RVU production

[illinigrad11]

Question for those of you compensated via RVU production. How many RVU's are a producing in a year's time and what does your practice volume and practice type look like to give some helpful background to those production numbers? Number of patient's seen in a typical day, percentage of routine care, wound care in the practice, surgical volume (cases in a typical week, bunions and hammertoes vs. triples and TAR's), etc.
I'm not looking for MGMA data, already have access to that. I'm interested in real life anecdotes.

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[CutsWithFury]

Less than two years out of residency here...

Took a full year to get rolling. I’m based out of a small community hospital. Not a large healthcare system.

Currently I’m doing 600-700 RVUs per month

I do everything. I mean everything. From clipping toenails to big foot and ankle recon and everything in between (both elective and non elective)

I do a lot of wound care as well. Both local wound care and taking patients to the OR for limb salvage procedures.

I could do more if I had an APRN/PA to see my post ops but I don’t.

I see between 20-30 patients per day.

 

[JAJE]

Less than two years out of residency here...

Took a full year to get rolling. I’m based out of a small community hospital. Not a large healthcare system.

Currently I’m doing 600-700 RVUs per month

I do everything. I mean everything. From clipping toenails to big foot and ankle recon and everything in between (both elective and non elective)

I do a lot of wound care as well. Both local wound care and taking patients to the OR for limb salvage procedures.

I could do more if I had an APRN/PA to see my post ops but I don’t.

I see between 20-30 patients per day.

Impressive! So many questions for you. Did you replace a doc or did you start from scratch? At how many RVU's does your production bonus kick in? What's your RVU value? I legit want to pick your brain, I have so many questions. Let me know if you would prefer that in a private chat.

 

[CutsWithFury]

Impressive! So many questions for you. Did you replace a doc or did you start from scratch? At how many RVU's does your production bonus kick in? What's your RVU value? I legit want to pick your brain, I have so many questions. Let me know if you would prefer that in a private chat.

No I built this thing from the ground up. I didn’t take over someone else’s volume. I earned it. That’s all I will say. Private message me for more.

 

[msuDPM]

Less than two years out of residency here...

Took a full year to get rolling. I’m based out of a small community hospital. Not a large healthcare system.

Currently I’m doing 600-700 RVUs per month

I do everything. I mean everything. From clipping toenails to big foot and ankle recon and everything in between (both elective and non elective)

I do a lot of wound care as well. Both local wound care and taking patients to the OR for limb salvage procedures.

I could do more if I had an APRN/PA to see my post ops but I don’t.

I see between 20-30 patients per day.

Almost exactly the same. 2.5 years working since residency.

Do everything (including toenails, warts, etc) other than TAR. As far as rearfoot/ankle goes tend to do more trauma than big elective recon (trying to build on that).

3.5 days clinic, 1-1.5 days OR. 3-7 or 8 cases/week depending on what call brings. 35-40 patients on the schedule on a full day, 20ish on the half day. (We get a 10-15% no show/same day cancel rate)

If I don't take much/any time off in a month, typically 650-750 RVU.

 

[CutsWithFury]

Almost exactly the same. 2.5 years working since residency.

Do everything (including toenails, warts, etc) other than TAR. As far as rearfoot/ankle goes tend to do more trauma than big elective recon (trying to build on that).

3.5 days clinic, 1-1.5 days OR. 3-7 or 8 cases/week depending on what call brings. 35-40 patients on the schedule on a full day, 20ish on the half day. (We get a 10-15% no show/same day cancel rate)

If I don't take much/any time off in a month, typically 650-750 RVU.

Do you have PA Or APRN to see your post ops?

How many MAs do you have to help you breakdown and change dressings?

Just curious

 

[msuDPM]

Do you have PA Or APRN to see your post ops?

How many MAs do you have to help you breakdown and change dressings?

Just curious

No PA/NP. (I wish). There are 2 of us (DPMs), but we are only in clinic together 1.5 days every 2 weeks. We each have an assistant that functions as an MA in the office and our surgical assistant in OR. We have one additional full time office MA.

 

[CutsWithFury]

A personal surgical assistant for podiatry is nice though

 

[msuDPM]

A personal surgical assistant for podiatry is nice though

Certainly a benefit. It's just the way of my hospital though. Every surgical specialty has their own CST, some others have PA/NPs that work in clinic or on the floor, but none come into the OR.

