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
physicians.
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.
Source:
www.acro.org/washington/RVU.pdf
