Doctor Pay: RVUs Determine Income
Summary
TLDRDr. Eric Bricker discusses the intricacies of physician payment through work Relative Value Units (wRVUs) in healthcare. He explains how wRVUs are tied to specific CPT codes for services like office visits and procedures, and how they translate into annual salaries. The video highlights the disparity in wRVUs between specialties, particularly the undervaluation of primary care physicians' work, which often doesn't convert into billable codes. This system, he argues, hinders effective primary care and needs reform for better healthcare outcomes.
Takeaways
- đ The video is a continuation of a series on physician payment, focusing on 'Work RVUs' (Relative Value Units) and their significance in healthcare operations.
- đŒ Dr. Eric Bricker provides a link to a previous video for more details on RVUs and assumes the audience has a basic understanding of the concept.
- đą Work RVUs are tied to specific CPT codes, which are used when a doctor bills for their services, such as office visits or procedures.
- đ The value of an RVU is determined by the RUC (Relative Value Scale) and is associated with the complexity and time required for a service.
- â° An example given is the CPT code 99202 for a new patient visit with medium complexity, which equates to 0.93 RVUs and requires about 20 minutes of face-to-face time.
- đ Another example is the CPT code 45380 for a colonoscopy with biopsy, which takes 30-60 minutes and equates to 3.56 RVUs.
- đ° The annual salary of a physician can be calculated based on the total RVUs they generate in a year, with an example of a gastroenterologist earning $712,000 for 10,500 RVUs.
- đ„ The video discusses the median RVUs by specialty, with cardiothoracic surgeons having the highest at 9822 RVUs per year, and primary care physicians significantly lower at 4900 RVUs per year.
- đïž The video points out the discrepancy in RVUs between specialists and primary care physicians, despite similar weekly working hours.
- đŒ The benefits of the RVU system are skewed towards the employers of physicians, as it encourages competition and volume of patients seen.
- đ However, the cons for physicians include not being paid for all the work they do, particularly affecting primary care physicians who perform a lot of unbillable care coordination.
- đ The video concludes that the current RVU-based fee-for-service system hinders effective primary care and suggests that changes are needed for improvement.
Q & A
What is the topic of Dr. Eric Bricker's video?
-The topic of Dr. Eric Bricker's video is 'Dr. Pay Part 2: Work RVUs', which discusses the concept of Relative Value Units (RVUs) and their impact on physician payment.
What does RVU stand for?
-RVU stands for Relative Value Unit, a measure used to determine the payment for medical services provided by physicians.
How are RVUs connected to the services a doctor provides?
-RVUs are tied to specific CPT (Current Procedural Terminology) codes, which represent the services provided by doctors such as office visits or procedures.
What is an example of an Evaluation and Management (E/M) CPT code?
-An example of an E/M CPT code is 99202, which represents a new patient visit of medium to lower complexity with an expected 20 minutes of face-to-face time with the patient.
How many RVUs are assigned to the 99202 CPT code?
-The 99202 CPT code is assigned 0.93 RVUs.
What is the significance of the number of RVUs a physician accumulates?
-The number of RVUs a physician accumulates is directly related to their annual income, as it translates into the volume of services they have provided.
How does the video illustrate the difference in RVUs between a primary care physician and a specialist?
-The video uses the example of a gastroenterologist who performs a colonoscopy with biopsy (CPT code 45380), which has 3.56 RVUs, compared to the E/M code 99202 with 0.93 RVUs, showing the higher value assigned to certain procedures.
What is the average number of RVUs for a gastroenterologist in the 75th percentile?
-A gastroenterologist in the 75th percentile builds 10,500 RVUs per year.
How does the video address the issue of primary care physicians and their workload?
-The video points out that primary care physicians often work a similar number of hours per week as specialists but have significantly fewer RVUs due to the nature of their work, which may not be billable under CPT codes.
What is the median number of RVUs for primary care physicians in internal medicine and family practice?
-The median number of RVUs for primary care physicians in internal medicine and family practice is 4,900 per year.
What is the main argument against the current RVU-based fee-for-service system as presented in the video?
-The main argument against the current RVU-based fee-for-service system is that it does not adequately compensate primary care physicians for the non-billable work they do, such as care coordination, which is essential for effective primary care.
How does the video suggest the current system affects the quality of primary care?
-The video suggests that the current system, by not compensating for all the work done by primary care physicians, may lead to insufficient care coordination and a lack of adequate and effective primary care.