 

[air bud]

2.5 years out. Been at current job for almost 1 year - VERY rural setting
I do everything from ingrown nails to rearfoot recon and trauma including ankle/calc. Don't do TARS.
I do about 140 RVUS a month - but increasing slowly.
I have 1 MA who does everything, sometimes the MA for the other surgeon in my office helps out.
I can ask for a scrub tech to be my assistant if I want, available 90 percent of time.
I do about 5-8 cases a month, depends on trauma from ER.
I see between 5 and 12 patients a day, 7 or 8 is normal.
3 days in clinic, 1 day in OR, 4 day work week for all providers in my hospital system.

 

[janV88]

I started 9 months ago at my new job. Hospital employed within orthopedic group. Typically average 500-600rvus. February was low, but I hear that’s normal.

My practice is 90% MSK due to being in orthopedic group of 2 general orthopedists and 5 PAs. I see almost all foot and ankle referrals/they eventually get sent to me. I can’t have a PA due to state laws but they have seen my post ops on occasion due to scheduling or if I’m out of town. We have 2 surgical assist who cover the 3 of us. My half surgery day it’s a toss up if I’ll get an assist but my full surgery day I always have an assist. 1 main MA but my busier clinics we have a couple MAs that float between me and the PA. No mandated call. No chip and clip. I see the occasional DM ulcer. Clinic 3.5 days. Surgery 1.5 days. Average 2-6 cases a week. 60-80 patient visits a week.

 

[ldsrmdude]

Really nice information on here. Just for some perspective for those that don't know, the mean wRVU for surgical podiatrists is something like 5800 annually. So to get 600 wRVU a month puts you around the 75th percentile. 750 wRVU a month is 90th percentile.

I've been with the group I'm with for just less than 2 years. I work in a poor, underserved community (the two counties I work in are the two poorest in the state, also have the lowest health scores in the state) and have a broad scope of what I do. I spend a lot of time (inpatient and outpatient) with wounds. Very little trauma, although I'm changing practice locations and will supposedly be getting more trauma at this new hospital. Generally between 3-6 cases a week, probably half elective and half I&D, wounds, amps, etc. I don't do a ton of big cases. I'll do a few flatfoot cases a year, maybe some rearfoot fusions, couple of ankle scopes/Brostrom here and there, etc. I average probably 1-2 TMA's a month. Practice is maybe 20-25% chip/clip. I'm generally between 100-150 wRVU per week at this point and will probably be around the mean for this year assuming my practice doesn't drop off too much when I move locations. I see around 20 patients per day. 3 days of clinic, 1 wound center day, 1 day of surgery.

 

[illinigrad11]

Thanks for all the responses thus far. Follow up question on how billing works with RVU based compensation:

1) Let's say you see a new patient with an ingrown hallux nail and do a phenol matrixectomy. You bill a 99203 with a 25 modifier and a 11750 (59, TA). Is your wRVU total for that patient visit 3.00 (1.42 + 1.58 for those two codes) or do you get a percentage of the wRVU value of the second code billed?

2) You do a flatfoot reconstruction, with a Gastroc (27687), Kouts (28300), Evans (28300) and NC AD (28740). Is your wRVU total for the surgery 35.16 (6.41 + 9.73 + 9.73 +9.29) or do you get either a consistent or increasing percentage decrease for subsequent codes? If not 35.16, how would you figure your wRVU total for the above mentioned case?

 

[air bud]

Thanks for all the responses thus far. Follow up question on how billing works with RVU based compensation:

1) Let's say you see a new patient with an ingrown hallux nail and do a phenol matrixectomy. You bill a 99203 with a 25 modifier and a 11750 (59, TA). Is your wRVU total for that patient visit 3.00 (1.42 + 1.58 for those two codes) or do you get a percentage of the wRVU value of the second code billed?

2) You do a flatfoot reconstruction, with a Gastroc (27687), Kouts (28300), Evans (28300) and NC AD (28740). Is your wRVU total for the surgery 35.16 (6.41 + 9.73 + 9.73 +9.29) or do you get either a consistent or increasing percentage decrease for subsequent codes? If not 35.16, how would you figure your wRVU total for the above mentioned case?

Depends on system and contracts. My system I got 100 percent of each. But I have a friend in large system on east coast who gets tiered like on a private pay tiered schedule.

 

[janV88]

Thanks for all the responses thus far. Follow up question on how billing works with RVU based compensation:

1) Let's say you see a new patient with an ingrown hallux nail and do a phenol matrixectomy. You bill a 99203 with a 25 modifier and a 11750 (59, TA). Is your wRVU total for that patient visit 3.00 (1.42 + 1.58 for those two codes) or do you get a percentage of the wRVU value of the second code billed?

