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Discussion in 'Pain Medicine' started by Felton55, Dec 17, 2012.

  1. Felton55

    Felton55 5+ Year Member

    Aug 22, 2011
    I have searched through the threads on this and am still unclear. When people talk about wRVU compensation models, they quote $50 to over $80/RVU as a range.

    Below copied from a post by Pinch and Burn:

    70+ --above avg
    80-- definitely a gem."

    However, the CMS rate per RVU is only $34.04. I am confused as to where this extra money is materializing when setting salary. Is that the difference in commercial vs CMS reimbursement rates? If so, it seems extremely high.

    I am guessing is it due to my lack of understanding of RVU vs wRVU reimbursements.
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  3. NOSfan

    NOSfan 10+ Year Member

    Aug 15, 2007
    Relative value units (RVUs) – RVUs capture the three following components of patient care.

    1. Physician work RVU – The relative level of time, skill, training and intensity to provide
    a given service. Each CPT® code is targeted for review at least every five years to
    determine the work RVU for a particular service and consider if it remains the same as
    the value previously set. Code values can increase or decrease if the components of
    service have changed during the preceding years. A code with a higher RVU work takes
    more time, more intensity or some combination of these two. Some radiation oncology
    codes, such as treatment codes, have no associated physician work.

    2. Practice Expense RVU – This component addresses the costs of maintaining a practice
    including rent, equipment, supplies and nonphysician staff costs. The practice expense
    RVU is now calculated using a "bottom up" methodology where the direct costs of
    providing a service are calculated (staff time, supplies and equipment time) and indirect
    costs are allocated. Indirect costs are those that cannot be directly attributed the
    provision of a service, such as having a waiting room or a billing service. Direct costs
    are those that can be assigned to a specific service; a direct cost would be the actual
    supplies, equipment and staff time used for a given CPT code. Frequently, a CPT® code
    will be assigned a practice expense RVU for a facility setting, such as a hospital, and a
    different practice expense RVU for a nonfacility setting, such as a freestanding center.
    Generally, freestanding radiation oncology centers receive more practice expense
    compensation than hospital-based centers, since the practice expense of owning and
    operating equipment and providing staff resources are significantly more than the
    practice expenses covered by the physician in a hospital setting. As an aside, the hospital
    is paid under Hospital Outpatient Prospective Payment System (HOPPS or OPPS) for the
    radiation oncology equipment and services. Hospital-based physicians are paid under the
    Medicare Physician Fee Schedule (MPFS) in the same manner as freestanding-based

    3. Malpractice RVUs - These are generally the smallest component of the RVU values and
    represent payment for the professional liability expenses. RUC and CMS rules suggest
    that these expenses are to be reviewed and updated on a bi-annual basis, but in practice,
    that has frequently not occurred.

  4. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Oct 7, 2011
    and CMS reimburses wRVU at the rate of $34.

    in my particular situation, my bonus is based on the wRVU, not the total RVU. if you see medicare/medicaid, they will probably quote you rates of $25-30 per wRVU. if you dont see medicaid... congrats!!!!
  5. Jitter Bug

    Jitter Bug 7+ Year Member

    Jul 17, 2009
    Not all jobs reimburse physicians at the CMS value. Depending on your specialty or geography, the salary you earn has to be competitive with other jobs in the area or you will not take the job.

    So employers will work backwards: they have a good idea how many RVU's you will earn in a year, and how much they want to pay you in salary. Then they will divide A by B and offer you an RVU dollar value.

    Remember they may get a fixed rate check from CMS but you will have patients with other insurances who pay more or less, and that affects the bottom line.
    Last edited: Dec 17, 2012
  6. specepic

    specepic 7+ Year Member

    Feb 2, 2008
    New England
    so the work RVU for a LESI may be 1.7-2 or so, but the total RVU for that is a lot higher. So the hosp gets x amount of $, and they pay the doc more than 60 something bucks b/c they get a lot more than that. Private payers do pay a lot more typically than 30 something per RVU.

    The reason it is higher than 30 something per RVU for PAIN is that the wRVU is a small part of the picture vs a non-procedure speciality where the wRVU is a higher percentage of the total.

    If you want to make closer to 30 something per RVU, go into peds
  7. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Oct 7, 2011
    yes i forgot to mention that component.

    i have a base salary that is quite competitive for the area by itself. above a certain number of wRVU, then i get a bonus, that seems low. but again, the majority of my pay is the base salary.

    it does mean i have to see medicare/caid, but then i am less concerned about losing money seeing them - unless they no show, which drives me mad.

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