Has anyone ever been (or is being) paid 100% RVU based compensation? I can see the potential downsides of more cherry picking, a more competitive environment, or not being paid for a slow shift, unpredictable earnings, but would the RVU based compensation potentially end up paying out a higher salary? I know there are a lot of factors including volume and the amount per RVU- but wondering what the potential downsides are.
RVU based compensation
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This has been discussed before. I would recommend a search because there was a lot of important points made by various individuals that likely won't be repeated here.
In general, RVU-based compensation is all based on how you set it up. It usually encourages you to work harder. So when a colleague is a slacker and you're having to pick up his/her slack, you'll feel better knowing that you're getting paid more than your colleague.
Where I work, we are RVU-based but have an hourly minimum. You cannot go below that hourly minimum for the month. We eliminate cherry picking of charts by paying for all charts -- not just the insured. Every few years, my group will average the reimbursements from insured and non-insured patients and then adjust the RVU accordingly.
We are not competitive. In fact, I work in a very good environment where we alternate patients. Sometimes we pass on the next patient if we know we're going to be tied up in a procedure, with a critical patient, etc. However, the doc that's working with you will almost always call or find you to see if they can grab the next one if you're tied up. I've been in procedures where I was wrapping up, told them I would see them in about 5 minutes, and they put my name on the tracking board for the patient.
As I said, it's all in how it's set up and how your colleagues are. If you're only paid for patients that pay their bills, then I can see where it would create a competitive environment.
In general, RVU-based compensation is all based on how you set it up. It usually encourages you to work harder. So when a colleague is a slacker and you're having to pick up his/her slack, you'll feel better knowing that you're getting paid more than your colleague.
Where I work, we are RVU-based but have an hourly minimum. You cannot go below that hourly minimum for the month. We eliminate cherry picking of charts by paying for all charts -- not just the insured. Every few years, my group will average the reimbursements from insured and non-insured patients and then adjust the RVU accordingly.
We are not competitive. In fact, I work in a very good environment where we alternate patients. Sometimes we pass on the next patient if we know we're going to be tied up in a procedure, with a critical patient, etc. However, the doc that's working with you will almost always call or find you to see if they can grab the next one if you're tied up. I've been in procedures where I was wrapping up, told them I would see them in about 5 minutes, and they put my name on the tracking board for the patient.
As I said, it's all in how it's set up and how your colleagues are. If you're only paid for patients that pay their bills, then I can see where it would create a competitive environment.
We are 100% P&L based (so not even RVU, what you actually bring in...). There is a small practice tax taken out to compensate admin time for those doing it, and there is also a night stipend/tax for those doing more/less nights than average.
I strongly prefer it. With multiple caveats--
(1) The books need to be open so you see what the hell is going on under the dash. Some CMG giving you a pure RVU pay scale, then taking 30% of your earnings for themselves would be... suboptimal.
(2) Scheduling needs to be equitable, since volume and reimbursement can be different during different times and days-of-week.
(3) You need a strong QI system, and a group ethos that while speed is VERY important, quality, safe care is the MOST important.
(4) People are going to be aggressive picking up charts and cases. Cherry picking of, say, insured patients is NEVER ALLOWED. Period. Cherry picking an easy-to-dispo case because your shifts ends in 30 minutes is just logical. But you need to be able to play nice with your partners when it is slow, and go every-other and talk through any issues.
I would not worry about "not being paid for slow shifts" if you are going to be full-time at a place long-term. Things will average out. IF you are doing a 144 shifts a year (12x12) it is very unlikely you are going to have significantly more slow shifts than your partners.
The benefit is you actually get paid for the work you do! The benefit is if you get the automatic bonus if you get the crap beat out of you x 10 hours... you are getting paid more! The benefit is if you are getting slammed, and the overnight doc asks you to pick up a few extra charts... no problem, you'll get paid! The benefit is YOUR personal charting, YOUR ability to properly write procedure notes, YOUR ability to bill for critical care time comes right back to YOU! The benefit is if you bust your butt, and see 2pt/hr and rapidly dictate and don't doddle and chat during work... you'll make more money than the person seeing 1.7/hr. And you'll see there is just a general philosophical bent (call it capitalism) for your shop to be lean and fast and get things through.... it'll be VERY rare for you to show up and have the outgoing doc sitting on the edge of his chair with his coat on, and 10 charts in the rack.