Outlines
đŒ Understanding RVUs and Physician Payment
Dr. Eric Bricker introduces the concept of Relative Value Units (RVUs) in the context of physician payment. He builds upon a previous video on the topic, explaining that RVUs are associated with specific CPT codes used in billing for medical services. The video provides examples of how RVUs are calculated for different services, such as office visits (CPT code 99202) and procedures like colonoscopies (CPT code 45380). It also translates the number of RVUs into annual salary, using the example of a gastroenterologist who earns $712,000 for 10,500 RVUs per year. The summary emphasizes the importance of RVUs in determining physician income and how they relate to the value and operation of healthcare services.
đ The Impact of RVUs on Physician Workload and Compensation
This paragraph delves into the disparities between the number of RVUs generated by different specialties and the actual hours worked by physicians. It highlights the median RVUs for various specialties, with cardiothoracic surgeons at the top, and contrasts this with the significantly lower median RVUs for primary care physicians. The video discusses the challenges faced by primary care physicians, who often perform unbillable work such as care coordination, which is not reflected in their RVUs. The summary points out the benefits and pitfalls of the RVU system, noting that it primarily benefits employers by encouraging volume over quality of care. It also addresses the issue of undercompensation for primary care physicians, suggesting that the current system hinders effective primary care and needs reform for adequate primary care provision.
Mindmap
Keywords
đĄRVUs
đĄCPT Codes
đĄEvaluation and Management (E/M)
đĄPhysician Payment
đĄGastroenterologist
đĄPercentile
đĄPrimary Care Physicians
đĄCare Coordination
đĄCPT Code 99490
đĄFee-for-Service
đĄValue-Based Care
Highlights
Introduction of Dr. Eric Bricker and the topic of physician payment through work RVUs (Relative Value Units).
Explanation of RVUs and their connection to specific CPT codes for billing medical services.
Assumption that the audience has a basic understanding of RVUs from a previous video.
Examples given to illustrate how RVUs are calculated for different medical services, such as office visits and procedures.
The significance of the 99202 CPT code for a medium complexity new patient visit and its associated RVU value.
Calculation of total RVUs for multiple patients with the same CPT code.
Use of the 45380 CPT code for a colonoscopy with biopsy as an example of a more complex procedure and its higher RVU value.
Conversion of RVUs into annual physician salary, with a specific example for a gastroenterologist.
Discussion on the median RVUs by specialty and the implications for physician income.
Comparison of the average number of hours worked per week by specialists versus primary care physicians.
The discrepancy between the volume of work and the number of RVUs generated, especially for primary care physicians.
The benefits of the work RVU system for employers, such as increased patient volume and competition.
The cons for physicians, including not being paid for all the work they do, especially in primary care.
The introduction of the 99490 CPT code for care coordination and its limited reimbursement by commercial insurance companies.
The impact of the RVU-based fee-for-service system on the adequacy and effectiveness of primary care.
The argument that the current payment system hinders the development of adequate primary care until changes are made.
Conclusion and thanks for watching, emphasizing the importance of understanding the RVU system in healthcare.
Transcripts
hello this is dr eric bricker and thank
you for watching a healthcare z today's
topic is
dr pay part 2
work rvus so my previous week's video
about
physician payment was so popular that
i'm going to continue to cover
dr pay because it is so important to how
health care operates that is probably
worthy of more than one video and so now
we're going to talk about rvus now rvu
stands for
relative value units now i will leave a
link in the show to a previous video
that i have made about rvus that
explained in more detail but i'm going
to assume you kind of know what a rvu is
now and i'm also going to leave a link
in the shows for my prior video on how
doctors are paid as well so watch that
one too now work rvus like i said are
relative value units and they are tied
to
specific
cpt codes so when a doctor bills for
their services all those bills have
codes on them for um essentially what
are called either evaluation and
management which are office visit codes
or for doing a particular procedure like
a colonoscopy or a surgery and so the
relative value units which are
determined by ruck which is the previous
video that i made
is tied to the cpt codes okay so let me
give you some examples so an e m an
evaluation management cpt code for an
office visit an example might be 99202
which is a new patient visit of kind of
medium to lower complexity um it's
expected that the doctor's going to
spend about 20 minutes of face-to-face
time with the patient for that and that
is an rvu of 0.93 so 0.93 rvus for that
99202 cpt code so they build that
let's say they see five patients with
that so you would do five times the zero
point nine three that's how many rvus
they would build for those five patients
now let's go and use another example for
an actual procedure so four five three
eight zero is for a colonoscopy with
biopsy typically performed by a
gastroenterologist and that takes about
30 to 60 minutes to perform your typical
colonoscopy per the mayo clinic i'll
leave a link in the show notes to that
and that would give the rvus for that
one colonoscopy of
3.56 so it's about four times as many
rvus as the evaluation and management
code
99202 okay now let's translate this into
overall physician salary for a year so
let's say there's a gastroenterologist
