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All Branch Topic (ABT) minimal RVU expectations...

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DD214_DOC

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I know why these matter for the federal employee providers, but I have yet to find a reason why any active duty should really care about meeting them. Does anyone else know?
 

sonofva

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I think it has to do with hospital and department funding, as it was described to me. Mtf gets dollars for total rvu which get distributed to departments to buy stuff and pay contractors

There is someone who is tracking your rvu and medical coding.

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jabreal00

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I think it has to do with hospital and department funding, as it was described to me. Mtf gets dollars for total rvu which get distributed to departments to buy stuff and pay contractors

There is someone who is tracking your rvu and medical coding.

Sent from my iPhone using SDN mobile

^^This^^

My first assignment after completing fellowship I was sent to small to medium sized MTF located in a large Army base. I was chief of my section. RVUs are all what the command (DCCS/Hospital commander) cared about. We had meetings every quarter to go over the clinic's RVUs as well as each individual providers RVU in that clinic. We had no control of our schedule, number of clinic or procedure slots and all appointments were done by central appointments.

At the end of the year big command gives money to each hospital based on the year to date RVU. Overall funding can decrease if RVUs are down because on paper it looks like the MTF does not have a lot of business or has decreasing business. This is important for those small to medium sized MTFs. A slash in funds means not being able to support an ER or an inpatient service. Once that happens, it's a vicious cycle of more loss in funding which leads to inability to hire nursing and ancillary staff. Eventually a MTF can close. So for each hospital commander and DCCS it is grow or die in many small to medium sized MTFs.

MEDCENS don't have the same type of pressure.
 

HighPriest

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    At best it's a fitrep bullet.

    If the command isn't making its metrics then the CO gets leaned on by external powers, and that sort of thing tends to run downhill.
    beat me to it. You're measuring them so that someone can put on his or her OER that they were able to track productivity, and next year they'll "make improvements" by mandating that you do 10% more. it does have to do with what the hospital gets delegated every fiscal year (I don't like to say "gets paid", because I feel like that might insinuate that work was being done). However, until the Army actually stops distributing cash to it's hospitals based upon low productivity, this is an empty threat.
     

    DD214_DOC

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    There are many problems with this, such as:

    1. Push to produce RVUs which -- at some point -- affects the quality of clinical care being delivered.
    2. One policy/push to produce lots of RVUs, which requires carrying a sizeable panel and frequent appointments along with a good source of referrals, and then another policy that requires your clinic/service to function as a, "consultation-only" service and does not want providers having sizeable panels, attempts to reduce referrals from primary care by functioning as a consultant, pushes the disposition goal to return stable patients back to primary care, and institutes a policy that limits follow-up appointments to a maximum of 8 sessions. So, essentially, let's make RVU production a top priority while creating other policies that significantly interfere with your ability to produce RVUs. Brilliant.
    3. Many people choose to practice in the DoD/VA system because they did not like the emphasis and priority of producing RVUs experienced in the civilian sector, and many knowingly accepted lower income potential for this reason. Let's completely negate this for everyone, and now all of these providers have to function in basically the same type of system and environment but with less pay. Do people wonder why so many are leaving? At least, they have been where I'm at.
    4. See end result of point 3. More providers leave, which places additional burden on the providers who stay, many of which have to assume administrative and other responsibilities, which interferes with their ability to produce RVUs.

    Ugh. I'm pretty sure many others post-residency have written essentially the exact same thing as I just did over the years.
     

    dr zaius

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    What I find interesting is that here OR cases do not generate RVUs. It's all through clinic and consult notes. Yet, everyone is cracking down on RVUs...and they keep yelling at surgical services for not generating enough.
     

    psychbender

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    Even more dumb/weirdness. When I was a resident, I spent time in Landstuhl doing acute pain. There, they realized that anesthesia cannot generate RVUs, so they divorced regional and acute pain from the Anesthesiology Department, made it its own Department of Acute Pain Medicine (staffed entirely by the anesthesiologists), and put in a full formal consult note (with full ROS and PE) and procedure note into AHLTA or Essentris, complete with all proper codes, for every single block performed for surgery (and inpatient consult/procedure notes for patients with catheters). The net effect was APM became the most 'productive' service in the hospital, able to obtain additional support staff and equipment. No major changes in work, just changes in structure and coding. Now that's how you game the system.
     

    HighPriest

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    What I find interesting is that here OR cases do not generate RVUs. It's all through clinic and consult notes. Yet, everyone is cracking down on RVUs...and they keep yelling at surgical services for not generating enough.
    Yeah, that's not just you. Not to mention, when I do a case with five parts that would bill thousands of dollars, they code with the most simplistic, lowest-generating code possible.
     

    HighPriest

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    Even more dumb/weirdness. When I was a resident, I spent time in Landstuhl doing acute pain. There, they realized that anesthesia cannot generate RVUs, so they divorced regional and acute pain from the Anesthesiology Department, made it its own Department of Acute Pain Medicine (staffed entirely by the anesthesiologists), and put in a full formal consult note (with full ROS and PE) and procedure note into AHLTA or Essentris, complete with all proper codes, for every single block performed for surgery (and inpatient consult/procedure notes for patients with catheters). The net effect was APM became the most 'productive' service in the hospital, able to obtain additional support staff and equipment. No major changes in work, just changes in structure and coding. Now that's how you game the system.
    And we had that at my last station. It was eventually fixed after a ton of work by one of my colleagues, but in a nutshell they were t allowing our anesthesia personnel to "count" thinks like epidurals. Even though our major product as a hospital was babies - by far. I mean, we dumped out so many kids, you'd think it was perpetually prom night.
     

    DD214_DOC

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    Yeah. It's dumb, dude. This is milmed.

    The OPORD I mentioned seems to more or less be ignored by everyone. Is this pretty typical? I guess with no local command interest in enforcing it, not much reason to follow. This begs another question, though -- what does one do if local command policy/procedures conflicts with an OPORD?
     
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