But if can, like all good things, be perverted either into a scheme to keep your money away from you (some CMGs) or allow unscrupulous physicians to cherry pick and be bad partners.
I strongly prefer it. With multiple caveats--
(1) The books need to be open so you see what the hell is going on under the dash. Some CMG giving you a pure RVU pay scale, then taking 30% of your earnings for themselves would be... suboptimal.
(2) Scheduling needs to be equitable, since volume and reimbursement can be different during different times and days-of-week.
(3) You need a strong QI system, and a group ethos that while speed is VERY important, quality, safe care is the MOST important.
(4) People are going to be aggressive picking up charts and cases. Cherry picking of, say, insured patients is NEVER ALLOWED. Period. Cherry picking an easy-to-dispo case because your shifts ends in 30 minutes is just logical. But you need to be able to play nice with your partners when it is slow, and go every-other and talk through any issues.
I would not worry about "not being paid for slow shifts" if you are going to be full-time at a place long-term. Things will average out. IF you are doing a 144 shifts a year (12x12) it is very unlikely you are going to have significantly more slow shifts than your partners.
The benefit is you actually get paid for the work you do! The benefit is if you get the automatic bonus if you get the crap beat out of you x 10 hours... you are getting paid more! The benefit is if you are getting slammed, and the overnight doc asks you to pick up a few extra charts... no problem, you'll get paid! The benefit is YOUR personal charting, YOUR ability to properly write procedure notes, YOUR ability to bill for critical care time comes right back to YOU! The benefit is if you bust your butt, and see 2pt/hr and rapidly dictate and don't doddle and chat during work... you'll make more money than the person seeing 1.7/hr. And you'll see there is just a general philosophical bent (call it capitalism) for your shop to be lean and fast and get things through.... it'll be VERY rare for you to show up and have the outgoing doc sitting on the edge of his chair with his coat on, and 10 charts in the rack.
But if can, like all good things, be perverted either into a scheme to keep your money away from you (some CMGs) or allow unscrupulous physicians to cherry pick and be bad partners.
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Base plus productivity model with my SDG. Busy department(s), so it's a good combination for reasons already mentioned.
Thanks so much for those who have replied- I did review the other thread on "production based compensation" which has good information. I've looked at a few contracts that are either a straight up hourly rate IC and employed (pros are that if you have a slower shift you still get paid, cons are that it doesn't provide an incentive to work harder), a combo of a low hourly rate with RVU based incentive pay (this sounds like a nice medium), but i'm now coming across contracts with straight up RVU-based pay which seems a bit risky with no guaranteed base salary (pros: the harder/more efficient you work, the more you get paid, cons being that there's no guaranteed base pay so it seems as though if you are consistently scheduled shifts that are not busy you or are stuck with staffing that do not turn over beds fast/boarding pts. you may end up with a lower overall hourly rate which is the overall risk). I'm not certain if those with total production based compensation are happy with their set up (I do understand a lot depends on your colleagues/culture of the ED/ payer mix set up, etc) I'm just wondering which model of compensation are most people are happy with?
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I like RVU compensation with a "floor". I just signed for a part time job that is 100% RVU with a $200/hr floor.
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If you have a 'floor', then how is it 100% RVU? the 'floor' money means you're guaranteed at least 200/hr regardless of how productive you are....
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100% RVU is only good if you have a good payer mix and are very well staffed and can easily dispo patients. It works alright if you have a pod system. Having your ED like a fish bowl free for all can encourage predatory behavior (doctors waiting by the ambulance bay to pick patients as happens in my shop). If your ED is boarding you lose money. If there is a delay in cleaning the room or you are short on nurses that means you are making less money. The books need to be open as if they are not It's easier for a CMG to screw you over.
I work at a majorly RVU based site where my base pay is like 40-60 dollars an hour. I would not recommend it because doing a holiday shift and not seeing many patients puts a bad taste in your mouth. I also believe ER is stressful enough I don't need to be stressing about how I can squeeze as many patients into a shift.
