Where can I find IM RVUs?

[sallyhasanidea]

Wanted to do some calculations on locums rates...

I have some examples from radiology, but wanted some respective numbers from IM

Let's say you are going to get $2500 for the "day". You need to do enough work to justify that.

Currently, Medicare pays about $36 for each professional RVU. This covers the labor cost.

$2500/$36 = 69 RVU

69 RVU is a doable day of work. What does this translate to?
-CXRs are worth 0.22 RVU for the professional component. So this is about 313 CXRs. If you are working 10 hrs for the day without breaks, it's 31 CXR/hour, or 1 every 2 minutes...for 10 hours straight. Doable.
-CT abd/pelvis is 1.82 RVU. So this is about 38 abd/pelvis CTs in the 10 hour day, or 3.8/hour. Doable.

The thing is, the place paying would only be making money on the technical stuff--basically giving you everything for the professional stuff, and you don't have to bill, collect, etc.

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[aafisahar]

Hospitalists get paid so that the hospital doesn't close. It's not about the RVUs but more so that ortho can fix knees and hips. If there aren't hospitalists, then no cases. Treating the pneumonias and heart failure is just the loss leader so that the elective revenue keeps flowing.

 

[gutonc]

This is an old article, but close enough. As a hospitalist (honestly, any non-procedural specialty), you're going to be all about the E&M codes (as a hospitalist, basically your H&P, f/u and D/C, with a smattering of ACP, tobacco abuse counseling and the like).

One thing to note on the chart, that may or may not be different from what you've seen in radiology, is the wRVU (what you as they physician are credited for) and the total RVU (what the hospital is paid for), which is always a bigger number.

 

[chessknt]

69 wrvu in a day is a stretch for a hospitalist. It would mean about 18 complex admits or about 35 complex follow ups or about 15 ICU level patients. Technically doable but a bad day to be sure and corners are probably going to be cut if you want to get out in time. Meanwhile 69 wRVU could be achieved with about 3 TKAs by an orthopod.

Welcome to E/M coding--it sucks.

 

[QuizzicalApe]

alternatively you get 2500 for the day because that's what the hospital is willing to pay you because they're desperate and otherwise they have to load their patients into a wheelbarrow and dump them out the window

 

[sallyhasanidea]

This is an old article, but close enough. As a hospitalist (honestly, any non-procedural specialty), you're going to be all about the E&M codes (as a hospitalist, basically your H&P, f/u and D/C, with a smattering of ACP, tobacco abuse counseling and the like).

One thing to note on the chart, that may or may not be different from what you've seen in radiology, is the wRVU (what you as they physician are credited for) and the total RVU (what the hospital is paid for), which is always a bigger number.

Do you know where I can find E&M codes for heme onc? Is there a publically accessible database somwhere?

 

[sallyhasanidea]

69 wrvu in a day is a stretch for a hospitalist. It would mean about 18 complex admits or about 35 complex follow ups or about 15 ICU level patients. Technically doable but a bad day to be sure and corners are probably going to be cut if you want to get out in time. Meanwhile 69 wRVU could be achieved with about 3 TKAs by an orthopod.

Welcome to E/M coding--it sucks.

Do you know where I can find wRVU/RVU's for other specialties like ortho? Where did you get the 3 TKA = 69 RVU number?

 

[chessknt]

Do you know where I can find E&M codes for heme onc? Is there a publically accessible database somwhere?

Google cms rvu lookup and go to their website and plug in cpt codes you are curious about.

E/m codes are a bludgeon, they are the same for every specialty so a pcp, oncologist, surgeon, congenital heart specialist etc all bills exactly the same for the three levels of service that exist even though the complexity of training put in to a consultation and the number of things addressed is hugely variable.

 

[NITRAS]

Wanted to do some calculations on locums rates...

I have some examples from radiology, but wanted some respective numbers from IM

Let's say you are going to get $2500 for the "day". You need to do enough work to justify that.

Currently, Medicare pays about $36 for each professional RVU. This covers the labor cost.

$2500/$36 = 69 RVU

69 RVU is a doable day of work. What does this translate to?
-CXRs are worth 0.22 RVU for the professional component. So this is about 313 CXRs. If you are working 10 hrs for the day without breaks, it's 31 CXR/hour, or 1 every 2 minutes...for 10 hours straight. Doable.
-CT abd/pelvis is 1.82 RVU. So this is about 38 abd/pelvis CTs in the 10 hour day, or 3.8/hour. Doable.

