I have all kinds of other metrics that they look at for me including "penetration rates" (gigitty...) from PCC, number of unique encounters, and number of "warm-handoff" consultations. All I know is that my penetration rates is the highest off all CBOCs for our VAMC, and last time checked, I was at 110% of my productivity expectation. I was told I can back off the throttle some. I am busy but not anything near swamped.We're set to move to this next year. They're kind of piloting it this fall to use as projections. What are your thoughts on this? Has it changed your clinical load at all?
YepMy company recently moved to an RVU system and I have worked with them at my previous employer. I am not loving it, but is has not impacted my practice immensely. Having a system based largely on billable units, you can imagine the pressure.
I'd question it only being 10%….are you purely a consult service or out-pt referral? If I was the latter I'd be okay with that %, but if you are spending any significant amount of time in the hospital providing clinical services that 10% seems awfully low.We use RVUs and that is factored into our compensation. The system is too complicated for me to understand without spending so much time on it that my productivity would go down. At this point, I am being compensated very well so am not complaining. The VP of finance told me that the RVUs are adjusted upward for psych by about 10% above the actual billing so that seems fair and helps to account for non-billable activities that I do for the hospital.
They don't expect a certain amount of RVU, I just get a percentage of whatever that is converted to dollars. About 75% of my work is in the outpatient clinic and many of the consults that I do lead to more work there so it all works out pretty well.I'd question it only being 10%….are you purely a consult service or out-pt referral? If I was the latter I'd be okay with that %, but if you are spending any significant amount of time in the hospital providing clinical services that 10% seems awfully low.
You'll want to know how the RVU and total RVU expected are being calculated, as those numbers are your bar and they can make a huge difference.
No clear mandate, but I hear ~1900 give or take 100 or so is in the realm.Re-visiting this question of RVUs... I am curious if anyone on this board can share what RVU expectations their institution has for them, and if they know how much their institution is compensated per RVU they generate?
Relative Value Unit. Just another semi-arbitrary measure of productivity.this is going to sound a bit naive I imagine, but what is an RVU?
It's technically a measure of efficiency that was twisted into a measure of productivity.Relative Value Unit. Just another semi-arbitrary measure of productivity.
We're not officially on them yet, but I track mine and am already devising ways to game the system to up my RVU's without increasing my actual workload if it comes down to itIt's technically a measure of efficiency that was twisted into a measure of productivity.
BL..think of it like a widget and a value is assigned to it, jobs are assigned a certain number, salaries are linked to them.
They are mostly bad for us, but widely utilized.
I tried to get interested and investigate in all this, but I just cant. Its boring. And there are so many problems with this given the nature of my position. I also have time time carved out for internship admin duties too, so I think my targets are bit lower than others.It probably would be tough to tie salary directly to RVUs at the VA given the larger salary structure, but it could be one of multiple performance indicators.
Wow. What's it like out there on the tail of the distribution?My RVUs are in the 4000 range.
We dont use RVU's, but I think prior to this the highest # I recall hearing was like 2700. Tell us your ways.My RVUs are in the 4000 range. The only thing that counts for RVUs are procedure codes. If you are doing anything else like talking on the phone or reviewing records or charting or collaborating, then you get nothing. At least with testing you can code the time to score, interpret, and write up the results. I haven't really compared the various RVUs for various procedures to see what is most efficient. At this point, I just do whatever work comes my way that I am competent to perform.
It can be exhausting at times, but at least i get compensated for it.Wow. What's it like out there on the tail of the distribution?
40 hours of patients booked solid every week and a bump every four weeks with being on-call.We dont use RVU's, but I think prior to this the highest # I recall hearing was like 2700. Tell us your ways.