I work at a majorly RVU based site where my base pay is like 40-60 dollars an hour. I would not recommend it because doing a holiday shift and not seeing many patients puts a bad taste in your mouth. I also believe ER is stressful enough I don't need to be stressing about how I can squeeze as many patients into a shift.
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Most of the time the RVU value is well above $200/hr so it wouldn't need to be used. It's a new contract and is anticipated about $300+/hr collections. It is believable, as the last group was getting close to that amount. The RVU floor is more psychological than anything. If you are on a a really slow slow shift, you don't have to worry about starving to death during the month.
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Hmm...sounds like overstating is a major concern with an RVU based setup. Also, it stinks that you end up getting hosed for working painful shifts like overnights and holidays.
Overall, seems like the potential to get screwed by the CMG or predatory admin is huge. Probably a good setup if you have a SDG, but otherwise sounds like a raw deal unless the floor is set at a competitive rate.
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Where are you making $300/hr? How many pt's you guys on average see/hr? Seems like a lot.
Although, I guess in my group (100% RVU) our average is like $260-270, maybe a little higher. I'm just below the group average. So not all that different.
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Another consequence of 100% RVU is the general concept of people doing less doctoring and more tests just to see more patients. There is no incentive to do anything in these ER's besides pick up patients. So if you are carrying 10-15 patients at a time, you just end up ordering a bunch of tests rather than actually being a doctor. Remember there is little-to-no incentive to dispo people as you only make money picking them up. If a doctor is given the choice of 1) dispoing a patient or 2) picking up a patient, they will always do #2. That's one reason why people with ankle sprains and ingrown toenails stay around in the ER much longer than they should.
I work full-time at a 100% RVU place and part-time at a salary. For a variety of reasons I prefer the salary place - but the main reason is I feel I can practice medicine much more comfortably. I do only what I think is necessary.
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Your comment about not dispoing patients in an RVU only environment doesn't really hold water. If you are only holding on to patients, your department gets gridlocked and no one new can come in, ergo you see no new patients, and make no money. If anything there is a desire to get everyone in and then get them either upstairs or out as quick as reasonably possible.
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You would think that doctors would want to operate like that. In practice though that isn't what happens. At least in my experience.
Remember if you can either one of the following things NEXT
1) dispo a patient
or
2) pick up a new patient, spent 5-10 minutes with them, put in orders, then do #1
doctors in an RVU environment specifically have an incentive to do #2 and not #1. I want the money from the new patient.
It's unfortunate, but understandable human behavior.
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I would have to disagree. I'm not an ED doc, but my ER shifts as a Peds resident always felt very similar to when I used to wait tables in college. Just like in a restaurant, you have to turn tables to make any money, the worst possible thing is a group that sits around for 45 minutes after paying their bill. Same thing in the ED.
Now, your point about less doctoring may still be true, but it's because rather than doing an actual workup for a patient, the focus becomes only on dispo. As soon as you know a patient is going to the unit or to the floor, why keep ordering tests or giving treatment when you can just move them up. I saw this during my PICU fellowship at a place where the ED had previously been extraordinarily small for the volume they were actually seeing. The answer was for the ED to prioritize speed through the ED above anything else, and patients ended up in the PICU without anything resembling a normal workup or treatment. Meant for a fair number of patients who ended up in an inappropriate location in the hospital (either in the ICU when they could have been stable for the floor, or on the floor with a quick Rapid Response Team call).
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I'm interested too. We earn $22.50/RVU.
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What region of the country are you in? $22.5 / RVU seems a bit on the soft side. If one takes in medicare rates ($37.89/RVU, although you might not get exactly this, it seems like a reasonable ballpark guess) then your overhead is around 41%.
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Northern CA. It is on the soft side. we get other income in our group so it's not the only way we make money. But I agree its low. We also have a high % of low socioeconomic patients too.
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1 RVU is $36. 22.50 is atrocious. Again maybe high overhead. Wouldnt those other sources of pay offset the overhead. Many groups use MLP profit to cover overhead and then people can keep the rest.
Also, depends on medicaid reimbursement by state. I dont know if Cali medicaid is good or not.