The thing is, the place paying would only be making money on the technical stuff--basically giving you everything for the professional stuff, and you don't have to bill, collect, etc.

A mid-level follow up encounter is 1.39 wRVU, a high level is 2.0 wRVU. A high level admit (most will be) is between 3.6-3.89 between obs and inpatient admission. Critical care is 4.5. Your discharges will mostly be 1.9 if inpatient. Obs is like 0.89. There is a small smatter of tobacco cessation (hardly worth the time) and advance care planning. . . . I think the average Hospitalist bills like 4000 wRVU’s a year.

So, your talking like 22-24 follow ups/discharges with 6 admits, plus a couple critical care ones. That’s a lot.

I’ve not seen $2500 for a day (but I haven’t looked in a bit either). I get $1400 for days (no admits) and $2000 for nights.

 

[CCM-MD]

Unrealistic for IM.

 

[gutonc]

Do you know where I can find E&M codes for heme onc? Is there a publically accessible database somwhere?

Please don’t choose a specialty based on this.
And they’re pretty much going to just be 9921X and 9920X for follow up and new patients. I can count the number of other codes I use on 2 or 3 fingers.

 

[sallyhasanidea]

Please don’t choose a specialty based on this.
And they’re pretty much going to just be 9921X and 9920X for follow up and new patients. I can count the number of other codes I use on 2 or 3 fingers.

So how does an oncologist on average make more than general IM outpatient, if they both use the CPT codes?

 

[tantacles]

So how does an oncologist on average make more than general IM outpatient, if they both use the CPT codes?

Consults pay more than admissions.

 

[gutonc]

So how does an oncologist on average make more than general IM outpatient, if they both use the CPT codes?

Because most of us get paid (either as a portion of our salary, or a fraction of gross revenues) for infusion/drugs. Sure, my clinic time is compensated the same as a PCP, endocrinologist or any other doc. But, it's the rare PCP that see's a patient for a 99213 and at the same time brings in $18K for a 30 minute drug infusion.

Please stop using income as a way to choose your specialty. If that's your only criterion, you need to situate yourself for a sure derm, plastics or neurosurgery match or find another profession.

 

[sallyhasanidea]

Consults pay more than admissions.

Where can I find the consult CPT codes? Wouldn't they just be follow up out patient visit?

 

[sallyhasanidea]

Because most of us get paid (either as a portion of our salary, or a fraction of gross revenues) for infusion/drugs. Sure, my clinic time is compensated the same as a PCP, endocrinologist or any other doc. But, it's the rare PCP that see's a patient for a 99213 and at the same time brings in $18K for a 30 minute drug infusion.

Please stop using income as a way to choose your specialty. If that's your only criterion, you need to situate yourself for a sure derm, plastics or neurosurgery match or find another profession.

Yes, but how much of that original 18k is the cost of the drug itself? That can't all be profit?

 

[CCM-MD]

Because most of us get paid (either as a portion of our salary, or a fraction of gross revenues) for infusion/drugs. Sure, my clinic time is compensated the same as a PCP, endocrinologist or any other doc. But, it's the rare PCP that see's a patient for a 99213 and at the same time brings in $18K for a 30 minute drug infusion.

Please stop using income as a way to choose your specialty. If that's your only criterion, you need to situate yourself for a sure derm, plastics or neurosurgery match or find another profession.

I have always thought that it’s so weird that oncologists are paid for the drugs they prescribe.

 

[QuizzicalApe]

Yes, but how much of that original 18k is the cost of the drug itself? That can't all be profit?

Depends on if the drug is bought by a hospital qualifying under the 340B program to get discounts or not

 

[tantacles]

Where can I find the consult CPT codes? Wouldn't they just be follow up out patient visit?

I'm talking about inpatient consults.

 

[gutonc]

I have always thought that it’s so weird that oncologists are paid for the drugs they prescribe.

It’s no different than any other profitable part of the medical enterprise.

Do ortho and plastics get paid so well (let’s assume an employed setup for the sake of making fair comparisons) because the work they do is more “important” or harder than what a hospitalist or pediatric endocrinologist does?

Obviously not. It’s because the thing they dobrings a lot of money to the hospital. Same for oncology. My oncology division is the 2nd most profitable in our hospital system after Ortho. We make up 60% of the income for the entire Department of Medicine, more than Cards and GI combined. As a result, we see some of that money. Not Ortho money of course. But it’s something.

 

[CCM-MD]

It’s no different than any other profitable part of the medical enterprise.

