tRVU v wRVU

[miamidoc101]

For those of you in RVU or hybrid base + RVU type shops, do yall get reimbursed by wRVU or tRVU?
Teamhealth is tRVU, so for example a level 5 chart 99285 I get 5.22 tRVU for that chart and thats what Im paid times the multiplier. New gig wants to pay by wRVU, which means I would only be getting 4.0 wRVU for the same amount of work.

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[Jabbed]

For those of you in RVU or hybrid base + RVU type shops, do yall get reimbursed by wRVU or tRVU?
Teamhealth is tRVU, so for example a level 5 chart 99285 I get 5.22 tRVU for that chart and thats what Im paid times the multiplier. New gig wants to pay by wRVU, which means I would only be getting 4.0 wRVU for the same amount of work.

I’m pretty sure that the standard is wRVU as that is your professional fee.

For your specific situation, the multiplier might be different between gigs and result in similar $/hr.

 

[JacobMcCandles]

It depends how else you’re compensated. That may or may not be better.

But, I think most billing companies that report this will tell you wRVU is more common.

 

[miamidoc101]

so most places for a level 5 chart yall are getting 4.0 RVU times whatever your multiplier is?

 

[Jabbed]

so most places for a level 5 chart yall are getting 4.0 RVU times whatever your multiplier is?

Yes.

For E&M codes the components of tRVU are:

-Work RVU: your professional fee
-Practice expense RVU: non-physician fees like rent, capital costs, nurse/tech fees, etc
-Practice liability RVU: cost of malpractice insurance

In truth you were never actually being paid the total RVU.

TeamHealth billed for 5.22 RVUs, collected ~$260 ($50/RVU) and then told you that you are paid ~$30/RVU x 5.22 RVU = ~$150-160 per encounter.

In reality your professional fee is worth ~$50/RVU x 4.0 RVU = ~$200 per encounter.

 

[miamidoc101]

that makes a lot of sense, thanks for clarification. i think the teamhealth multiplier is $21 so even worse than your estimate above

 

[JacobMcCandles]

that makes a lot of sense, thanks for clarification. i think the teamhealth multiplier is $21 so even worse than your estimate above

I’m no TeamHealth fan but there’s a lot more to it than that. Retirement, health insurance, malpractice, administrative overhead, etc. all come from collections. No group that employs physicians is going to pay out exactly what they collect to that physician long term as it isn’t a sustainable business model.

 

[thegenius]

For those of you in RVU or hybrid base + RVU type shops, do yall get reimbursed by wRVU or tRVU?
Teamhealth is tRVU, so for example a level 5 chart 99285 I get 5.22 tRVU for that chart and thats what Im paid times the multiplier. New gig wants to pay by wRVU, which means I would only be getting 4.0 wRVU for the same amount of work.

We used to be paid with tRVU and had our multiplier to get paid. Now we are paid via wRVU and our multiplier went up by like 40% or something. We came out about net even or maybe up a few percent.

 

[thegenius]

so most places for a level 5 chart yall are getting 4.0 RVU times whatever your multiplier is?

Depends if tRVU or wRVU. a level 5 chart for tRVU is like ~5.17 i think.
if wRVU it's 4.0

American College of Emergency Physicians;Top 20 ED Reimbursement Codes

Top 20 ED Reimbursement Codes

www.acep.org

 

[Jabbed]

I’m no TeamHealth fan but there’s a lot more to it than that. Retirement, health insurance, malpractice, administrative overhead, etc. all come from collections. No group that employs physicians is going to pay out exactly what they collect to that physician long term as it isn’t a sustainable business model.

Sure, but is that cost 45% of your professional fee beyond the explicit RVU reimbursement for malpractice coverage and practice expense that is built into the total RVU as in OP’s case?

When you don’t know what you’re actually bringing to the table it’s easy to fall prey to these CMG shenanigans like “we pay you the TOTAL RVU so you make MOAR money”.

 

[JacobMcCandles]

Sure, but is that cost 45% of your professional fee beyond the explicit RVU reimbursement for malpractice coverage and practice expense that is built into the total RVU as in OP’s case?

When you don’t know what you’re actually bringing to the table it’s easy to fall prey to these CMG shenanigans like “we pay you the TOTAL RVU so you make MOAR money”.

As stated, I’m not a TeamHealth fan and there’s a good chance he’s getting screwed but there’s always more to the story before I go off making assumptions as well as the OP comparing the two jobs and the compensation accurately.

 

[TooMuchResearch]

I have no idea what we use. Without a CMG skimming off the top, I don't think it matters.

I don't even look at productivity reports anymore.

I also finally realized most of our faster docs aren't that much faster but rather show up 20 minutes early and pick up 2-4 patients and are less available for sign out for those of us trying to leave.

 

[EctopicFetus]

In EM for the E/M codes the wRVU is 77% of the tRVU. The real difference is in the procedures.

In the end what matters is the conversion factor (or the number you are multiplying by). My SDG does tRVU but i think many/most do wRVU. If all the money is paid out it doesnt matter. Really it doesnt matter a ton until you take the CF into account. If anything they are incentivizing you bill procedures more.

For those who mention the other part.. lets be honest the practice expense and med mal isnt 23% of the overhead.. thats stupid..