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We have 100% RVU with a base. I work for a CMG though so there's always lack of transparency insofar as whether it is truly "RVU" vs "pph" which although they correlate are not quite the same. There is a compensation part of the CMG website that has several fixed and moving variables that no matter how many times they have tried to explain it, it never makes sense on my calculator. That being said, I bill critical care, procedures, bedside US "limited" studies, regional blocks, trigger point injections, fracture/reductions, the usual stuff....in the hopes that it truly makes a difference in the end. I average >10% critical care billing on average. Some months I've had as high as 16%. Personally, I think EM docs vastly underbill for this sort of thing.
Since we're on the topic...
1) Does anyone know if listing multiple diagnoses increases the billing at all? I'm not talking about justifying a level 4 to 5. Let's say it's a clear level 4 and will remain a level 4....one chart has a single diagnoses and the other has 3 or 4....does it really matter in the end? I usually just put the prevailing, pertinent diagnoses but no-one can ever seem to tell me whether it makes any difference.
2) Interpretation of pulse ox...is this a wives tale or can you actually bill more for this?
Since we're on the topic...
1) Does anyone know if listing multiple diagnoses increases the billing at all? I'm not talking about justifying a level 4 to 5. Let's say it's a clear level 4 and will remain a level 4....one chart has a single diagnoses and the other has 3 or 4....does it really matter in the end? I usually just put the prevailing, pertinent diagnoses but no-one can ever seem to tell me whether it makes any difference.
2) Interpretation of pulse ox...is this a wives tale or can you actually bill more for this?
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Also, I'll second the predatory behavior of docs in open "free for all" EDs like ours can really ruin a shift if you get stuck with someone who is grabbing 6 patents at a time. We have a few who will snipe from the ambulance bay, snipe out in the waiting room, indulge in a damn feeding frenzy to where you're only hope of getting someone is to keep clicking "refresh" on the tracking board or wait near the waiting room or ambulance bay. Our current dir seems to encourage this behavior and sends out monthly "scorecards" where providers are tracked on their PPH, RVU/hr, TATs, etc.. and although it is a reasonable way to motivate people and provides a competitive element, the ugly side is that it can really ruin your shift depending on who you're paired with to the point where you are pissed off the entire time because you can't get any patients. I really hate that aspect of RVU only environments.
OMG, I said "provider", I'm being brainwashed subconsciously by the corporate MAN. I meant physician! (slaps myself, hangs my head in shame...)
OMG, I said "provider", I'm being brainwashed subconsciously by the corporate MAN. I meant physician! (slaps myself, hangs my head in shame...)
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Tell them to stop being douchebags
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They'll tell you to stop being so slow. Two sides to every coin.
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Its good to have a feeding frenzy. Keeps the meat moving.
But if you have two hungry docs working, you don't want to fight each other for charts. Just look at each other and declare "every other". A pinch of communication goes a long way.
Or just play paper-rock-scissors to see who gets the nursemaids elbow...
But if you have two hungry docs working, you don't want to fight each other for charts. Just look at each other and declare "every other". A pinch of communication goes a long way.
Or just play paper-rock-scissors to see who gets the nursemaids elbow...
We’re essentially totally RVU based and it does require everyone play well in the sandbox to avoid the potential downfalls of an RVU based compensation. I think that’s probably a little easier to accomplish in an SDG vs a CMG.
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Nothing to do with this thread, but Janders - you’re alive!
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I tried explaining this predatory behavior on a different post. I see it too but no-one in our group, if called out on it, fights back. When it's slow and someone picks up three in a row because you happen to be looking at a CT report or talking to a consult, I'll ask lets split these up and it's never a problem. There is little to no (immediate) incentive to dispo someone when you are only paid for picking them up.
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If they say that...then I would sign up for every single patient on my shift. If I had scribes I would tell them to focus only on picking up patients.
This kind of behavior would eventually mitigate or stop...if you pick up a patient in the waiting room then you have to see them in the waiting room. You can't wait for them to come back.
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So, for reasons that I don't want to spend time typing...our "real" RVU multiplier is $28/RVU. I know that last year I made $250/hr, saw 2.2 pph, and avg RVU is 4.03. $28 isn't that good given that I heard we make like $44/RVU from our payors.
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Yup we bill for all this stuff too. Really helps to have a scribe too. I have heard, although I can't substantiate, that CC should be 5%. If it's more it invites or increases the chance of an audit.
