faster to get to than some areas in the actual metro area).

 

[Fpg1245]

It's not med onc that defines rural, it's CMS (and you can look that up yourself). In my particular case it's a town of ~8K in a county of 25K with a regional population of ~60K. It's 65 miles outside of major metro downtown and <1h to international airport (faster to get to than some areas in the actual metro area).

Compared to rad onc this isn’t rural at all especially since you are close to a major metro.

 

[gutonc]

Compared to rad onc this isn’t rural at all especially since you are close to a major metro.

Hence the "" around rural. I don't consider it rural either, but since CMS does, they can pay me (and the Rad Onc there too) more than they would 45 minutes closer to town.

 

[IM_to_ortho_hopeful]

Sing along, you know the words...all together now!
"It depends!"

For the position that @Oncology08 described, 6500 wRVU/y, 450K base, $90/wRVU over 5K, you're looking at $585K. Add in that $50K quality bonus and you're at $635K which is close enough to spit at $650K from.

I can tell you that with my current position, those numbers get you in the $500-550K range (with a 12K citizenship bonus). In my new position which is in a "rural" area, that same productivity puts you in the $700-750K range. And that's before the $25K "quality" bonus and retention after years 3-7.

Curious - are you actually able to see that volume of patients in rural areas? For 4 days a week, 18pt/d but in a county of 25k are you actually able to fill your schedule? Also how does the care coordination work - for example if you need a patient to go to a surgeon, but there's no surgeon around, do you inevitably have to send them to an academic center?

 

[gutonc]

Curious - are you actually able to see that volume of patients in rural areas? For 4 days a week, 18pt/d but in a county of 25k are you actually able to fill your schedule? Also how does the care coordination work - for example if you need a patient to go to a surgeon, but there's no surgeon around, do you inevitably have to send them to an academic center?

Based on the volume the clinic is already doing, I could see 30 a day 4 days a week and not get through the list. Although the county is relatively small, the next nearest oncology practices are 45 miles to the West, 130 miles to the East, 90 miles to the North and 150 miles to the South. So the catchment area is enormous and the population of the catchment area is probably 4-5x the county.

The clinic is part of a large "fake-ademic" healthcare system that has all the subspecialties you could want, and (more importantly) a system to get them there. Interestingly, of the 3 surgeons at this hospital (2 of whom are friends of mine), 1 is a board certified HPB surgeon and one a thoracic surgeon. Both moved there for lifestyle reasons and chose general surgery practice but they obviously split stuff among themselves accordingly. To be clear, nobody's doing Whipples or trisegmentectomies out there though, but that's because of the post-op ICU and anesthesiology available, not the surgical skill.

 

[mjp1720]

For my first job out of fellowship, I'm looking at a community practice job that is fairly close to academic (they have a small fellowship and everyone in the clinic subspecializes in 2 cancer types).

Got an offer for guarantee of $516,000 for the first two years with $40k - $50k in citizenship bonuses. It sounds amazing but I had some questions related to wRVUs. The conversion factor is $76.82 (which seems low compared to others I've seen on here), and there is an RVU pool above 4,464 wRVUs - after you meet that threshold 40% gets sent to the pool and is distributed equally to all those that met the threshold at the end of the year. Everyone met the RVU threshold pool last year (which I guess makes sense because 4,464 x $76.82 = $342k.

If I'm doing this math right (and I have no idea that I am), when I no longer have a protected salary it will take 6,717 wRVUs to get what my guarantee is. Does that sound right?