My to be fair very lean SDG is under 10% for everything including billing/coding, med mal, admin. So even if I push that out to 15% that leaves a healthy 8% thats left out there.. And keep in mind the MLPs have lower med mal costs, and are cheaper so take that into account since they are reimbursed the same as you (for the most part).

 

[TooMuchResearch]

In EM for the E/M codes the wRVU is 77% of the tRVU. The real difference is in the procedures.

In the end what matters is the conversion factor (or the number you are multiplying by). My SDG does tRVU but i think many/most do wRVU. If all the money is paid out it doesnt matter. Really it doesnt matter a ton until you take the CF into account. If anything they are incentivizing you bill procedures more.

For those who mention the other part.. lets be honest the practice expense and med mal isnt 23% of the overhead.. thats stupid..

My to be fair very lean SDG is under 10% for everything including billing/coding, med mal, admin. So even if I push that out to 15% that leaves a healthy 8% thats left out there.. And keep in mind the MLPs have lower med mal costs, and are cheaper so take that into account since they are reimbursed the same as you (for the most part).

Wow I doubt we're anywhere that lean with the number of office staff,. committees, and paid meetings we now have. But I have zero admin responsibility so can't complain too much!

 

[emergentmd]

Being paid by RVU just ends up being another layer to make compensation complicated so they can take more off the top without you having any idea how much they are making off you.

When we were taken over by TH, we went from SDG hourly + RVU to complete RVU. We were told we would be making more $$$ b/c the RVU model would benefit the faster docs. I knew this was BS and after a few months, everyone's pay went down no matter if you were the top or lower RVU producers.

Bottom line is, money just doesn't appear and there is essentially one pot and the docs in that group are all fighting for some % of the pot.

 

[WhatJobDoIPick]

Being paid by RVU just ends up being another layer to make compensation complicated so they can take more off the top without you having any idea how much they are making off you.

When we were taken over by TH, we went from SDG hourly + RVU to complete RVU. We were told we would be making more $$$ b/c the RVU model would benefit the faster docs. I knew this was BS and after a few months, everyone's pay went down no matter if you were the top or lower RVU producers.

Bottom line is, money just doesn't appear and there is essentially one pot and the docs in that group are all fighting for some % of the pot.

It's all a zero sum game, and an excuse to withhold pay. Why should I be paid less due to factors outside my control? If you feed me a steady 2.2 PPH I can handle that easily. If you don't fill rooms cause "nursing reasons" and I'm twiddling my thumbs for 3 hours but then you slam me with 8 patients in my final 2 hours, I'm not going to be able to see all of those.

 

[EctopicFetus]

It's all a zero sum game, and an excuse to withhold pay. Why should I be paid less due to factors outside my control? If you feed me a steady 2.2 PPH I can handle that easily. If you don't fill rooms cause "nursing reasons" and I'm twiddling my thumbs for 3 hours but then you slam me with 8 patients in my final 2 hours, I'm not going to be able to see all of those.

Keep in mind patient flow is usually outside of the control of the cmg.

Also keep in mind that rvus = income.

Some childish fantasy (not yours) of being paid just for existing is beyond stupid. Of course this depends on your set up.

In the end, if you work a at a cmg your pay is dictated on a supply/ demand curve.

If you work for an sdg with equal ownership you can decide how you want to divide the pot. The pot however is tied to rvus and volume and if lucky maybe a subsidy.

Rvus can be used for good or bad. Much depends on who controls the purse.

 

[WhatJobDoIPick]

Keep in mind patient flow is usually outside of the control of the cmg.

Also keep in mind that rvus = income.

Some childish fantasy (not yours) of being paid just for existing is beyond stupid. Of course this depends on your set up.

In the end, if you work a at a cmg your pay is dictated on a supply/ demand curve.

If you work for an sdg with equal ownership you can decide how you want to divide the pot. The pot however is tied to rvus and volume and if lucky maybe a subsidy.

Rvus can be used for good or bad. Much depends on who controls the purse.

Agree you certainly can't control arrivals. But we can control flow of patients into the department once they arrive.

 

[Janders]

We do true P&L for our docs, but when we want to look at metrics we can see wRVU easily.

As per various above commenters, hourly, hybrid, various RVU formulae… it’s all smoke and mirrors. Open books solve problems, you can see how much came in and where it went.

Like I’ve said before, it’s easy for 10% to do coding billing scheduling local admin and minor corporate functions like HR and IS stuff. Maybe 12%.

Then if you have PAs they need to get paid. In our system all the Pa generated revenue goes to the MDs, and the PAs get salaries and bonuses. As such perhaps another 10% of income is spent on PA costs (but you reap the rewards of this money).

That would leave 80% to go the MDs, but of course some of that is health insurance, or employer side 12% retirement matching, or whatnot (if you are w2, not 1099).

So you might see someone say they “only” get 70% of what they generate, but they aren’t including all their benefits nor the PA working alongside them feeding them revenue.

The real question is if 5-30% is going off to pay some corporate overlord or PE people…

 

[EctopicFetus]

Agree you certainly can't control arrivals. But we can control flow of patients into the department once they arrive.

We definitely dont.. the nurses do.. in most EDs we dont control the nurses much.. maybe where you work it is different. We continue with the pull to full push but the nurses dont seem to implement it.