I wonder about this too...
1) I don't think more diagnoses increases billing. Billing is a function of complexity of medical decision making and a bunch of other variables. Although these days we tend to make patients more "sick" than they actually are via their diagnoses. Like if someones sodium is 132, you could say they have "hyponatremia" but 132 is a non-factor for 99% of all patients.
2) I have seen CPT codes for billing and I've never seen one for interpretation of pulse ox. I don't think this applies to ER docs. But again I'm not sure.
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So listing multiple minor diagnoses does not increase the levels. However, comorbidies can. For example someone with a CHI and LOC who is 20 on no meds isnt the same as the 76 year old on Coumadin who took too many and has an INR of 9.
I teach my residents to always list DM, anticoagulant use and pregnancy on any patients as a secondary diagnosis as this will often increase the complexity of their care and MAY lead to an increased billing level. The scoring by chart coders isnt simple so you try to get as many “points” and then they can determine where they fall. For example you earn points by reviewing and stating you reviewed old medical records, obtaining information from EMS or NH records, stating you reviewed the radiology images etc.
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So you do have to keep in mind a few things. 1) There are practice costs like med mal, paying your medical director and benefits if you get them.
That being said $16/RVU is insane. Put another way if you generate 10 RVUs/hr they are taking 160/hr and in a 12 hour shift thats $1920 X 2 thats 4K a day. Good to be a CMG. They make even more off the mid levels you supervise.
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Looking at a position that is $130/hr then $32/wRVU/hr over 4.0 wRVU. At one of my sites (which is very efficient) I'm seeing 10-11 wRVU/hr (on higher end in group), but suspect this new place is a more typical environment and numbers wouldn't be as high. Could some of you all ball park you're wRVU and whether your shop is low, middle or high efficiency?
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I think you have a relatively good proposition. I am currently paid $22.5 per RVU. I can comfortably see 2-2.2 patients per hour over the course of an 8 hour shift and leave within 15-20 minutes of the end of my shift. However, this is dependent upon an appropriate time distribution of patient arrivals which is subject to random variation. We have no sign-outs. We have no mid-level providers. I cannot truly imagine that I will get beyond 4-4.5 RVUs per patient as there are a significant number of ESI at level 4-5 patients in the overall mix. The emergency department is relatively slow with respect to the overall workflow. I suspect our parents is moderate with typical mixture of Medicaid, Medicare, a good private payer mix, but a significant IHS component.
With respect to your offer, this seems relatively good. If my understanding is correct your pay would be as follows:
0 to 4.0 RVUs per hour would lead to $130, this equals $33/RVU. Additional RVUs above and beyond 4.0 wRVUs per hour are at $32. I suspect you are using multiple mid-level providers otherwise your overhead would be lean. Are you in a SDG? CMG? What does your payer mix look like?
If this understanding is correct and you see 10 wRVUs per hour (aggressive but possibly conceivable) you would earn $322 per hour.
However, I doubt that your income will be this impressive. The wRVU component appears to exist to account for appropriate earnings excluding overhead (e.g. CPT code 99285 - a “level V” encounter leads to 4.90 total RVUs of which 3.80 are wRVUs which allows for a 22% overhead for practice expense and malpractice). If you are earning an average per our view equal to the current Medicaid payment of $37.89 you have an effective overhead 35%, not including excess profits from mid-level providers that you may be required to “supervise”.
Another way to look at this is if you see one level IV and one level V patient per hour you would earn $205.52/hr. This is based upon 3.80+2.56 wRVUs/hr. $205.52 = $130 +$32/wRVU × (6.36 wRVU -4.0 wRVU). This does not look nearly so attractive. Now that I look at it this way, I am guessing that this is a CMG site.
With respect to your offer, this seems relatively good. If my understanding is correct your pay would be as follows:
0 to 4.0 RVUs per hour would lead to $130, this equals $33/RVU. Additional RVUs above and beyond 4.0 wRVUs per hour are at $32. I suspect you are using multiple mid-level providers otherwise your overhead would be lean. Are you in a SDG? CMG? What does your payer mix look like?
If this understanding is correct and you see 10 wRVUs per hour (aggressive but possibly conceivable) you would earn $322 per hour.