Do ortho and plastics get paid so well (let’s assume an employed setup for the sake of making fair comparisons) because the work they do is more “important” or harder than what a hospitalist or pediatric endocrinologist does?

Obviously not. It’s because the thing they dobrings a lot of money to the hospital. Same for oncology. My oncology division is the 2nd most profitable in our hospital system after Ortho. We make up 60% of the income for the entire Department of Medicine, more than Cards and GI combined. As a result, we see some of that money. Not Ortho money of course. But it’s something.

I get that but no other specialty sees money from prescribing meds. Its akin to a PCP getting paid for prescribing Lipitor or an endocrinologist getting paid for starting a novel diabetic agent... oncology is the only specialty that has that, and its weird. Would be odd if I got 50 bucks each time I bolused someone with normal saline or started on norepinephrine.

The income disparity in physician compensation based on specialty needs a hard look. I am looking forward to the 2021 CMS changes, even my specialty is technically taking a hit.

 

[Chemist0157]

It’s no different than any other profitable part of the medical enterprise.

Do ortho and plastics get paid so well (let’s assume an employed setup for the sake of making fair comparisons) because the work they do is more “important” or harder than what a hospitalist or pediatric endocrinologist does?

Obviously not. It’s because the thing they dobrings a lot of money to the hospital. Same for oncology. My oncology division is the 2nd most profitable in our hospital system after Ortho. We make up 60% of the income for the entire Department of Medicine, more than Cards and GI combined. As a result, we see some of that money. Not Ortho money of course. But it’s something.

Does oncology get paid for simply PRESCRIBING the medication or ADMINISTERING it? I thought the money came from having one's own infusion centers as I believe rheumatology can do the same thing, or anyone else administering medications at an infusion center.

I order Cytoxan, rituxmab, etc but not paid for that as it is being administered by an infusion center. Nephrology was paid at one time for ESAs being administered at dialysis before it was bundled into the dialysis payments.

 

[CCM-MD]

Does oncology get paid for ORDERING the medication or ADMINISTERING it? I thought the money came from having one's own infusion centers. Rheumatology does the same thing correct?

I order Cytoxan, rituxmab, etc but not paid for that as it is being administered by an infusion center. Nephrology was paid at one time for ESAs being administered at dialysis before it was bundled into the dialysis payments.

You're probably right. But idk if it matters. For example, if an oncologist is employed and the hospital's infusion center is administering the drug... does it really matter. At the end of the day, the oncologist is getting $450k+ while essentially billing the same E&M codes as an endocrinologist or other medical specialist.

 

[Chemist0157]

You're probably right. But idk if it matters. For example, if an oncologist is employed and the hospital's infusion center is administering the drug... does it really matter. At the end of the day, the oncologist is getting $450k+ while essentially billing the same E&M codes as an endocrinologist or other medical specialist.

No, I don't think it would matter much in that model.

 

[rokshana]

I'm talking about inpatient consults.

CMS doesn’t pay for consults anymore, so the coding is the same as any new pt visit..9922x

 

[tantacles]

CMS doesn’t pay for consults anymore, so the coding is the same as any new pt visit..9922x

oh boooooo

 

[collegestud2013]

Wanted to do some calculations on locums rates...

I have some examples from radiology, but wanted some respective numbers from IM

Let's say you are going to get $2500 for the "day". You need to do enough work to justify that.

Currently, Medicare pays about $36 for each professional RVU. This covers the labor cost.

$2500/$36 = 69 RVU

69 RVU is a doable day of work. What does this translate to?
-CXRs are worth 0.22 RVU for the professional component. So this is about 313 CXRs. If you are working 10 hrs for the day without breaks, it's 31 CXR/hour, or 1 every 2 minutes...for 10 hours straight. Doable.
-CT abd/pelvis is 1.82 RVU. So this is about 38 abd/pelvis CTs in the 10 hour day, or 3.8/hour. Doable.

The thing is, the place paying would only be making money on the technical stuff--basically giving you everything for the professional stuff, and you don't have to bill, collect, etc.

wRVUs are only comparable within the same specialty. It's pretty useless to compare than across different specialties since the work they do and reimbursement structure are completely different.

Currently the average CMS reimbursement per HOSPITALIST wRVU is around $55. This number can be very different for other specialties.

For IM hospitalists, the billing is actually straightforward. There are only 3 times of notes most hospitalists will bill for for the most part: H&Ps, follow-up notes (progress notes), and D/c summaries.

