Maximizing wRVUs - Cardiac Surgeon

[NEEDLE DRIVER]

I’ve been a practicing cardiac surgeon for 6 years and want to maximize my productivity. I feel like I do a decent job but am hearing how some surgeons are getting way more RVUs for the same cases. If anyone has any tips or tricks or a resource that was helpful for them I’d appreciate it.

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[operaman]

My unofficial fellowship “research” project was looking at this but in ENT. My method was to pull publicly available salary data and find the highest paid docs in my subspecialty field. Eliminated any with other appointments like chairs or major non clinical roles.

Once I had a list of the top, I pulled their Medicare billing data which shows what codes they bill and how often, assuming the Medicare data is a decently representative sample. Learned a TON from this - codes and billing strategies I didn’t even know existed. And many of these docs were in the 7-figures for many years so they must have been audited at some point given they were definitely outliers.

Then serendipitously some of their former patients came my way early in practice so I had access to all their past notes and templates that I promptly adopted and which confirmed what I hypothesized from the billing data.

So if you know people billing a lot more rvus, start looking at their data and see what they’re doing.

 

[NEEDLE DRIVER]

My unofficial fellowship “research” project was looking at this but in ENT. My method was to pull publicly available salary data and find the highest paid docs in my subspecialty field. Eliminated any with other appointments like chairs or major non clinical roles.

Once I had a list of the top, I pulled their Medicare billing data which shows what codes they bill and how often, assuming the Medicare data is a decently representative sample. Learned a TON from this - codes and billing strategies I didn’t even know existed. And many of these docs were in the 7-figures for many years so they must have been audited at some point given they were definitely outliers.

Then serendipitously some of their former patients came my way early in practice so I had access to all their past notes and templates that I promptly adopted and which confirmed what I hypothesized from the billing data.

So if you know people billing a lot more rvus, start looking at their data and see what they’re doing.

Yeah. That would be ideal. Unfortunately these docs don’t work where I do and I have no access to their data. But definitely something worth doing if you have that access. I could always just ask them. There aren’t many of us around.

 

[operaman]

Medicare data is public record. Can look up based on name/NPI and pull the raw data. I found codes billed, frequency, etc. for docs all over the US.

If theyre just out working you then that won’t show up, but if you find codes being billed that are unfamiliar, you may be able to tease out a pattern.

For example, in my world the code for I&D of a neck abscess pays like 4 wRVU. But there’s another code for open drainage of a retropharyngeal/parapharyngeal abscess that pays 12. I found many of my partners were just billing the first code even for para/retropharyngeal ones because they didn’t know about the other code.

There are also a lot of rarely used overvalued plastics recon codes that a lot of surgeons use fairly liberally. For example, named muscle rotational flaps that often take 5 minutes extra to do may pay as much or more than the primary case codes. Like if I do a sternohyoid rotational flaps to reinforce a tracheal anastomosis, it basically doubles the wRVU for the procedure. Start adding in little skin grafts and fat grafts and whatnot and it can get pretty insane. If the other docs are doing this frequently, it’ll show up in their Medicare data.