Turfing to the ER = more RVU's?

[McDoctor]

One of the residents at my program mentioned that he was looking into a job offer (an employment position) wherein his productivity was measured in RVU's. He said that referring a patient to the ER earned 3 RVU's. A 99214 E & M code, by comparison, was something like 1.5 RVU's. He didn't get into specifics, but the bottom line seemed to be a perverse incentive to turf most anything subacute to the ER.

Can anyone here who may be familar with RVU based productivity confirm or deny the veracity of this type of contract structure? I hope this is some weird anomaly or urban legend of some sort. If many family doctors are actually getting paid MORE to abuse the ER, this fact just might be enough to drive me that last millimeter over the edge of sanity.

I guess I can see the logic behind this type of contract structure, if you are being employed by the hospital. After all, the ER gets paid more to evaluate abdominal pain than a family doctor. I wonder what our ER brethren thinks of that crap, if actually true?

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[Apollyon]

Yikes! I haven't heard that. We're going to an RVU-bonus system (win-win - no loss of base pay) in July.

Where I'm at, FM rules the roost - there are able and adequate FM docs ALL OVER the area. This has the propensity for pretty lucrative collusion to occur.

 

[deleted87716]

Here's a good overview of various managed care compensation models, including RVU-based schemes: http://healthadmin.jbpub.com/mhc/readings/chapter%2007/jacm 22-3.p36-46.pdf

 

[gungho]

One of the residents at my program mentioned that he was looking into a job offer (an employment position) wherein his productivity was measured in RVU's. He said that referring a patient to the ER earned 3 RVU's. A 99214 E & M code, by comparison, was something like 1.5 RVU's. He didn't get into specifics, but the bottom line seemed to be a perverse incentive to turf most anything subacute to the ER.

Can anyone here who may be familar with RVU based productivity confirm or deny the veracity of this type of contract structure? I hope this is some weird anomaly or urban legend of some sort. If many family doctors are actually getting paid MORE to abuse the ER, this fact just might be enough to drive me that last millimeter over the edge of sanity.

I guess I can see the logic behind this type of contract structure, if you are being employed by the hospital. After all, the ER gets paid more to evaluate abdominal pain than a family doctor. I wonder what our ER brethren thinks of that crap, if actually true?

I have been on an RVU system and watched it like a hawk because I didn't trust my employers. I cannot imagine the scenario you outline. Perhaps if we had the code that is used to obtain those 3 RVU? Or are you saying that his prospective employers designated that RVU amount for the ER referral? If so, something smells...

 

[sophiejane]

Or are you saying that his prospective employers designated that RVU amount for the ER referral? If so, something smells...

Exactly what I was thinking.

 

[McDoctor]

I have been on an RVU system and watched it like a hawk because I didn't trust my employers. I cannot imagine the scenario you outline. Perhaps if we had the code that is used to obtain those 3 RVU? Or are you saying that his prospective employers designated that RVU amount for the ER referral? If so, something smells...

The employer designated the RVU. Glad to hear this sort of thing isn't commonplace.

 

[deleted87716]

One of the residents at my program mentioned that he was looking into a job offer (an employment position) wherein his productivity was measured in RVU's. He said that referring a patient to the ER earned 3 RVU's. A 99214 E & M code, by comparison, was something like 1.5 RVU's. He didn't get into specifics, but the bottom line seemed to be a perverse incentive to turf most anything subacute to the ER.

If the 3 RVUs are "earned" without ever seeing the patient (e.g., telling a patient who calls the office with chest pain to go to the ER), that would be truly bizarre. Most physicians receive no compensation whatsoever for telephone triage. OTOH, if the patient is seen in the office, and has something potentially life-threatening that requires immediate ER evaluation (e.g., ACS), I can understand it...these are usually 99215s by definition.

 

[McDoctor]

If the 3 RVUs are "earned" without ever seeing the patient (e.g., telling a patient who calls the office with chest pain to go to the ER), that would be truly bizarre. Most physicians receive no compensation whatsoever for telephone triage. OTOH, if the patient is seen in the office, and has something potentially life-threatening that requires immediate ER evaluation (e.g., ACS), I can understand it...these are usually 99215s by definition.

But not all "abdominal pains" or "chest pains" are life threatening. You evaluate and use your best judgement. You code a 99215, and if you can't rule out a life threatening process you send to the ER. You shouldn't get a monetary bonus for referring a patient from your office to the ER, beyond the E and M code billed to the insurance (the 99215). But if I was getting the story straight, this seemed to be what was described.

 

[deleted87716]

Of course, consistently referring truly stupid things to the ER will eventually backfire on you...I can't imagine that many patients would put up with it for long, and you'd trash your professional reputation in a hurry.