H&Ps: can be billed at a level 1, 2 , or 3. Most admissions H&Ps these days are billed at a level 3 which is assigned 3.86 wRVUs.

Follow-up notes are billed a level 1, 2 , or 3. Most follow-up notes these days are billed either level 2 (=1.39 wRVUs) or level 3 (=2.00 wRVUs).

D/C summaries are billed as either <30 minutes or >30 minutes. Nearly all hospitalist d/c summaries these days are billed at >30 minutes which is equal to 1.99 wRVUs.

In most hospital systems and for most hospitalists, roughly 20 is the max one can comfortably see independently (without the help of a midlevel or resident) in a 12-hour rounding shift.

On a typical day, for example, if you see 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges, then your wRVU for that day is: (12 x 2.00 ) + (3 x 1.39) + (5 x 1.99) = 38.12. Assuming the above $55 per wRVU, your total wRVU generated is $2096.60.

And if you work the typical 7-on-7-off scheduele, that's 182 shifts per year so in theory your total pay should be $381,581. In a reality most places with that type of volume will probably pay you a bit less, since you have to account for the wRVUs to cover not just your salary and bonus, but also your benefits, malpractice expenses (usually paid for by most hospitalist groups), and also cover for the costs of cross-coverage for any night-time staffing in the group (since nocturnists are usually paid a higher rate but the only wRVUs they generate is through admissions which usually falls very short of the salary they are paid, and the cross coverage work they do does not directly generate any additional wRVUs under their name).

To cut costs many hospitalist groups will add NPs/PAs ("midlevels') into their staffing, since they can bill the exact same numbers as above but just have a hospitalist attending be signing all their notes and get paid 1/3 to 1/2 as much as an attending. IMO some of the more senior midlevels that have been in practice for 5+ years are not far off from the expertise of an attending, and to mitigate the risk in most cases the midlevels are asked to see the least sick patients and ask the attending for management advice on anything they don't know how to handle. So it's possible in some places for a hospitalist to see 20 patients independently and then sign another 20 notes of a PA/NP. With 40 patients your wRVUs generated per day will be closer towards $4200 per day, and even if you spent $1000 of that paying for the midlevel for that day you'll still come out ahead and should make closer to $3000 per 12-hour shift. Under this model with 182 shifts per year you would be making $546k per year.

In the end I think the unicorn hospitalist jobs at the end of the day are probably those in teaching/residency programs, since you essentially can have residents see up to around 20 patients per day (maximum ACGME allowed number) without having to pay for the cost of a midlevel (remember that resident spots are funded by Medicare) and that leaves you time to see another 10-15 patients on your own if you like. And you can have resident night crosss-coverage without the expense of hiring a midlevel or attending to do it.

You can use the MGMA data to find the average wRVUs that are being produced in each specialty.

Agreed that salary/compensation shouldn't be the only criterion for picking a specialty, but OP mentioned in another post that he/she has $450k in debt so he/she needs to be practical as well.

 

[collegestud2013]

Also, keep in mind that at the end of the day, in most cases hospitalists are still being partially subsidized by the hospital because total billable wRVUs generated by the group as a whole often isn't enough to cover the total compensation expenses of everyone in the group (unless the hospitalists are really getting a low-balled deal). Hospitals are okay with this because hospitalists are expected to do some non RVU generating work that is valuable for the hospital such as discharge planning (which allows for beds to open up for new patients) and ordering tests and consults that other specialties can bill for. Of course since exact value of this work is difficult to quantify, it's theoretically possible to have downward pressure on salaries if there's an oversupply.

And hospitalist salaries so far have outpaced inflation in the past 10 years. In 2010, the median compensation was just a bit over $200k but in 2020 it's over $300k (and can go up to over $500k if you don't mind working extra shifts and seeing over 20 patients per shift).

And for OP's original question about locums, you can't really use RVUs to calculate to pay for locums. Locums hospitalists are pretty much always going to be losing money for the hospital since they are paid at higher rates than the same full-time counterparts at the same hospital, and are compensated for expenses like travel and housing. Most hospitals will only use locums as a last resort to fill shifts they can't fill with full-time people so locums is rarely a long-term sustainable option since the hospital is essentially doing to cut losses in the short-run (and just pay the lowest rate they can get for someone to fill a shift ASAP) so you'll never get the sustained shifts in the long-term.

Source: I'm currently a hospitalist

 

[NITRAS]

wRVUs are only comparable within the same specialty. It's pretty useless to compare than across different specialties since the work they do and reimbursement structure are completely different.