2) You do a flatfoot reconstruction, with a Gastroc (27687), Kouts (28300), Evans (28300) and NC AD (28740). Is your wRVU total for the surgery 35.16 (6.41 + 9.73 + 9.73 +9.29) or do you get either a consistent or increasing percentage decrease for subsequent codes? If not 35.16, how would you figure your wRVU total for the above mentioned case?

Mine mirrors insurance reimbursement. For scenario #1 it would be 100% for each. For scenario #2 it’s 100% for highest then 50% for each additional code.

 

[CutsWithFury]

Mine mirrors insurance reimbursement. For scenario #1 it would be 100% for each. For scenario #2 it’s 100% for highest then 50% for each additional code.

Same. Which sucks but hospitals need to do that or else they would get killed on the RVU incentive bonuses at the end of the fiscal year.

 

[azfootdoc]

Make sure when talking RVU's you differentiate between RVU's and wRVU's. Big difference. Most contracts will pay you as a portion of wRVU's. It's worth educating yourself on the difference. You want to make sure you are comparing apples to apples.

That said I love the comments. Very good information. Just wanted to weigh in. I am 12 years into practice 3.5 days office 0.5 days Wound Clinic 0.5 days OR and 0.5 days admin. I did 5200 wRVU last year (just about average according to MGMA) and 7700 RVU.

 

[ldsrmdude]

Make sure when talking RVU's you differentiate between RVU's and wRVU's. Big difference. Most contracts will pay you as a portion of wRVU's. It's worth educating yourself on the difference. You want to make sure you are comparing apples to apples.

That said I love the comments. Very good information. Just wanted to weigh in. I am 12 years into practice 3.5 days office 0.5 days Wound Clinic 0.5 days OR and 0.5 days admin. I did 5200 wRVU last year (just about average according to MGMA) and 7700 RVU.

Hopefully we’re all talking about wRVU. I don’t even find out total RVU and for me, it doesn’t matter since it’s all based on wRVU. It was a bit confusing when I switched from private practice to hospital-employed, but now I’ve got a pretty good handle on it.

 

[CutsWithFury]

Make sure when talking RVU's you differentiate between RVU's and wRVU's. Big difference. Most contracts will pay you as a portion of wRVU's. It's worth educating yourself on the difference. You want to make sure you are comparing apples to apples.

That said I love the comments. Very good information. Just wanted to weigh in. I am 12 years into practice 3.5 days office 0.5 days Wound Clinic 0.5 days OR and 0.5 days admin. I did 5200 wRVU last year (just about average according to MGMA) and 7700 RVU.

Great post. I think that is easy to mis-interpret when you are first starting out in a hospital based practice. I was commenting on wRVUs as this is the only data that is given to me when I get my monthly production summaries.

 

[air bud]

Great post. I think that is easy to mis-interpret when you are first starting out in a hospital based practice. I was commenting on wRVUs as this is the only data that is given to me when I get my monthly production summaries.

Yep . WRVUs

 

[dtrack22]

Is there anyone who gets paid on anything other than wRVU? I mean I understand wanting to clarify but I’ve never heard of any physician being paid based on peRVU or mRVU or total RVU. Of course you should educate yourself on what an RVU is before signing a contract but it would be very safe to assume that every discussion you have with an employer, in terms of your production and compensation, is in the context of wRVU exclusively.

 

[FootGuy1]

Make sure when talking RVU's you differentiate between RVU's and wRVU's. Big difference. Most contracts will pay you as a portion of wRVU's. It's worth educating yourself on the difference. You want to make sure you are comparing apples to apples.

That said I love the comments. Very good information. Just wanted to weigh in. I am 12 years into practice 3.5 days office 0.5 days Wound Clinic 0.5 days OR and 0.5 days admin. I did 5200 wRVU last year (just about average according to MGMA) and 7700 RVU.

How many patients/surgeries are you seeing during a week? Call?

 

[jehjr]

This is great information. I am heading into the second half of my first year. At this point I average about 100 wrvu/week. 3.5 days of clinic and one day of surgery. Current surgical load has been 2-5 cases per week. Surprisingly little wound care.

I am also in a rural health clinic attached to a critical access hospital, and I do most everything.

Can I ask what people are getting per wRVU? If people don’t want to post, I would appreciate a PM.

 

[malleolusman]

Doing 500-700 wRVU per month. Medium sized hospital with 4 sister hospitals.

