RVU question

[Redmen27]

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Hey all,

I'm right out of fellowship and started in an established practice a couple of months ago. My personal practice is steadily growing. I had some questions about my compensation breakdown which I received for the first time last week. I will address my questions with the practice, but also wanted some information from peers. My set salary is solid, but my bonus is based on RVU's above my base. Is there a set RVU dollar amount for a pain physician? Does this vary regionally? How do I find out what this is? Also, I know that RVUs are broken up into professional RVUs and facility RVUs. Of the total RVU, what is the typical percent for the professonal fee? Thanks.

 

[Tenesma]

go to CMS and look at RVU breakdown by CPT code... as there is also a malpractice component... there is no set percentage, and instead the breakdown is based on risk and resources needed...

 

[Pain Applicant1]

This website should answer all of your questions. CPT codes are created and owned by the AMA. This AMA website will breakdown how CPT values are determined, including each individual RVU breakdown, as there are multiple RVUs that make up the total RVU value. Be sure to click on the CPT code to see the breakdown. Your pro fee will differ as will the total RVU amount depending on where the procedure is performed (i.e., facility vs non-facility). For your purpose, most likely facility will be considered ASC or hospital and non-facility will be your office.

https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do?submitbutton=accept

 

[ampaphb]

The general consensus is that the negotiable component of this compensation structure is your conversion factor. Do not blindly accept the general consensus.

The ASA puts out RVU values that are different, and far less variable, from year to year, than those from CMS. Optimally, your compensation should be based on ASA RVUs.

Your employer will tell you that the conversion factor should be between 35-40. This is, in fact, the Medicare factor. Depending on what the payer mix of the practice is, that number should be multiplied to represent the blended rate of all the payers (e.g. 125% of Medicare average x Medicare conversion factor of 40 = 50).

 

[PinchandBurn]

Competitive rvu equivalents are $75 to $80 an rvu. Usually you have to hit a threshold to ge tht like 7000 rvu or so an year. If ppl offer you less than tht its questionable. You can calculate this by looking at mgma data. I have heard if you are board certified you should definitelt be at atleast the $80 range or above...

 

[ampaphb]

Competitive rvu equivalents are $75 to $80 an rvu. Usually you have to hit a threshold to ge tht like 7000 rvu or so an year. If ppl offer you less than tht its questionable. You can calculate this by looking at mgma data. I have heard if you are board certified you should definitelt be at atleast the $80 range or above...

AS with much on this site, Pinch and Burn's numbers are double what they should be. With the medicare conversion factor being 36, if you make 80 per RVU, you are generating 222% of Medicare. Nice work if you can get it, but clearly not representative of real world reimbursement.

 

[PinchandBurn]

AS with much on this site, Pinch and Burn's numbers are double what they should be. With the medicare conversion factor being 36, if you make 80 per RVU, you are generating 222% of Medicare. Nice work if you can get it, but clearly not representative of real world reimbursement.

Ampa. Agreed, this is not typical. But depending on where you practice (assuming not a big Metro city like Chicago, NYC, etc) this is certainly attainable. We are talking wRVU numbers here. I encourage the OP to look at his/her region's MGMA annual salary data and then divide that by 7000.

So for example $500k /7000 = 71 for a wRVU. It takes some negotiating, but these sorts of numbers are what one should 'shoot' for. Again, probably not going to happen in a Major Metro City (should have used that disclaimer) 😉

 

[ampaphb]

The MGMA 2008 median TOTAL compensation for anesthesia pain is $481,595 (Table 76A, p.212)

The MGMA 2008 median wRVU is 7,877. (Table 76D, p.212)

481595/7877 = 61, not 71.

Plus, total compensation includes revenue earned from DME, facility fees, real estate holdings, legal depositions, court appearances, consulting, and other ancillary streams not directly attributable to patient visits and procedures.

All of the above reduce the conversion factor from 61 down to 50, which is the realistic number I would anticipate you might obtain if you negotiate with your potential employer

 

[PinchandBurn]

Fair enough.

THere are regions in the US where the MGMA data for 2010 was 500+ in multispecialty groups. When doing the math for that one gets 71.