However, I doubt that your income will be this impressive. The wRVU component appears to exist to account for appropriate earnings excluding overhead (e.g. CPT code 99285 - a “level V” encounter leads to 4.90 total RVUs of which 3.80 are wRVUs which allows for a 22% overhead for practice expense and malpractice). If you are earning an average per our view equal to the current Medicaid payment of $37.89 you have an effective overhead 35%, not including excess profits from mid-level providers that you may be required to “supervise”.
Another way to look at this is if you see one level IV and one level V patient per hour you would earn $205.52/hr. This is based upon 3.80+2.56 wRVUs/hr. $205.52 = $130 +$32/wRVU × (6.36 wRVU -4.0 wRVU). This does not look nearly so attractive. Now that I look at it this way, I am guessing that this is a CMG site.
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It's an employed community site that's part of a University System. I've emailed them back for more clarification. Also skeptical that my napkin math adds up in the way they are actually pitching it. Thanks for the reply.
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Tails I win, heads you lose. Ask for concrete examples.
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5% CC time is terrible. National average is 8%. However most EM docs are terrible at appropriately documenting CC time. If done appropriately you should probably be billing 10-15% CC time for most community ERs. Any one you are giving multiple meds to for hyperkalemia, hypokalemia requiring IV therapy, anyone with a concerning upper GI bleed, anyone you place on bipap, anytime you give a anticoagulant reversal agent, anytime you give more than 1 unit of blood products, any severe sepsis or septic shock patient, status epilepticus, anyone admitted to the ICU, any stroke alert, any trauma alert, anyone with an acute limb threatening injury, anyone with a organ threatening injury that you are acting on including calling consultants, any severe asthmatic, anyone requiring multiple re-evaluations, any dysrhythmia patient you gave more than one IV med to. As long as you aren’t doing questionable things, there should be no fear regarding your CC billing. Get paid what you’re deserved.
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That's true as long as you spend >30 minutes on the patient. A lot of "high risk critical" patients I spend <30 minutes on. I bill accordingly. I document critical care for the SVT that requires adenosine as 15-20 minutes as that's all the time I spend on them. If audited, I think a lot of those <30 minute critical care documents will support the true critical care that actually gets billed when it's >30 minutes. I don't just include time spent at bedside, but also discussion with consultants, documenting, reviewing old charts, etc. My critical care bill rate is about 7-10%, but I document critical care <30 minutes on an additional 5% or so. I work in a high acuity ER.
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Something I've been confused about for a while: is it legit to bill CC time when I do one of these things to a pt because I reasonably conclude that they may have an emergent condition, but then the next day the inpt team concludes there is no emergent condition, eg it's just a minor virus or they were malingering or whatever?
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A few things. The national average of CC being a bit over 7% is Medicare only. No one knows what it is for all comers to the ED. Your billing company can give you an idea of where you should be based on your level 5s and admit %. They say your CC should be roughly 1/3 of your admit % per a few billing companies I spoke with.
If you look up the ACEP CC info they will tell you what the requirements are. It doesn’t matter what ends up happening what matters is the risk of deterioration not that they do deteriorate.
If you look up the ACEP CC info they will tell you what the requirements are. It doesn’t matter what ends up happening what matters is the risk of deterioration not that they do deteriorate.
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deleted859535
I have a similar approach and, at times, will notate that CCT was less than 30 minutes so I don't get dinged as a "hey, you could've billed CCT on this person" by our billing company -- no, not if I didn't spend 30+ minutes in good faith on all the things that are included in that time measurement. I chart rather thoroughly and chart biopsy aggressively when need be, so frequently I am >30 minutes on people that I may only have been at bedside for 15-20 minutes cumulatively, not to mention discussion for admission, etc. My CCT is anywhere between 5-15% monthly.
Could you give an example?
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Intensivists will regularly bill 60-90 mins for critical care for each patient spending maybe 10 minutes rounding. I think if you bill critical care you probably did more than 30 minutes.