 

[Redsting]

I am curious what the bonus structures/ pay per wRVU is? I will be switching to that set up and recently started educating myself on it and would like to see what is happening out there. I am in a rural area, started from nothing, slowly building, doing a little of everything except big recons.

 

[FootDPM215]

Hello all,

This is a great thread as it seems more and more DPMs are tracking towards the hospital model, but there is not as much complementary information out there for those entering this area to use to both gauge reasonable compensation due to all the variables (salary, wRVU, bonus, regionality of compensation, etc).

I am also potentially changing jobs to the hospital model. I wanted to post a salary construct question but also I had some questions as DPMs in the hospital system is new and they are still figuring out some of the compensation components if anyone can comment (or tell me to not worry).

- Salary is currently set at $240,000 for 5000 wRVU (was going to shoot for $250k for 5000 or $240k for 4800 maybe just to negotiate something), set salary for first 2 years and then adjusted (decreased) based on hitting the target with a 90% within target grace (so hitting at least 4500 wRVU will not cause a salary change). The bonus is $50/wRVU above the initial 5000 wRVU. I was told (waiting to get in writing) that if I bill and we are reimbursed on multiple procedures, I would get 100% of each of the covered procedures wRVU values towards my base/bonus.
- Other inclusions are $3000 CME, all societies (APMA, ASPS, ACFAS, state) and license (state, DEA, etc) fees are included and not part of CME costs; vacation/PTO for education factored in; 15-mile non-compete. Generally, the rest of the contract is fairly standard.

The practice was independent and then bought out by the hospital recently (~ 2 years ago), so there was some presence/patient volume to begin with from the solo practitioner in his decades of practicing. There are currently two other "new" DPMs with the group and they have been there for 1 and 2 years each with the 3rd (initial owner) doctor currently <50% and is slowly backing out over the next few years, the reason for selling to the hospital. The hospital seems committed to growing the service line, with two new office spaces (3 total) in their target demographic region, tons of internal referral, ED and UCs.

It seems overall like a fair deal, even as originally written. With the levels of wRVUs everyone who has responded here and in talking with other friends in hospital or RVU based setups, seems easily obtainable in a few years and a high probability of bonusing.

- Other questions include?
1.) Does the in-clinic X-ray technical RVU value go to you? (towards your goal?)
2.) How are "cash" items dealt with? Orthotics, Powersteps, etc?
3.) How is DME like boots, braces calculated with a wRVU value? - they were going to figure out a wRVU value based on a $/wRVU conversion.
(these three items in a private practice situation would tend to go towards your collections for a bonus, so how do they go towards a wRVU goal/bonus?)

Anything else to look for in a contract? What I have has been reviewed by a lawyer and seems fair. Plus this isn't my first time going through this and have looked at many contracts in helping past residents. Just trying to make the right decision for my family and me in looking at this change and want to make sure everything is set-up correctly in this initial contract, going forward.

Thanks in advance,

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As a disclaimer, I have been an SDN member for about 8-10 years but recently changed my username due to wanting to make it more anonymous as my last one could easily be traced back to me.

 

[air bud]

If you are truly an employee of the hospital then none of that counts towards production. X-rays get officially read by radiologist. you will still get more credit when billing by overreading (or more data points to get to higher levels). DME will be done through the hospital. Cash items you will have to negotiate how to value. I believe @CutsWithFury has experience with that.

 

[CutsWithFury]

Hello all,

This is a great thread as it seems more and more DPMs are tracking towards the hospital model, but there is not as much complementary information out there for those entering this area to use to both gauge reasonable compensation due to all the variables (salary, wRVU, bonus, regionality of compensation, etc).

I am also potentially changing jobs to the hospital model. I wanted to post a salary construct question but also I had some questions as DPMs in the hospital system is new and they are still figuring out some of the compensation components if anyone can comment (or tell me to not worry).

- Salary is currently set at $240,000 for 5000 wRVU (was going to shoot for $250k for 5000 or $240k for 4800 maybe just to negotiate something), set salary for first 2 years and then adjusted (decreased) based on hitting the target with a 90% within target grace (so hitting at least 4500 wRVU will not cause a salary change). The bonus is $50/wRVU above the initial 5000 wRVU. I was told (waiting to get in writing) that if I bill and we are reimbursed on multiple procedures, I would get 100% of each of the covered procedures wRVU values towards my base/bonus.
- Other inclusions are $3000 CME, all societies (APMA, ASPS, ACFAS, state) and license (state, DEA, etc) fees are included and not part of CME costs; vacation/PTO for education factored in; 15-mile non-compete. Generally, the rest of the contract is fairly standard.

