.

[CCM-MD]

Lol can you imagine?
- 5 RVUs for pontificating about why the O2 went from 97 to 90.
- 10 RVUs for an ABG (obtained and interpreted).
- 4 RVUs for considering the drop in sodium being from HF exacerbation
- 5 RVUs for documenting why the potassium is 3.4
- 2 RVUs for each medication added to the reconciliation.
- 1 RVU every time the hospitalist clicks the mouse.
- 50 RVUs per family meeting and code status discussion.

I would imagine NPs and PAs reaping a ton of benefits to this.

Agree. The enormous reimbursement for mindlessly driving a camera into the poop hole makes so much more sense!

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[chessknt]

Lol can you imagine?
- 5 RVUs for pontificating about why the O2 went from 97 to 90.
- 10 RVUs for an ABG (obtained and interpreted).
- 4 RVUs for considering the drop in sodium being from HF exacerbation
- 5 RVUs for documenting why the potassium is 3.4
- 2 RVUs for each medication added to the reconciliation.
- 1 RVU every time the hospitalist clicks the mouse.
- 50 RVUs per family meeting and code status discussion.

I would imagine NPs and PAs reaping a ton of benefits to this.

Can you imagine a world where subspecialty training actually reflected in billing? Eg a 20 minute uncomplicated diabetes follow-up didn't bill nearly the same as a complex diabetes follow up or an adult congenital heart patient or a cirrhotic? Or conversely imagine a world where every procedure was paid as a function of time alone? Eg 1 hour of bronching paid the same as an hour of colo or an hour of cath--because that is about the level of complexity that was put into E/M billing with the exception that you had to document an obscene amount of bull**** to even get paid your scraps.

 

[sloh]

There’s a lot of understandable disappointment that office visits like spending time educating an obese T2DM w/ NAFLD doesn’t generate enough RVU’s compared to procedures. But is there strong evidence that spending this time meaningfully changes behavior and outcomes?
Seems like many of these patients are recalcitrant to lifestyle change regardless of how much time you spend with them.

 

[NicMouse64]

There’s a lot of understandable disappointment that office visits like spending time educating an obese T2DM w/ NAFLD doesn’t generate enough RVU’s compared to procedures. But is there strong evidence that spending this time meaningfully changes behavior and outcomes?
Seems like many of these patients are recalcitrant to lifestyle change regardless of how much time you spend with them.

I think the idea would be more that the complex patients with t2dm, htn, CKD, COPD w/ acute exacerbation should be compensated much better than they currently are being reimbursed.

 

[sevo00]

Could employ your own CRNA and make money off the anesthesia services

no wonder their are GI docs in support of crna independence

 

[blue.jay]

I'm going to disagree here. I feel like pulm critical care does a variety of procedures. Where I am it includes: central lines, a lines, swans, intubations, ECMO, bronchs, chest tubes, thoras and lps- especially in. Cardio thoracic icu you're going to see a bunch of procedures.

I vote for cardiology too.. tons of procedures with unique skills.

My close friend is a critical care fellow in Ohio and he said CCU NPs in their institution do central lines, a-lines, Swan-Ganz and trans venous pacer.

Depending on the region (Northeast) fellows don't even get to do that many intubations for which they are required to call Anesthesia (CRNA). Someone in this forum had mentioned that their place allows ICU NP to do flexible diagnostic bronchoscopy (for may be suctioning mucus plug and BAL?).
You have to do one more year of interventional pulmonary fellowship to learn some unique procedures like valves and stenting but still IP doesn't have the procedure volume as cardiology or GI and hence doesn't pay well with limited jobs in academic centers.

I haven't heard of any midlevel doing a PCI, TAVR, Mitraclip, PFO closure,watchman, carotid or peripheral stent

 

[deleted980918]

I vote for cardiology too.. tons of procedures with unique skills.

My close friend is a critical care fellow in Ohio and he said CCU NPs in their institution do central lines, a-lines, Swan-Ganz and trans venous pacer.

Depending on the region (Northeast) fellows don't even get to do that many intubations for which they are required to call Anesthesia (CRNA). Someone in this forum had mentioned that their place allows ICU NP to do flexible diagnostic bronchoscopy (for may be suctioning mucus plug and BAL?).
You have to do one more year of interventional pulmonary fellowship to learn some unique procedures like valves and stenting but still IP doesn't have the procedure volume as cardiology or GI and hence doesn't pay well with limited jobs in academic centers.

I haven't heard of any midlevel doing a PCI, TAVR, Mitraclip, PFO closure,watchman, carotid or peripheral stent

I am on call this weekend. The IC attending on call with me did a thrombectomy for an unstable PE, a few diagnostic LHC, 4 PCI including a STEMI just now. Tomorrow is his TAVR days and he has 2 TAVR scheduled and a couple below the knee peripheral cases too. I would say this is a typical procedure days for him.

 

[deleted980918]

He only did 1 year of IC and learned most of the peripheral skills on the job. This is the beauty of cardiology I think, there are so many new tech and gadgets there’s always room for improvement and self learning. This is in a big competitor market on the coast.

 

[GassYous]

no wonder their are GI docs in support of crna independence

There was a time when GI docs were trying to take over all of the anesthesia services by using endo nurses to push propofol. All that talk abruptly stopped when Michael Jackson died.

 

[sevo00]

There was a time when GI docs were trying to take over all of the anesthesia services by using endo nurses to push propofol. All that talk abruptly stopped when Michael Jackson died.

isn't it illegal for the proceduralist to take a share of the anesthesia charge? how ae GI docs getting away with it?

 

[chessknt]

isn't it illegal for the proceduralist to take a share of the anesthesia charge? how ae GI docs getting away with it?