Currently the average CMS reimbursement per HOSPITALIST wRVU is around $55. This number can be very different for other specialties.

For IM hospitalists, the billing is actually straightforward. There are only 3 times of notes most hospitalists will bill for for the most part: H&Ps, follow-up notes (progress notes), and D/c summaries.

H&Ps: can be billed at a level 1, 2 , or 3. Most admissions H&Ps these days are billed at a level 3 which is assigned 3.86 wRVUs.

Follow-up notes are billed a level 1, 2 , or 3. Most follow-up notes these days are billed either level 2 (=1.39 wRVUs) or level 3 (=2.00 wRVUs).

D/C summaries are billed as either <30 minutes or >30 minutes. Nearly all hospitalist d/c summaries these days are billed at >30 minutes which is equal to 1.99 wRVUs.

In most hospital systems and for most hospitalists, roughly 20 is the max one can comfortably see independently (without the help of a midlevel or resident) in a 12-hour rounding shift.

On a typical day, for example, if you see 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges, then your wRVU for that day is: (12 x 2.00 ) + (3 x 1.39) + (5 x 1.99) = 38.12. Assuming the above $55 per wRVU, your total wRVU generated is $2096.60.

And if you work the typical 7-on-7-off scheduele, that's 182 shifts per year so in theory your total pay should be $381,581. In a reality most places with that type of volume will probably pay you a bit less, since you have to account for the wRVUs to cover not just your salary and bonus, but also your benefits, malpractice expenses (usually paid for by most hospitalist groups), and also cover for the costs of cross-coverage for any night-time staffing in the group (since nocturnists are usually paid a higher rate but the only wRVUs they generate is through admissions which usually falls very short of the salary they are paid, and the cross coverage work they do does not directly generate any additional wRVUs under their name).

To cut costs many hospitalist groups will add NPs/PAs ("midlevels') into their staffing, since they can bill the exact same numbers as above but just have a hospitalist attending be signing all their notes and get paid 1/3 to 1/2 as much as an attending. IMO some of the more senior midlevels that have been in practice for 5+ years are not far off from the expertise of an attending, and to mitigate the risk in most cases the midlevels are asked to see the least sick patients and ask the attending for management advice on anything they don't know how to handle. So it's possible in some places for a hospitalist to see 20 patients independently and then sign another 20 notes of a PA/NP. With 40 patients your wRVUs generated per day will be closer towards $4200 per day, and even if you spent $1000 of that paying for the midlevel for that day you'll still come out ahead and should make closer to $3000 per 12-hour shift. Under this model with 182 shifts per year you would be making $546k per year.

In the end I think the unicorn hospitalist jobs at the end of the day are probably those in teaching/residency programs, since you essentially can have residents see up to around 20 patients per day (maximum ACGME allowed number) without having to pay for the cost of a midlevel (remember that resident spots are funded by Medicare) and that leaves you time to see another 10-15 patients on your own if you like. And you can have resident night crosss-coverage without the expense of hiring a midlevel or attending to do it.

You can use the MGMA data to find the average wRVUs that are being produced in each specialty.

Agreed that salary/compensation shouldn't be the only criterion for picking a specialty, but OP mentioned in another post that he/she has $450k in debt so he/she needs to be practical as well.

You seeing 40 patients a day?

That scenario is C-R-A-Z-Y! That's 21 minutes/patient for 14 hours. They all have to be physically seen.

 

[sloh]

wRVUs are only comparable within the same specialty. It's pretty useless to compare than across different specialties since the work they do and reimbursement structure are completely different.

Currently the average CMS reimbursement per HOSPITALIST wRVU is around $55. This number can be very different for other specialties.

For IM hospitalists, the billing is actually straightforward. There are only 3 times of notes most hospitalists will bill for for the most part: H&Ps, follow-up notes (progress notes), and D/c summaries.

H&Ps: can be billed at a level 1, 2 , or 3. Most admissions H&Ps these days are billed at a level 3 which is assigned 3.86 wRVUs.

Follow-up notes are billed a level 1, 2 , or 3. Most follow-up notes these days are billed either level 2 (=1.39 wRVUs) or level 3 (=2.00 wRVUs).

D/C summaries are billed as either 30 minutes. Nearly all hospitalist d/c summaries these days are billed at >30 minutes which is equal to 1.99 wRVUs.

In most hospital systems and for most hospitalists, roughly 20 is the max one can comfortably see independently (without the help of a midlevel or resident) in a 12-hour rounding shift.