The practice was independent and then bought out by the hospital recently (~ 2 years ago), so there was some presence/patient volume to begin with from the solo practitioner in his decades of practicing. There are currently two other "new" DPMs with the group and they have been there for 1 and 2 years each with the 3rd (initial owner) doctor currently <50% and is slowly backing out over the next few years, the reason for selling to the hospital. The hospital seems committed to growing the service line, with two new office spaces (3 total) in their target demographic region, tons of internal referral, ED and UCs.

It seems overall like a fair deal, even as originally written. With the levels of wRVUs everyone who has responded here and in talking with other friends in hospital or RVU based setups, seems easily obtainable in a few years and a high probability of bonusing.

- Other questions include?
1.) Does the in-clinic X-ray technical RVU value go to you? (towards your goal?)
2.) How are "cash" items dealt with? Orthotics, Powersteps, etc?
3.) How is DME like boots, braces calculated with a wRVU value? - they were going to figure out a wRVU value based on a $/wRVU conversion.
(these three items in a private practice situation would tend to go towards your collections for a bonus, so how do they go towards a wRVU goal/bonus?)

Anything else to look for in a contract? What I have has been reviewed by a lawyer and seems fair. Plus this isn't my first time going through this and have looked at many contracts in helping past residents. Just trying to make the right decision for my family and me in looking at this change and want to make sure everything is set-up correctly in this initial contract, going forward.

Thanks in advance,

-----
As a disclaimer, I have been an SDN member for about 8-10 years but recently changed my username due to wanting to make it more anonymous as my last one could easily be traced back to me.

I have a similar contract set up but my base is a lot higher since I am on my second contract with the hospital and I produce pretty high in terms of MGMA percentiles. I have base + quality care bonuses (patient satisfaction, etc) + RVU incentive bonus. My RVU incentive bonus is given bi-annually instead of annually. I also have tiered dollar RVU rates depending on how many RVUs I am producing.

For example:

RVU threshold to bonus is 5000. From 5001-6000 I get paid $45 per RVU. If I do 6001 or over I then get paid $50 per RVU.

As for your questions

- I read and bill all my x-rays that I TAKE IN CLINIC and this counts toward my RVU total monthly. All other imaging (CT, bone scan, MRI, etc) is read by radiology. All inpatient x-rays are read by radiology

- I have shockwave in my hospital practice. This is a cash service where the patient pays the fee. I negotiated an RVU value for the treatment which adds to my RVU total monthly. It's "procedure" that was added into the EMR system. Therefore I can just select it and it loads to the note. THIS IS MANDATORY IF YOU WANT TO ENSURE YOU GET PAID FOR THE SERVICE. I made sure IT was all over this. Just documenting in your note and hoping the hospital coders pick it up will not get you the RVU credit for the service or cash item. I am sure you could do the same for custom orthotics, power steps, etc. You need to get this stuff built into the EMR so that billers will pick it up when they see the code.

- DME is through a third party vendor who has a contract. I get no money for DME. I honestly don't know how that could work out in a hospital practice unless you want to buy the DME yourself and sell for a mark up. Sounds like a lot of unneccessary work to me. Its not worth it. The hospital would not help you either since they are not making money off of it.

 

[Feeter]

Recent graduate from residency. Took a job at an academic institution and is a large hospital system. $46 per RVU for first 4500 (target) and its $36 anything above. Also get a salary as a faculty that is separate. $5500 for CME. Been here one year and monthly average is 555 RVUs with one month off. 3.5 days in clinic, 1 day in OR and 0.5 days for academics. Have a scribe for notes. 25 to 30 pts a day and 5 surgeries a week. No DME, x rays, PT revenue sharing.

 

[CutsWithFury]

Recent graduate from residency. Took a job at an academic institution and is a large hospital system. $46 per RVU for first 4500 (target) and its $36 anything above. Also get a salary as a faculty that is separate. $5500 for CME. Been here one year and monthly average is 555 RVUs with one month off. 3.5 days in clinic, 1 day in OR and 0.5 days for academics. Have a scribe for notes. 25 to 30 pts a day and 5 surgeries a week. No DME, x rays, PT revenue sharing.

Scribe for notes? Go to hell


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[msuDPM]

Scribe for notes? Go to hell


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Agreed.