SDN members see fewer ads and full resolution images. Join our non-profit community!

Turfing to the ER = more RVU's?

Discussion in 'Family Medicine' started by McDoctor, May 10, 2007.

  1. McDoctor

    McDoctor Over One Billion Cured 5+ Year Member

    656
    5
    Feb 13, 2006
    McHospital
    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?
     
  2. SDN Members don't see this ad. About the ads.
  3. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

    18,502
    2,541
    Nov 24, 2002
    SCREW IT!
    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.
     
  4. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    10,882
    2,649
    Jan 21, 2006
  5. gungho

    gungho gungho Physician 10+ Year Member

    263
    0
    Jun 24, 2002
    behind glass
    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...
     
  6. sophiejane

    sophiejane Exhausted Moderator Emeritus 7+ Year Member

    2,778
    5
    Sep 18, 2003
    Waco, TX
    Exactly what I was thinking.
     
  7. McDoctor

    McDoctor Over One Billion Cured 5+ Year Member

    656
    5
    Feb 13, 2006
    McHospital
    The employer designated the RVU. Glad to hear this sort of thing isn't commonplace.
     
  8. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    10,882
    2,649
    Jan 21, 2006
    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.
     
  9. McDoctor

    McDoctor Over One Billion Cured 5+ Year Member

    656
    5
    Feb 13, 2006
    McHospital
    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.
     
  10. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    10,882
    2,649
    Jan 21, 2006
    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.
     

Share This Page