On a typical day, for example, if you see 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges, then your wRVU for that day is: (12 x 2.00 ) + (3 x 1.39) + (5 x 1.99) = 38.12. Assuming the above $55 per wRVU, your total wRVU generated is $2096.60.

And if you work the typical 7-on-7-off scheduele, that's 182 shifts per year so in theory your total pay should be $381,581. In a reality most places with that type of volume will probably pay you a bit less, since you have to account for the wRVUs to cover not just your salary and bonus, but also your benefits, malpractice expenses (usually paid for by most hospitalist groups), and also cover for the costs of cross-coverage for any night-time staffing in the group (since nocturnists are usually paid a higher rate but the only wRVUs they generate is through admissions which usually falls very short of the salary they are paid, and the cross coverage work they do does not directly generate any additional wRVUs under their name).

To cut costs many hospitalist groups will add NPs/PAs ("midlevels') into their staffing, since they can bill the exact same numbers as above but just have a hospitalist attending be signing all their notes and get paid 1/3 to 1/2 as much as an attending. IMO some of the more senior midlevels that have been in practice for 5+ years are not far off from the expertise of an attending, and to mitigate the risk in most cases the midlevels are asked to see the least sick patients and ask the attending for management advice on anything they don't know how to handle. So it's possible in some places for a hospitalist to see 20 patients independently and then sign another 20 notes of a PA/NP. With 40 patients your wRVUs generated per day will be closer towards $4200 per day, and even if you spent $1000 of that paying for the midlevel for that day you'll still come out ahead and should make closer to $3000 per 12-hour shift. Under this model with 182 shifts per year you would be making $546k per year.

In the end I think the unicorn hospitalist jobs at the end of the day are probably those in teaching/residency programs, since you essentially can have residents see up to around 20 patients per day (maximum ACGME allowed number) without having to pay for the cost of a midlevel (remember that resident spots are funded by Medicare) and that leaves you time to see another 10-15 patients on your own if you like. And you can have resident night crosss-coverage without the expense of hiring a midlevel or attending to do it.

You can use the MGMA data to find the average wRVUs that are being produced in each specialty.

Agreed that salary/compensation shouldn't be the only criterion for picking a specialty, but OP mentioned in another post that he/she has $450k in debt so he/she needs to be practical as well.

Thanks for the breakdown. Among the hospitalists you know, what seems to be the average gross compensation per year? Do you know any that have made over 400k/yr?

 

[collegestud2013]

You seeing 40 patients a day?

That scenario is C-R-A-Z-Y! That's 21 minutes/patient for 14 hours. They all have to be physically seen.

No, that's a hypothetical scenario of a hospitalist seeing 20 patients by him/herself and supervising another 20 patients to be seen by a midlevel and signing their notes. For billing purposes, patients seen by midlevel do not need to be seen by the attending on the same day as long as the attending is comfortable signing their note (since PAs and NPs are not considered trainees they can see patients without an attending seeing them). The case is not true however with residents' patients (since they are trainees an attending must physically see them to be able to sign their note).

 

[collegestud2013]

Thanks for the breakdown. Among the hospitalists you know, what seems to be the average gross compensation per year? Do you know any that have made over 400k/yr?

Average salary (including bonus but not including benefits or malpractice cost) these days outside of academic medine is around low $300ks for a standard 7-on-7-off schedule (or similar schedule working around same total hours per year). Yes there are people making $400k+ and even $500k+ just from hospitalist pay alone but that usually involves routinely seeing more than 20 patients per 12 hr shift (possibly with the help of an NP or PA or even better with residents), doing mostly night shifts, or working more shifts per month (averaging 20-24 shifts per month instead of the 15 shifts per month that you get from doing 7on/7off).

 

[sallyhasanidea]

wRVUs are only comparable within the same specialty. It's pretty useless to compare than across different specialties since the work they do and reimbursement structure are completely different.

Currently the average CMS reimbursement per HOSPITALIST wRVU is around $55. This number can be very different for other specialties.

For IM hospitalists, the billing is actually straightforward. There are only 3 times of notes most hospitalists will bill for for the most part: H&Ps, follow-up notes (progress notes), and D/c summaries.

H&Ps: can be billed at a level 1, 2 , or 3. Most admissions H&Ps these days are billed at a level 3 which is assigned 3.86 wRVUs.

Follow-up notes are billed a level 1, 2 , or 3. Most follow-up notes these days are billed either level 2 (=1.39 wRVUs) or level 3 (=2.00 wRVUs).