There are actually codes for telephone calls (that involve patient care) and chart review, but yeah, those would be for situations outside "the norm" for psychotherapy, assessment, etc. And I have no idea if/when/how they're reimbursed; I'd imagine they're probably just more for internal productivity tracking than actual external billing.My RVUs are in the 3000 range. The only thing that counts for RVUs are procedure codes. If you are doing anything else like talking on the phone or reviewing records or charting or collaborating, then you get nothing. At least with testing you can code the time to score, interpret, and write up the results. I haven't really compared the various RVUs for various procedures to see what is most efficient. At this point, I just do whatever work comes my way that I am competent to perform.
edited to correct
Tail end of the distribution on that too. I could actually work less, but I like the checks. I used to work as hard for almost half the money so I can't complain. This is the first time in my life where I have experienced direct rewards for hard work and success. Today is really a challenge because it was all kids and families and it looks like an 8 for 8 day. I actually will have done 36 appointments this week and used the four cancel/no shows to score and write up an assessment. Man, that hottub is going to feel good tonight.Still, 3200 wRVUs is a TON. I hope you are very well compensated!!
Yeah, occasionally use the phone codes (967-968), I'm still trying to get the e-consult thing up and going here. Not much of an issue now, but, if they give us RVU targets in teh future, I'm going to insist on the e-consult to track that time.There are actually codes for telephone calls (that involve patient care) and chart review, but yeah, those would be for situations outside "the norm" for psychotherapy, assessment, etc. And I have no idea if/when/how they're reimbursed; I'd imagine they're probably just more for internal productivity tracking than actual external billing.
With assessments, you can count the chart review, I am pretty sure. We can't bill for phone calls at our hospital as to the best of my knowledge, no insurance will reimburse for it. The one exception would be when I use a crisis code where the phone calls can be part of the time that you are counting.There are actually codes for telephone calls (that involve patient care) and chart review, but yeah, those would be for situations outside "the norm" for psychotherapy, assessment, etc. And I have no idea if/when/how they're reimbursed; I'd imagine they're probably just more for internal productivity tracking than actual external billing.
Sorry, had to bump this. I just found out our "target" RVUs beginning in September will be a bit over 4000 (assuming 100% clinical effort). Minimum to "not get fired" is apparently 2700. They are apparently changing the system significantly, but they had some things that are just flat out crazy built into their assumptions (475 new patient intakes?).
I'm fortunately insulated from this in my current role, but it came up in the context of ongoing discussion about my long-term plans within the department. My only thought is that we do work on a medical "attending" model with trainees billing under their supervisor. Between an attending and a couple interns or post-docs, those numbers start to look a little more realistic (though I still have no idea what individual practitioner does 500 intakes a year). If trainees don't count, I have no idea how anyone could manage to pull that off.
*re-reads self-care thread very carefully*
If that 4000 mark is not based on trainees then it is an impossibly high mark. Are they going pay almost 200k a year if you hit it? That's about what I would get and even then it's not worth it for me to work that much more. The 3200 I did last year was close to my limit. If I was doing inpatient it might be different as I would have no no shows and I could do three 30'minute sessions an hour still be able to use the bathroom and squeeze more , but most patients need more than 18 minutes of treatment. A doc I work with does several 45 minute sessions at end of day with no break to squeeze in an extra appointment a day. Ultimately, if they pay for the productivity then there is motivation to do more and then we have to balance that with what we can do and still be clinically effective. I prefer to be the one in charge of that equation as opposed to the bean counters.Sorry, had to bump this. I just found out our "target" RVUs beginning in September will be a bit over 4000 (assuming 100% clinical effort). Minimum to "not get fired" is apparently 2700. They are apparently changing the system significantly, but they had some things that are just flat out crazy built into their assumptions (475 new patient intakes?).
I'm fortunately insulated from this in my current role, but it came up in the context of ongoing discussion about my long-term plans within the department. My only thought is that we do work on a medical "attending" model with trainees billing under their supervisor. Between an attending and a couple interns or post-docs, those numbers start to look a little more realistic (though I still have no idea what individual practitioner does 500 intakes a year). If trainees don't count, I have no idea how anyone could manage to pull that off.
*re-reads self-care thread very carefully*
No worries. I'll apparently be too busy working to read them anywaysThose are completely unrealistic numbers.
I still owe you those articles. I'm out sick, but I'll get them to you when I'm back in the office.
