RVU expectations for AMCs

[ironkiwi]

Hi, I am wrapping up postdoc and considering a couple different offers. One AMC site has an RVU expectation of 2500/year, and I'm just wondering how that compares. It is a peds Neuro job, so assessments are longer (5 hours of testing), and they estimated I would have to complete 10 assessments per month or 50 hours of testing a month. I get 6months to get used to the new job, then start supervising interns and post-docs. We get 2 hours of tech/testing support for most cases. Any thoughts on the workload/RVU expectations? Thanks!

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[AcronymAllergy]

10 assessments/50 testing hours per month seems very reasonable, but I'm not sure if that'd actually meet 2500 RVUs/year. I think the last time I looked at the numbers, a standard outpatient adult neuropsych would get you something like 13-14 RVUs per, although it might've been a bit higher. If that were the case, it'd work out to a total of about 192 evals/year, which is just under 4/week assuming a 52-work-week year, or 4/week assuming a 48-work-week year. Still not horrible, but definitely more than what they're quoting. Unless they're using different RVU numbers.

I've heard other folks on listservs mentioning an expectation around that number, although I don't recall what the consensus response was.

Edit: just checked, and yeah, if you did all of your own testing, with 2023's CMS numbers: If you used 96116 for the interview (90791 gives more RVUs, but I was too lazy to scroll down to find the value), and let's say you did 3 hours of testing, 2-3 hours of 96132/96133, and 1 hour of feedback (also 96133), you're looking at 13.6 to 15.6 RVUs per eval. Take off about 3 if not doing any of your own testing. Using the upper value, that's 160 evals/year, or 3.3 per week for a 48-week work year.

I suspect kiddo evals may be longer, but I dunno how many additional RVUs they'd net you.

 

[WisNeuro]

10 assessments/50 testing hours per month seems very reasonable, but I'm not sure if that'd actually meet 2500 RVUs/year. I think the last time I looked at the numbers, a standard outpatient adult neuropsych would get you something like 13-14 RVUs per, although it might've been a bit higher. If that were the case, it'd work out to a total of about 192 evals/year, which is just under 4/week assuming a 52-work-week year, or 4/week assuming a 48-work-week year. Still not horrible, but definitely more than what they're quoting. Unless they're using different RVU numbers.

I've heard other folks on listservs mentioning an expectation around that number, although I don't recall what the consensus response was.

Edit: just checked, and yeah, if you did all of your own testing, with 2023's CMS numbers: If you used 96116 for the interview (90791 gives more RVUs, but I was too lazy to scroll down to find the value), and let's say you did 3 hours of testing, 2-3 hours of 96132/96133, and 1 hour of feedback (also 96133), you're looking at 13.6 to 15.6 RVUs per eval. Take off about 3 if not doing any of your own testing. Using the upper value, that's 160 evals/year, or 3.3 per week for a 48-week work year.

I suspect kiddo evals may be longer, but I dunno how many additional RVUs they'd net you.

Longer evals actually drive down your RVU's per time spent after they nerfed the codes. And, if you're only getting a couple hours of tech support, that hurts. The way the codes work, maximizing interviews and report/feedback time is the way to drive up RVU's.

 

[psych.meout]

Is that tech/testing support just the paid psychometrists? Wouldn't the interns and post docs be doing some of the test admin and scoring, too?

 

[WisNeuro]

Is that tech/testing support just the paid psychometrists? Wouldn't the interns and post docs be doing some of the test admin and scoring, too?

At least for interns, depends on the payer, Medicare and a few other payers won't reimburse for their work, so it's a big fat 0 RVUs for those.

 

[psych.meout]

At least for interns, depends on the payer, Medicare and a few other payers won't reimburse for their work, so it's a big fat 0 RVUs for those.

Oof, that sucks.

 

[ironkiwi]

Thanks, all! The schedule they suggested seemed optimistic to me, and it sounds like it might be.... I start by supervising first year post-docs, so they should be pretty self-sufficient at least testing-wise, and RVUs for testing will count, but I might be busier than they think to meet the expectations...

 

[Pragma]

2500 is on the lower end these days. It is turning into the wild west out there.

 

[AcronymAllergy]

2500 is on the lower end these days. It is turning into the wild west out there.

Good to know for those of us with less experience in the non-VA world.

I hope employers are increasing compensation to cover the increased RVU expectations (but my cynical side assumes they aren't). Probably also helps to know how much money is actually being made off of your services.

Although I think 2500 works out to about 4 outpatient neuropsych evals/week with a few weeks of vacation thrown in, which isn't an outrageous expectation, with some wiggle room for no-shows. But like WisNeuro said, the most economically-efficient way to go is to use a tester for the "cheap" stuff (i.e., test admin and scoring) so you can bill more of your time out with 96132/96133.

 

[Pragma]

Good to know for those of us with less experience in the non-VA world.

I hope employers are increasing compensation to cover the increased RVU expectations (but my cynical side assumes they aren't). Probably also helps to know how much money is actually being made off of your services.

Although I think 2500 works out to about 4 outpatient neuropsych evals/week with a few weeks of vacation thrown in, which isn't an outrageous expectation, with some wiggle room for no-shows. But like WisNeuro said, the most economically-efficient way to go is to use a tester for the "cheap" stuff (i.e., test admin and scoring) so you can bill more of your time out with 96132/96133.

2500 cases with a tech would mean roughly 250 cases per year. In Medicare dollars that is maybe a gross revenue of 200k. Take out any institutional % and overhead, benefits, cost of tech + benefits, materials, etc, and I wonder how much an AMC could actually offer you in salary and total compensation. Part of why RVUs have gone up is because having targets like 2500 would mean losing money or paying less.

Self testing will reduce costs but it is not going to significantly impact revenue and you will only inefficiently generate RVUs while seeing fewer cases. If you only saw more like 200 cases self testing, that is roughly $160k gross revenue in Medicare dollars. How much can they afford to pay you when you factor in benefits, institutional % and overhead, materials…?

 

[AcronymAllergy]

2500 cases with a tech would mean roughly 250 cases per year. In Medicare dollars that is maybe a gross revenue of 200k. Take out any institutional % and overhead, benefits, cost of tech + benefits, materials, etc, and I wonder how much an AMC could actually offer you in salary and total compensation. Part of why RVUs have gone up is because having targets like 2500 would mean losing money or paying less.

Self testing will reduce costs but it is not going to significantly impact revenue and you will only inefficiently generate RVUs while seeing fewer cases. If you only saw more like 200 cases self testing, that is roughly $160k gross revenue in Medicare dollars. How much can they afford to pay you when you factor in benefits, institutional % and overhead, materials…?

Yet another reason we need to keep (financially) supporting practice organizations so they can perpetually push for increased compensation of MH-related CPT codes. Although that may never happen.

 

[WisNeuro]

Yet another reason we need to keep (financially) supporting practice organizations so they can perpetually push for increased compensation of MH-related CPT codes. Although that may never happen.

Kind of a double whammy in recent years, some of the testing codes nerfed, and then a lowering of the RVU conversion factor, which takes reimbursement down across the board.