D/C summaries are billed as either <30 minutes or >30 minutes. Nearly all hospitalist d/c summaries these days are billed at >30 minutes which is equal to 1.99 wRVUs.

In most hospital systems and for most hospitalists, roughly 20 is the max one can comfortably see independently (without the help of a midlevel or resident) in a 12-hour rounding shift.

On a typical day, for example, if you see 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges, then your wRVU for that day is: (12 x 2.00 ) + (3 x 1.39) + (5 x 1.99) = 38.12. Assuming the above $55 per wRVU, your total wRVU generated is $2096.60.

And if you work the typical 7-on-7-off scheduele, that's 182 shifts per year so in theory your total pay should be $381,581. In a reality most places with that type of volume will probably pay you a bit less, since you have to account for the wRVUs to cover not just your salary and bonus, but also your benefits, malpractice expenses (usually paid for by most hospitalist groups), and also cover for the costs of cross-coverage for any night-time staffing in the group (since nocturnists are usually paid a higher rate but the only wRVUs they generate is through admissions which usually falls very short of the salary they are paid, and the cross coverage work they do does not directly generate any additional wRVUs under their name).

To cut costs many hospitalist groups will add NPs/PAs ("midlevels') into their staffing, since they can bill the exact same numbers as above but just have a hospitalist attending be signing all their notes and get paid 1/3 to 1/2 as much as an attending. IMO some of the more senior midlevels that have been in practice for 5+ years are not far off from the expertise of an attending, and to mitigate the risk in most cases the midlevels are asked to see the least sick patients and ask the attending for management advice on anything they don't know how to handle. So it's possible in some places for a hospitalist to see 20 patients independently and then sign another 20 notes of a PA/NP. With 40 patients your wRVUs generated per day will be closer towards $4200 per day, and even if you spent $1000 of that paying for the midlevel for that day you'll still come out ahead and should make closer to $3000 per 12-hour shift. Under this model with 182 shifts per year you would be making $546k per year.

In the end I think the unicorn hospitalist jobs at the end of the day are probably those in teaching/residency programs, since you essentially can have residents see up to around 20 patients per day (maximum ACGME allowed number) without having to pay for the cost of a midlevel (remember that resident spots are funded by Medicare) and that leaves you time to see another 10-15 patients on your own if you like. And you can have resident night crosss-coverage without the expense of hiring a midlevel or attending to do it.

You can use the MGMA data to find the average wRVUs that are being produced in each specialty.

Agreed that salary/compensation shouldn't be the only criterion for picking a specialty, but OP mentioned in another post that he/she has $450k in debt so he/she needs to be practical as well.

Thanks very much for the detailed responses, this is exactly what I was looking for.

So with these numbers it's technically still possible for a hospitalist to make 800k+ a year assuming no days off; how realistic is it for you to see

this on a typical day: 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges? Would it be realistic add admissions on top for additional income? Also, if you are giving NP's easier cases (rocks I assume), is it still realistic to bill the follow ups as level 3?

 

[NITRAS]

At my institution, midlevels can bill by themselves and the hospital get paid at a percentage (like 85-something percentage). I can only bill for their work if I see the Patient. My google-fu may be a bit lacking, but everything I’m seeing seems to apply to outpatient setting.

Admissions is done differently depending on where you work. Were I work, we have an MOD (our name for the doc on duty) and rotating group of PA’s/docs that do the admission. The teams pick up the patient’s in the morning, so the rounding docs don’t have to do admissions. This is generally really nice as a rounding doc. Your list is made in the am, and isn’t going to grow.

I don’t know about you, but I’m on day 6 of 10 and I know I’m a bit tired. Before COVID I could make close to $400k without killing myself. A little harder now.

There are gigs where you can work most days, but you aren’t going to see patient’s to justify that high of a salary.

 

[collegestud2013]

Thanks very much for the detailed responses, this is exactly what I was looking for.

So with these numbers it's technically still possible for a hospitalist to make 800k+ a year assuming no days off; how realistic is it for you to see

this on a typical day: 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges? Would it be realistic add admissions on top for additional income? Also, if you are giving NP's easier cases (rocks I assume), is it still realistic to bill the follow ups as level 3?

