wRVU Numbers

[Sushirolls]

With the 2020 or 2021 wRVU changes, what's the lay of the land now for employed jobs and what thresholds they are putting out there for annual contractual requirements?

I just realized my not being in wRVU land anymore, I'm getting rusty.

Here is my understanding:
99204 2.6
99205 3.5
90792 4.16
99417 0.61
90833 1.5
99213 1.3
99214 1.92
99215 2.8
99406 0.24
96127 0.00

Here is my source:

RVU Calculator - AAPC Relative Value Units

CPT® RVU calculator provides a quick analysis of the work relative value units associated with a certain volume of CPT or HCPCS codes.

www.aapc.com

*old used to be 1.0 for 99213, and 1.5 for 99214 if I recall.

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[MedMan80]

25th percentile for me is around 2800 for CAP, 3500 for Adult. Over this and we can make a bonus..

 

[forchinet121]

25th percentile for me is around 2800 for CAP, 3500 for Adult. Over this and we can make a bonus..

Is there a cap? At my hospital (I’m only a rising pgy4 but they showed me a contract) they are placing caps on max income so they pay a 60 dollar per wrvu bonus above 3500 but then place a cap at like 90th percentile of income or something. So if I were to generate way more wrvu my understanding is they wouldn’t pay any extra which seems insane to me

 

[PikminOC]

Is there a cap? At my hospital (I’m only a rising pgy4 but they showed me a contract) they are placing caps on max income so they pay a 60 dollar per wrvu bonus above 3500 but then place a cap at like 90th percentile of income or something. So if I were to generate way more wrvu my understanding is they wouldn’t pay any extra which seems insane to me

Yes CEO always gets his multimillions. Where do you think that money comes from? Worker bees.

 

[Merovinge]

Is there a cap? At my hospital (I’m only a rising pgy4 but they showed me a contract) they are placing caps on max income so they pay a 60 dollar per wrvu bonus above 3500 but then place a cap at like 90th percentile of income or something. So if I were to generate way more wrvu my understanding is they wouldn’t pay any extra which seems insane to me

As a counterpoint, I actually think that's a reasonable setup. There are doctors around me in CAP who generate more wRVUs than the neurosurgeons from their same organization. It is not good care, as I have had the opportunity to work with this doc's outpatients at PHP/IOP level of care. I have received zero phone calls back to discuss cases and documentation is scant to say the least (not withstanding what the patients and families say about the care).

They are essentially forcing you to either have some work/life balance or spend more time with your patients, as seeing extra does nothing for you. I hate to see healthcare orgs telling doctors to do anything but this is a place where it doesn't seem entirely unreasonable given what I have witnessed being practiced as psychiatry.

 

[Sushirolls]

Salary caps come from CMS or its other bureaucratic rules about non-profits. The basic gist is that non-profits can't be paying people non-industry standard wages. Wages have to be "Fair Market Value." I suspect every non-profit Big Box shop will have FMV elements in their contract to not run afoul of some organization be it IRS, CMS, or whomever. Superficially this makes sense.

However, it is punitive to scenarios where the only doc, who is over worked in specialty X, gets told they won't get paid more. Are their means for a hospital to 'document' and justify that they aren't paying more than FMV but simply working someone hard, yes, but they don't want to. Easier to say nah, we won't pay you more, we'll just pocket it. But please do, keep working more...

The more nefarious nature of FMV is entities like MGMA start doing physician surveys in ways that FMV now becomes a weapon, a tool, to suppress income and stick it to doctors.

Don't want salary caps, can't be at the Non-profit Big Box shops saddled by FMV restrictions.

 

[forchinet121]

As a counterpoint, I actually think that's a reasonable setup. There are doctors around me in CAP who generate more wRVUs than the neurosurgeons from their same organization. It is not good care, as I have had the opportunity to work with this doc's outpatients at PHP/IOP level of care. I have received zero phone calls back to discuss cases and documentation is scant to say the least (not withstanding what the patients and families say about the care).

They are essentially forcing you to either have some work/life balance or spend more time with your patients, as seeing extra does nothing for you. I hate to see healthcare orgs telling doctors to do anything but this is a place where it doesn't seem entirely unreasonable given what I have witnessed being practiced as psychiatry.

I see your point but Imagine them telling a surgeon that extra cases won’t result in extra compensation. I am not positive but I imagine they wouldn’t take being treated like that.

 

[J ROD]

Most places I have talked to recently and have seen others contract have threshold at 4800 wrvu before bonus. Most were 4000. My place increased it to 4800 as well. However at this point there is no cap on any physician. Which is why I stay. I do the work of two and get paid as such. Every other place I saw had a threshold bonus so you would eventually hit that ceiling. At some point it would not make sense to keep seeing more as the return on your time could be better spent at home or working elsewhere part time.

 

[Merovinge]

I see your point but Imagine them telling a surgeon that extra cases won’t result in extra compensation. I am not positive but I imagine they wouldn’t take being treated like that.

It would be no different for them although the range on the wRVU's before hitting the max would be higher given their much higher averages. This specific CAP was eclipsing 10,000 wRVUs before the 2021 changes to outpatient coding. He obviously is a highly valued doctor in that group given his production which is really a backwards setup (e.g. organization values doctors who pump out RVUs as opposed to good care).

 

[SmallBird]

One year as an attending I billed 7000 RVUs and another year subsequently I billed 3000. The care was better in the first system and although our documentation was briefer, we all saw so many more patients that the providers had much more experience, and the system was optimized to avoid wasting time on non-patient care functions. At the system where I billed less everyone was very sure that there lack of productivity was because they were providing higher quality care but I just felt everyone was slow and inefficient and access was terrible.

 

[Sushirolls]

So 4000-4800 seems to be the where the Big Box shops are placing the threshold?

 

[SmallBird]

For what?

So 4000-4800 seems to be the where the Big Box shops are placing the threshold?

For what? Salary cap or incentive?

 

[Sushirolls]

For routine salary minimums, in contract, per year.

 

[SmallBird]

For routine salary minimums, in contract, per year.

Right on, 4000 sounds right.