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deleted547339
Billing 90 minutes on a stable icu patient is fraudulent. I don’t bill CC time on a lot of my patients to in the unit. One thing a lot of people don’t realize is that if you spend any time doing CC, you should bill (essentially) all of your time as CC time. If you cardiovert an unstable rhythm, that only take 5 minutes, but you can bill for documentation, talking with family, talking with consultants/admitting docs, looking at records, talking to nursing staff, ems. etc - just not separately billable procedures and teaching. It’s pretty easy to do this and get to 30 mins - and that’s entirely legit. It’s actually a lot harder to get to 30 mins in the icu because you already know the patient.
You can bill for 15 mins, but you won’t get reimbursed.
And no, you can’t bill CC time on every trauma alert. If you come in as a trauma but only have a laceration, you can’t bill CC time - they’re not critically ill. You might try, and you might even get paid, but that is fraud. You can argue that it’s a broken system, but that’s what’s accurate.
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I’m no longer at a level one trauma center but I disagree. See the cpt definition and let me know why you don’t think it qualifies. McKesson the billing company suggests you should. All trauma activations other than transfers.
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deleted547339
Because you can’t bill critical care for someone being critically injured if they aren’t injured - I’m not saying it doesn’t happen, but it’s fraud. My hospital got hit in the remote past for billing cc time on all trauma activations.
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For trauma activations: Is it legitimate to bill critical care time until you realize there are no critical injuries? That can happen 5 minutes into the encounter (a physical exam), or after lab / imaging comes back...often 45 minutes later.
That's my approach for traumas. It's critical care until I realize there is nothing critical going on.
That's my approach for traumas. It's critical care until I realize there is nothing critical going on.
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Not sure that works. After all, we work in the "emergency room" and approach each patient as if they have a potentially life or limb threatening emergency. Only after ruling out these emergencies do we feel comfortable making a final disposition. I see 1.76 patients per hour, this requires 34.01 minutes per patient and I bill 34+ minutes of critical care time for every patient. I don't think passes any "sniff test". I think one can build critical care time only if there is a reasonable concern for a critical process.
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It’s the possibility of decompensation.
Critical Care FAQ
CPT currently defines a critical illness or injury as an illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition.
Critical care services are defined as a physician's direct delivery of medical care for a critically ill or critically injured patient. It involves decision making of high complexity to assess, manipulate, and support vital organ system failure and/or to prevent further life threatening deterioration of the patient's condition. Examples of vital organ system failure include, but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure.
CMS adds that in order to qualify as critical care for Medicare patients, "the failure to initiate these interventions on an urgent basis would likely result in sudden, clinically significant or life threatening deterioration in the patient's condition."
Note that CPT and CMS are slightly different. Simply if a trauma shows up as an activation, there is a high likelihood of deterioration (Otherwise it’s wouldn’t be a trauma). Maybe it has to do where we work. In residency we had trauma red, yellow and green. The greens were like straight mvas and no trauma surgeon would come down. The yellows were your standard type traumas and the reds were the near codes. As an attending we just had traumas we activated and the green type traumas where they wouldn’t even go to our trauma bays just into rooms.
Maybe it is semantics we are discussing but another way to look at it as I was told by a billing company.. if you have to stop what you are doing to see that patient immediately then its critical care.
Critical Care FAQ
CPT currently defines a critical illness or injury as an illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition.
Critical care services are defined as a physician's direct delivery of medical care for a critically ill or critically injured patient. It involves decision making of high complexity to assess, manipulate, and support vital organ system failure and/or to prevent further life threatening deterioration of the patient's condition. Examples of vital organ system failure include, but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure.
CMS adds that in order to qualify as critical care for Medicare patients, "the failure to initiate these interventions on an urgent basis would likely result in sudden, clinically significant or life threatening deterioration in the patient's condition."
Note that CPT and CMS are slightly different. Simply if a trauma shows up as an activation, there is a high likelihood of deterioration (Otherwise it’s wouldn’t be a trauma). Maybe it has to do where we work. In residency we had trauma red, yellow and green. The greens were like straight mvas and no trauma surgeon would come down. The yellows were your standard type traumas and the reds were the near codes. As an attending we just had traumas we activated and the green type traumas where they wouldn’t even go to our trauma bays just into rooms.
Maybe it is semantics we are discussing but another way to look at it as I was told by a billing company.. if you have to stop what you are doing to see that patient immediately then its critical care.
