Rvu rates

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Attending1985

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As a follow up to my last post anyone willing to share their rvu rate and general location. I’ll start 70$ Midwest
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I'm positive (hopeful) that my job is not typical. I'm hunkering down at a community academic job, light workload. Our RVU rate is like $35. Let's just say I'm not one to pick up extra work in this job.
 
Mine's kind of funky at a large academic center in the midwest. I get low $70's per wRVU I'm credited for, but only credited for 0.7-0.8 of every wRVU I bill for that's not procedural (ECT, Spravato) or a psychotherapy add-on. So my actual rate is actually around $60 per wRVU.
 
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esob said:
Sorry if this is a dumb question, but if Medicare's average RVU (according to the all-knowing AI) is ~ $33, where is the money coming from to make employers double that figure?
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There's a much larger pot of money for OPPS on-campus than there is in the office based Medicare physician fee schedule.
 
esob said:
Sorry if this is a dumb question, but if Medicare's average RVU (according to the all-knowing AI) is ~ $33, where is the money coming from to make employers double that figure?
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$33 is the conversion factor, not how much is reimbursed. It’s only one part of a formula that includes several other variables including geography, facility status, malpractice, etc. It’s why you see us talking about wRVUs (RVUs for work performed) as opposed to the total RVUs for various codes. I’m on my phone but later I’ll post a one to two page link that explains the formula including GPCI and the various forms of RVU included in the formula.

That conversion factor is just the dollar value you multiply the formula by in order to get an actual monetary value for various codes.
 
Attending1985 said:
As a follow up to my last post anyone willing to share their rvu rate and general location. I’ll start 70$ Midwest
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Is that the updated (2021+) or the old 2020 Physician FFS -- because that is fantastic for the 2021 PFFS
 
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esob said:
Sorry if this is a dumb question, but if Medicare's average RVU (according to the all-knowing AI) is ~ $33, where is the money coming from to make employers double that figure?
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Not the article I wanted (can't find it, it was in a neuro journal) but here's link to a blog that explains it decently. If you're employed, you're likely only going to get reimbursed based on wRVU. If you're in PP and take CMS (medicare/medicaid) then you'll get the total RVU reimbursement from CMS and whatever you can negotiate from private insurers.

namas.co

How Relative Value Units Are Calculated - NAMAS

October 30, 2020 | By Edward Townley, Founder, Cogent9 Consulting We use relative value units (RVUs) in many aspects of our practices. Some physician compensation arrangements are based on RVUs; other practices use them for staffing models and productivity measurements. Where did RVUs come from...
namas.co namas.co
 
esob said:
Sorry if this is a dumb question, but if Medicare's average RVU (according to the all-knowing AI) is ~ $33, where is the money coming from to make employers double that figure?
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Simply put, there still exist some insurance companies that pay more than medicare. Upwards to 3x.

So Big Box entities, look at their payer mix.

If 5 out of 10 patients is medicare, 3 are 3x medicare, 1 is 0.9 medicare, and one is 1.5x medicare; this means, a blended payer rate for 1 wRVU is 1.64x Medicare. So in this hypothetical example, using $33 per 1 medicare wRVU, the Big Box shop is Grossing, $54 for a blended payer mix wRVU.
That means they'll offer you $40.

The possible negotiations, which is unlikely, but theoretical, is knowing these 3 things. The local medicare conversion factor. The blended payer mix conversion factor and the best paying insurance conversion factor. The minimum. The blend. The max. Trying to get your pay closer to the blended payer mix, is the goal, but no Big Box entity will give it. They aren't satisfied for the other money they get that isn't the wRVU, but the rest of the RVU (facility and liability?).

They can sometimes offer really high rates for production, on just those few wRVUs, because they already made so much profit on the baseline ~4600 wRVUs needed for the salary. So they might be stealing from that bucket, or just letting you get the TRUE blended payer mix for those few wRVUs, to make you feel good about yourself.
 
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annoyedpsychiatrist said:
How many wrvus are you guys averaging annually? Especially in the outpatient setting?
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I do 6 hours per week and bill around 15 wRVUs per week with a 20% late cancellation/no-show rate. So if you extrapolate that to a 32 hour work week x 46 weeks that's ~3700/yr.

ETA: I'm at 2,700 wRVUs for the year so far, so on pace to hit right around 4,000 total. I also have a full admin week every 4 weeks where I'm only collecting wRVUs for those 6 clinic hours. So if I were working true FT clinical hours I'd be around 5,500 for the year doing inpatient consults + 6 hrs of outpatient/wk.
 
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I'm out of the wRVUs game.
Medicare is capped. And at some point the one that pays close to medicare will be dropped or given chance to increase rates. Than I'll move on to the next lowest payer. However, I'm getting very top heavy with one really good payer. So always bit uneasy to have all your eggs in one basket.
 
I was recently offered $68/wRVU for outpatient full time in the West

Comparing to my current salaried position, I'd be taking a relative pay cut if my productivity were similar.
 
J ROD said:
That's outpatient. Inpatient was around 11500 average over couple years.
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I was initially about to comment that 11,500 wRVU/year was a grind then I realized I was ~800 wRVU short of that last year and thought "yea that's not that bad" lol.
 
psych_0 said:
I was initially about to comment that 11,500 wRVU/year was a grind then I realized I was ~800 wRVU short of that last year and thought "yea that's not that bad" lol.
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Yeah I had two NP inpatient to help with the notes with inpatient units. And at times with ED and medical floor consults. I find doing outpatient more a grind as I do all the notes and have to see folks all day long. Inpatient I had more control over my schedule and could see folks at my leisure and would normally be done by mid afternoon. Also, outpatient is very isolating as you see your patients all day. Little time interact with coworkers.
 
J ROD said:
Yeah I had two NP inpatient to help with the notes with inpatient units. And at times with ED and medical floor consults. I find doing outpatient more a grind as I do all the notes and have to see folks all day long. Inpatient I had more control over my schedule and could see folks at my leisure and would normally be done by mid afternoon. Also, outpatient is very isolating as you see your patients all day. Little time interact with coworkers.
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Yea, that has always been my biggest gripe with outpatient. No camaraderie amongst colleagues. Plus, you become a slave to the grind, especially if your salary is tied to wRVUs. I used to hate late visits as a resident and LOVE no-shows. As an attending, I imagine you'd have to just deal with late visits or else collect a minor no-fee or just not get those wRVUs if you don't have a no-show policy.

Also just love going at my own pace. And of course, walking away from antisocial malingerers yelling in your face just to discharge them back to previous lifestyle for easy 90792s. That also helps prevent burnout lol.
 
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