RVU? Is that like a special recreational vehicle for EM docs? Not exactly. Read below for a quick and to the point description of RVUs and how they will affect you.
Relative value units, or RVUs, were created by the Federal Government in 1992 in an attempt to standardize physician payments. The Federal Government created the Resource Based Relative Value Scale (RBRVS) which assigned each CPT (Current Procedure Terminology) code a value. This value is the Relative Value Unit or RVU. The Medicare Fee Schedule is based on RVUs. In essence, the CPT code codifies procedures that the physician does and the RBRVS assigns a value to these codes which are RVUs. The RVU every year is then calculated and recalculated into an amount.
What makes up a RVU?
RVUs are a combination of 3 different components:
Work – the estimated value of the time, effort, expertise, and intensity of a service. This usually comprises about 55% of the RVU.
Practice Expense – the overhead costs needed to offer and run the services. This usually comprises about 42% of the RVU.
Professional Liability Insurance (PLI) – the estimated value of malpractice insurance for the service. This usually comprises about 3% of the RVU.
Currently, each RVU is valued at roughly $36 (as of March 2016). The common CPT codes for emergency medicine are 99281, 99282, 99283, 99284, 99285 and 99291 which correspond to higher levels of care as the numbers go up. So for example, finger abrasion is a 99281 CPT code while cardiac arrest is a 99291 code. For each CPT code the RVU value is below:
99281: 0.59 RVUs
99282: 1.16 RVUs
99283: 1.75 RVUs
99284: 3.33 RVUs
99285: 4.93 RVUs
99291: 6.33 RVUs
This means that if you have a critical care patient, you’re potentially billing 6 RVUs which is roughly $220. This is usually on top of a base hourly salary. How does this play out on a normal 12 hour shift? Let’s look at an example (please also bear in mind that this is assuming you get all of the RVUs. Some groups may take a portion and share the remaining with you):
You’re working a 12 hour shift at a typical ER where you usually see a variety of patients but today you saw the following:
99282 coded patients: 8
99283 coded patients: 8
99284 coded patients: 4
99285 coded patients: 4
Your total RVUs across all patients is: 56.32 x $36 = $2027.52
This means that you’re earning about $2,000 for the day on top of your base hourly salary. That’s a nice chunk of change for a one day shift along with your hourly salary if you were to really work a shift like this.
Pros and Cons of RVUs
Now that you understand how RVUs work, what are their pros and cons?
Pros: RVUs help compensate those physicians who can efficiently and adequately evaluate, treat, and document on their patients. By utilizing RVUs, you promote adequate throughput in the ED and thus control the flow of your ED. RVUs also provide another potential monetary stream for EM physicians.
Cons: RVUs can create competition between providers working during the same time for complex cases or for cases that have procedures (when you have procedures your RVUs also go up). While a little “friendly competition” between colleagues may be nice it can definitely become unfriendly when money is in the middle. RVUs may also be a disadvantage to the slower physician who may not be capable of seeing X number of patients per hour compared to other physicians. RVUs are also a disadvantage to those physicians who work night shifts and who may supervise mid-level providers such as NPs and PAs. In those circumstances, many places have either a bonus built in or a conversion factor to offset the decrease in potential RVUs.