Again, I guess it depends on region, but also using newer MGMA data if one is able to get their hands on it.

 

[ampaphb]

Fair enough.

THere are regions in the US where the MGMA data for 2010 was 500+ in multispecialty groups. When doing the math for that one gets 71.

Again, I guess it depends on region, but also using newer MGMA data if one is able to get their hands on it.

Since we seem to not let this go, lets be clear once again, that is TOTAL COMPENSATION, NOT just patient visits and procedures

My point here is not to argue with you about the details of the best compensated region in the best of circumstances. Instead, it is to have the readers of this forum have reasonable expectations when they go into negotiations, rather than expecting a best case scenario.

 

[mid|ine]

My last contract was a wRVU contract and my numbers were in PaB's range.

BTW, would love to see the latest MGMA data if anyone has it.

 

[bedrock]

Since we seem to not let this go, lets be clear once again, that is TOTAL COMPENSATION, NOT just patient visits and procedures

My point here is not to argue with you about the details of the best compensated region in the best of circumstances. Instead, it is to have the readers of this forum have reasonable expectations when they go into negotiations, rather than expecting a best case scenario.

agree-

One reason a lot of physicians are disappointed with what they're offered vs what they see in MGMA has to do with total compensation. Looking beyond standard professional fees is important when evaluating employment opportunities. It's not about having the best guaranteed salary the first year. Rather, the other revenue streams beyond visits and procedures are critical, and they often only apply in 1-2 years when you buy-in to a practice or made it through a trial year. But you need to ensure (before accepting an offer) that you'll eventually be able to participate/receive those other revenues or you'll be disappointed later.

 

[PinchandBurn]

Hey AMPA

no worries. Not trying to argue. Definitely not trying to instigate a 'who's the best' region debate.

Just making sure that new grads and those looking get a 'ball park' figure. When I initially was trying to negotiate, I didnt have anyone to really bounce ideas off of. In fact, initially a group had offerred 50 or so . Here's what I would tell the new grad/job looker

50--avg
60-good
70+ --above avg
80-- definitely a gem.

Also, make sure your wRVU isnt divided between insured and medicaid. This way there's no cherry picking and you dont have to care what type of insurance people have.

I think this info is helpful to those looking because it gives MDs something to go off. Far too often, I see MDs getting low balled by admin and other MDs.

 

[ziggyziggy]

Hey AMPA

no worries. Not trying to argue. Definitely not trying to instigate a 'who's the best' region debate.

Just making sure that new grads and those looking get a 'ball park' figure. When I initially was trying to negotiate, I didnt have anyone to really bounce ideas off of. In fact, initially a group had offerred 50 or so . Here's what I would tell the new grad/job looker

50--avg
60-good
70+ --above avg
80-- definitely a gem.

Also, make sure your wRVU isnt divided between insured and medicaid. This way there's no cherry picking and you dont have to care what type of insurance people have.

I think this info is helpful to those looking because it gives MDs something to go off. Far too often, I see MDs getting low balled by admin and other MDs.

What is a good conversion factor for ASA units ? Should it be similar to wRVU conversion factor?

 

[giddyup]

what kind of percentages should a new grad expect to get when you are reimbursed on a base + % collections scale? i am not getting reimbursed by RVU but instead by base + % collections once overhead is covered. just wondering what numbers other people are seeing.

 

[fentanyl patch]

ditto.....I have the exact same question. What's an appropriate % number to make you feel like you're not getting taken advantage of? Do the "collections" generally involve only the professional fee or the professional fee + ASC facility fee? What is a good target number for yearly collections brought in for an average busy practice? Thanks!

 

[fentanyl patch]

never mind.......a quick search opened up a wealth of information.

 

[nwbgn]

ditto.....I have the exact same question. What's an appropriate % number to make you feel like you're not getting taken advantage of? Do the "collections" generally involve only the professional fee or the professional fee + ASC facility fee? What is a good target number for yearly collections brought in for an average busy practice? Thanks!

I too would like to know this information. Fentanyl, what search parameters / results did you come up with?

 

[PinchandBurn]

never mind.......a quick search opened up a wealth of information.

were you able to convert ASA units over to wRVU? IF so , whats the conversion?