I just looked at my numbers, and if salary were adjusted (which it wouldn't cause I'm at a VA), I would be making over 200,000/year if that happened. Meaning, my current RVU target is half that.If that 4000 mark is not based on trainees then it is an impossibly high mark.
I'd get around 130k for hitting it per the business office, but they also have some weird assumptions about billing (50% collection? That may be true department-wide if you factor in things like ED admissions to psych inpatient but I'm pretty sure collection in our relatively high SES outpatient clinic is immensely higher). We're eat-what-you-kill right now, so I think 200 is probably closer to reality. The whole system is in the process of changing though, so I don't think any of this should be taken too seriously. Its only semi-relevant to me personally since NIH-willing I won't ever be anywhere close to 100% clinical effort. I just found it funny to see the discussion of 2000 and have my department come in with double that and be like "Well...of course. Why wouldn't you do 500 intakes?." Note: The meeting was with an MBA with a background in medical billing, not a provider.If that 4000 mark is not based on trainees then it is an impossibly high mark. Are they going pay almost 200k a year if you hit it? That's about what I would get and even then it's not worth it for me to work that much more. The 3200 I did last year was close to my limit. If I was doing inpatient it might be different as I would have no no shows and I could do three 30'minute sessions an hour still be able to use the bathroom and squeeze more , but most patients need more than 18 minutes of treatment. A doc I work with does several 45 minute sessions at end of day with no break to squeeze in an extra appointment a day. Ultimately, if they pay for the productivity then there is motivation to do more and then we have to balance that with what we can do and still be clinically effective. I prefer to be the one in charge of that equation as opposed to the bean counters.
50% collection might be a reasonable target depending on your institution's billing practices. You might find out for yourself what your collection rate has been recently. There's no reason why someone shouldn't be able to give the historical collection rates for each service, or each clinician.I'd get around 130k for hitting it per the business office, but they also have some weird assumptions about billing (50% collection? That may be true department-wide if you factor in things like ED admissions to psych inpatient but I'm pretty sure collection in our relatively high SES outpatient clinic is immensely higher). We're eat-what-you-kill right now, so I think 200 is probably closer to reality. The whole system is in the process of changing though, so I don't think any of this should be taken too seriously. Its only semi-relevant to me personally since NIH-willing I won't ever be anywhere close to 100% clinical effort. I just found it funny to see the discussion of 2000 and have my department come in with double that and be like "Well...of course. Why wouldn't you do 500 intakes?." Note: The meeting was with an MBA with a background in medical billing, not a provider.
The answer to who does 500 intakes per year is I probably do about that many in sub acute rehab. Our rvu requirements look similar to yours as well. Which is why I started the self-care thread....Sorry, had to bump this. I just found out our "target" RVUs beginning in September will be a bit over 4000 (assuming 100% clinical effort). Minimum to "not get fired" is apparently 2700. They are apparently changing the system significantly, but they had some things that are just flat out crazy built into their assumptions (475 new patient intakes?).
I'm fortunately insulated from this in my current role, but it came up in the context of ongoing discussion about my long-term plans within the department. My only thought is that we do work on a medical "attending" model with trainees billing under their supervisor. Between an attending and a couple interns or post-docs, those numbers start to look a little more realistic (though I still have no idea what individual practitioner does 500 intakes a year). If trainees don't count, I have no idea how anyone could manage to pull that off.
*re-reads self-care thread very carefully*
Most people take more time off than 2 weeks in a given year (you've basically accounted for all the major holidays and nothing else. I think I was out a total of 15 work days last year in addition to the 10 major holidays).Is 4,000 RVU really that crazy? I thought a 90837 (53+ min psychotherapy session) was 3 RVUs. Based on that, seeing 6 clients a day for 50 weeks is 4,500 RVU.
That's it?I was out a total of 15 work days last year
No, I didn't exhaust my leave days. Need to keep some in there for rainy days. Some of those days I was out were sick days too, which is separate bank of time.That's it?
The VA doesn't give you 4 weeks off at least? (on top of holidays)?