who builds 10
500
rvus per year now
that would put them in the 75th
percentile for gastroenterologists in
other words they build more than the
average gastroenterologist
that would they would end up making
about 68
per rvu which comes out to about seven
hundred and twelve thousand dollars now
the point of this video is not to say
that seven hundred and twelve thousand
dollars is or is not a justified salary
for a gastroenterologist in the 75th
percentile i'm just saying that's how 10
500 rvus then translates into the annual
salary or into dollars which is easier
for us to understand all right now let's
look at
what the median rvus are by specialty so
in this case median being 50th
percentile so not 75th percentile okay
let's start at the top the highest is
cardiothoracic surgeons
at
9822 rvus per year next is neurosurgeons
with 9
33 rvus per year next is radiologist
with 8862
rvus per year next up is ophthalmologist
at 8438
rvus per year and next we have
orthopedic surgeons at 8009
per year now obviously there's many
other specialties there's emergency
medicine there's
dermatology there's ear nose and throat
etc it goes on and on and on let's just
look at primary care physicians right
because when we talk about value-based
care and wanting to provide more
preventive care and chronic disease care
to keep people more healthy and from
being sick
let's look at primary care physicians so
for internal medicine and for family
practice the primary care physicians
that treat adults they on average bill
four thousand
nine hundred rvus per year four thousand
nine hundred rvus per year shoot that's
like half these other people up here
well obviously primary care physicians
are working half as much as all these
specialists right no of course not being
sarcastic so if you look at the average
number of hours worked per week on
average a specialist works 52 hours a
week and a primary care physician works
51 hours a week
how can this be
how can specialists and primary care
physicians work almost the same number
of hours now i'm sure every single
physician watching this video is like i
work more than 52 hours a week look
everybody overestimates the number of
hours a week that they work i'm just
saying this is what the survey said now
how is it that they can work essentially
the same amount of hours per week but
the rvus can be so different and it goes
back to this point up here which is the
rvus are only tied to cpt codes so if
primary care physicians
do work
that they can't bill on a cpt code then
it can't be captured in their rvus
does that exist well i'm going to answer
that video at the end of the question so
stick around now
what are the benefits and pitfalls what
are the pros and cons of work rv use
well
it i'll leave a link in the show notes
to a review that said that look work
rvus by and large benefit the employer
of the doctor whether it be the hospital
system or the private equity firm or the
whoever owns the group practice it
benefits the employer of the physicians
more so than the physicians themselves
why is that because for the employer the
doctors compete for patients because
they want to see as many patients as
possible to build as many rvus as
possible and so it keeps the hospital
busy in the world of work rvus doctors
are only paid by volume they are not
paid by quality they are only paid by
volume they are not paid by quality not
only that
many physician groups even pay their
physicians a graduated rvu scale
such that the dollars per rvu goes up
the more rvus they bill so that just
adds kerosene to the fire to build more
rvus now
what are the cons for the doctor for the
rvu system is you will not be paid for
all the work that you do and that holds
true for primary care physicians and for
specialists i'm not saying specialists
are able to bill for everything they do
no of course not they do work as well
that they can't build for however
all of the care coordination that
primary care physicians do
takes a ton of time in regards to phone
calls and emails and collecting and
communicating medical records and having
family conversations and doing refills
in fact there is so much care
coordination by primary care physicians
that medicare actually added
a cpt code
for care coordination that starting in
2015
primary care docs could actually bill
for it's 99490
they can bill it once a month
for 20 minutes of care coordination
activity over the course of that month
now so that's fine
here's the problem
commercial insurance companies by and
large do not reimburse
99490 that's right if you're in an
employer sponsored plan your health
insurance carrier more than likely does
not pay
the primary care physicians that see
your employees and their family members
to coordinate their care and so what
happens
yes there are absolutely primary care
physicians that go way out of their way
to do a ton of care coordination they're
not getting paid for it and at the end
of the day
oftentimes what you pay for gets done
and so oftentimes the degree of care
coordination that your employees and
their family members actually need is
not getting that's not getting
reimbursed for and that is one of the
root causes for why primary care
physicians only have 4 900
rvus per year as opposed to 9820
rvu's per year because they're doing all
this work right 51 hours of work versus
52 hours of work they're doing the same
number of hours but they can't translate
those hours into cpt codes and they
can't
translate those cpt codes into rbus and
they can't translate those rvus then
into their income so
this is a detailed explanation
as to why the current rvu based fee for
cert for fee for service system by
definition
will hamper
adequate and effective primary care and
one would argue that until this system
has changed we will never have
adequate primary care because of the way
it's paid for and that's my point for
today thank you for watching
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