You can charge for sedation if you are also doing a procedure but some odd rule only allows you to bill 15 minutes no matter how long you run it and it bills like 0.1 rvu so its pretty weak. GI definitely ruined it.

 

[jdh71]

Let's add a few:
Svt ablation 19
Tavr- 25.13 - (do 4-6 per day)
Impella implant 7ish (takes 10 min)
Impella reposition 3.5ish (usually 5 min)

Compare that to 70 minute admission which is 3.5 wrvu and you realize why proceduralists make a lot more money.

This is why every cards I know right know is falling all over themselves trying to do TAVRs. They are all fighting over procedure block time and getting real aggressive with us on PFT reads or consults for ****ty lungs. We currently have to always politely remind them we are in an . . . what the kids these days are calling a "pandemic" . . . we are busy with patients who are what the kids these days are calling "sick as ****" and running extra folks in the unit every day. This means fewer of us in clinic to do consults and the PFTs are going to be backburner (who can't wait a week for a PFT read? There is NO such thing as a PFT "emergency"). Also . . . some folk's failure to plan appropriately doesn't make it now my urgency. And sorry, that bed for your elective TAVR, may go to one of these crusty jugglers, sorry, not sorry, #savinlives

 

[Siggy]

I'm going to disagree here. I feel like pulm critical care does a variety of procedures. Where I am it includes: central lines, a lines, swans, intubations, ECMO, bronchs, chest tubes, thoras and lps- especially in. Cardio thoracic icu you're going to see a bunch of procedures.

Not only that, you come to easily love some of these procedures. I'll place a transvenous pacemaker for a bottle of diet coke.

 

[Siggy]

There was a time when GI docs were trying to take over all of the anesthesia services by using endo nurses to push propofol. All that talk abruptly stopped when Michael Jackson died.

I believe you mean Joan Rivers. Jackson died because his doctor was giving him PO propofol as a sleep aid. Rivers died from a throat procedure.

 

[ewax]

I believe you mean Joan Rivers. Jackson died because his doctor was giving him PO propofol as a sleep aid. Rivers died from a throat procedure.

oral propofol? what?

 

[Siggy]

oral propofol? what?

That was Dr. Murray's initial claim.

 

[jdh71]

oral propofol? what?

they come in a gummy bear shapes, but taste kind of bitter

 

[VA Hopeful Dr]

This is why every cards I know right know is falling all over themselves trying to do TAVRs. They are all fighting over procedure block time and getting real aggressive with us on PFT reads or consults for ****ty lungs. We currently have to always politely remind them we are in an . . . what the kids these days are calling a "pandemic" . . . we are busy with patients who are what the kids these days are calling "sick as ****" and running extra folks in the unit every day. This means fewer of us in clinic to do consults and the PFTs are going to be backburner (who can't wait a week for a PFT read? There is NO such thing as a PFT "emergency"). Also . . . some folk's failure to plan appropriately doesn't make it now my urgency. And sorry, that bed for your elective TAVR, may go to one of these crusty jugglers, sorry, not sorry, #savinlives

That's some quality sarcasm right there

 

[Instatewaiter]

This is why every cards I know right know is falling all over themselves trying to do TAVRs. They are all fighting over procedure block time and getting real aggressive with us on PFT reads or consults for ****ty lungs. We currently have to always politely remind them we are in an . . . what the kids these days are calling a "pandemic" . . . we are busy with patients who are what the kids these days are calling "sick as ****" and running extra folks in the unit every day. This means fewer of us in clinic to do consults and the PFTs are going to be backburner (who can't wait a week for a PFT read? There is NO such thing as a PFT "emergency"). Also . . . some folk's failure to plan appropriately doesn't make it now my urgency. And sorry, that bed for your elective TAVR, may go to one of these crusty jugglers, sorry, not sorry, #savinlives

I mean we're only asking you to do like five PFT reads a week. I mean, can't you guys manage that.

You guys are all like, "woe is me, we're managing twice as many ICU beds as we normally have to" Or "I can't read your pfts because our the newest ICU is in the converted gift shop"

I thought you guys were Pulm critical Care not Pulm Critical Can't

 

[jdh71]

I mean we're only asking you to do like five PFT reads a week. I mean, can't you guys manage that.

You guys are all like, "woe is me, we're managing twice as many ICU beds as we normally have to" Or "I can't read your pfts because our the newest ICU is in the converted gift shop"

I thought you guys were Pulm critical Care not Pulm Critical Can't

All very very good points.

 

[ewax]

I mean we're only asking you to do like five PFT reads a week. I mean, can't you guys manage that.

You guys are all like, "woe is me, we're managing twice as many ICU beds as we normally have to" Or "I can't read your pfts because our the newest ICU is in the converted gift shop"

I thought you guys were Pulm critical Care not Pulm Critical Can't

 

[chessknt]

I mean we're only asking you to do like five PFT reads a week. I mean, can't you guys manage that.

You guys are all like, "woe is me, we're managing twice as many ICU beds as we normally have to" Or "I can't read your pfts because our the newest ICU is in the converted gift shop"

I thought you guys were Pulm critical Care not Pulm Critical Can't

5 pfts is almost an entire 0.5 wrvu with that I can almost get half a free lunch from the cafeteria!

 

[tantacles]

I mean we're only asking you to do like five PFT reads a week. I mean, can't you guys manage that.

You guys are all like, "woe is me, we're managing twice as many ICU beds as we normally have to" Or "I can't read your pfts because our the newest ICU is in the converted gift shop"

I thought you guys were Pulm critical Care not Pulm Critical Can't

Consider this joke stolen. I’m excited to make some pulm/Cc docs VERY angry.