$800k is probably unrealistic as an employed hospitalist. To make that much in most areas of medicine would require some form of practice ownership or additional sources of non-clinical income. The number of shifts and volume need to make $500k at most places isn't sustainable for most hospitalists in the long-run and there's a high burnout rate which leads to turnover and cutting back on clinical hours. Of course this is based on current reimbursement rates, which will likely change in the future. For example, the average hospitalist pay around 2010 was just over $200k, but in 2020 with an average of just over $300k that's well outpaced inflation. However, on the 2021 CMS proposed reimbursement changes many inpatient specialties are expected to see reimbursement drop of 4-8% while outpatient reimbursement is expected to increase.

Probably could squeeze in 1 more admission in addition to those 20 follow-ups by yourself but it would be hectic day. I think the more efficient way to increase your volume and hence RVUs these days is still to use a PA and NP to see some of the patients and bill for their work, but as a midlevel they would only be paid for a fraction of the RVUs they generated. As I mentioned above the other option would be to be to work at a place with residents and bill for their work but without the overhead costs of hiring a midlevel.

 

[door_to_balloon_knot]

CMS doesn’t pay for consults anymore, so the coding is the same as any new pt visit..9922x

While this is true for CMS not all payors have adopted this rule. Unfortunately the only to find out is to ask.

 

[Osteoth]

wRVUs are only comparable within the same specialty. It's pretty useless to compare than across different specialties since the work they do and reimbursement structure are completely different.

Currently the average CMS reimbursement per HOSPITALIST wRVU is around $55. This number can be very different for other specialties.

For IM hospitalists, the billing is actually straightforward. There are only 3 times of notes most hospitalists will bill for for the most part: H&Ps, follow-up notes (progress notes), and D/c summaries.

H&Ps: can be billed at a level 1, 2 , or 3. Most admissions H&Ps these days are billed at a level 3 which is assigned 3.86 wRVUs.

Follow-up notes are billed a level 1, 2 , or 3. Most follow-up notes these days are billed either level 2 (=1.39 wRVUs) or level 3 (=2.00 wRVUs).

D/C summaries are billed as either <30 minutes or >30 minutes. Nearly all hospitalist d/c summaries these days are billed at >30 minutes which is equal to 1.99 wRVUs.

In most hospital systems and for most hospitalists, roughly 20 is the max one can comfortably see independently (without the help of a midlevel or resident) in a 12-hour rounding shift.

On a typical day, for example, if you see 12 Level 3 follow-ups, 3 Level 2 follow-ups, and have 5 discharges, then your wRVU for that day is: (12 x 2.00 ) + (3 x 1.39) + (5 x 1.99) = 38.12. Assuming the above $55 per wRVU, your total wRVU generated is $2096.60.

And if you work the typical 7-on-7-off scheduele, that's 182 shifts per year so in theory your total pay should be $381,581. In a reality most places with that type of volume will probably pay you a bit less, since you have to account for the wRVUs to cover not just your salary and bonus, but also your benefits, malpractice expenses (usually paid for by most hospitalist groups), and also cover for the costs of cross-coverage for any night-time staffing in the group (since nocturnists are usually paid a higher rate but the only wRVUs they generate is through admissions which usually falls very short of the salary they are paid, and the cross coverage work they do does not directly generate any additional wRVUs under their name).

To cut costs many hospitalist groups will add NPs/PAs ("midlevels') into their staffing, since they can bill the exact same numbers as above but just have a hospitalist attending be signing all their notes and get paid 1/3 to 1/2 as much as an attending. IMO some of the more senior midlevels that have been in practice for 5+ years are not far off from the expertise of an attending, and to mitigate the risk in most cases the midlevels are asked to see the least sick patients and ask the attending for management advice on anything they don't know how to handle. So it's possible in some places for a hospitalist to see 20 patients independently and then sign another 20 notes of a PA/NP. With 40 patients your wRVUs generated per day will be closer towards $4200 per day, and even if you spent $1000 of that paying for the midlevel for that day you'll still come out ahead and should make closer to $3000 per 12-hour shift. Under this model with 182 shifts per year you would be making $546k per year.

In the end I think the unicorn hospitalist jobs at the end of the day are probably those in teaching/residency programs, since you essentially can have residents see up to around 20 patients per day (maximum ACGME allowed number) without having to pay for the cost of a midlevel (remember that resident spots are funded by Medicare) and that leaves you time to see another 10-15 patients on your own if you like. And you can have resident night crosss-coverage without the expense of hiring a midlevel or attending to do it.

You can use the MGMA data to find the average wRVUs that are being produced in each specialty.

Agreed that salary/compensation shouldn't be the only criterion for picking a specialty, but OP mentioned in another post that he/she has $450k in debt so he/she needs to be practical as well.

This is great, thanks.