Doctor Pay: RVUs Determine Income

Summary

Dr. 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

• 🚑 The video is a continuation of a series on physician payment, focusing on 'Work RVUs' (Relative Value Units) and their significance in healthcare operations.
• 💼 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.
• 🔢 Work RVUs are tied to specific CPT codes, which are used when a doctor bills for their services, such as office visits or procedures.
• 📈 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.
• ⏰ 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.
• 💉 Another example is the CPT code 45380 for a colonoscopy with biopsy, which takes 30-60 minutes and equates to 3.56 RVUs.
• 💰 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.
• 🏥 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.
• 🕊️ The video points out the discrepancy in RVUs between specialists and primary care physicians, despite similar weekly working hours.
• 💼 The benefits of the RVU system are skewed towards the employers of physicians, as it encourages competition and volume of patients seen.
• 🔑 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.
• 🔄 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

00:00

💼 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.

05:01

📊 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.

Keywords

💡RVUs

RVUs, or Relative Value Units, are a measure used in healthcare to determine the amount a physician is paid for services rendered. They are a core concept in the video as they are tied to specific CPT codes, which represent different medical services or procedures. The video explains that the number of RVUs earned can significantly impact a physician's annual salary, with examples given for an office visit code (99202) and a colonoscopy procedure (453800).

💡CPT Codes

CPT Codes are standardized medical codes used to bill for services provided by healthcare professionals. In the context of the video, they are directly tied to RVUs, determining the relative value and thus the payment for each service. The script provides examples of CPT codes for an office visit and a colonoscopy, illustrating how these codes are used to calculate the physician's earnings.

💡Evaluation and Management (E/M)

Evaluation and Management services refer to the range of clinical work performed by a physician during a patient encounter. In the video, E/M services are associated with office visit codes, such as the 99202 code mentioned for a new patient visit of medium to lower complexity. The script explains that these services are a significant factor in calculating RVUs and, by extension, physician compensation.

💡Physician Payment

Physician Payment is the compensation received by healthcare providers for the services they offer. The video discusses how physician payment is intricately linked to RVUs and CPT codes, emphasizing the importance of understanding this relationship for both healthcare providers and the operation of the healthcare system as a whole.

💡Gastroenterologist

A Gastroenterologist is a physician specializing in the digestive system and its disorders. The video uses the example of a gastroenterologist performing a colonoscopy with biopsy, a procedure with a high RVU value, to illustrate how specialty physicians can earn a substantial income based on the RVUs they accumulate annually.

💡Percentile

Percentile refers to a statistical measure that indicates the relative standing of a value within a dataset. In the video, the 75th percentile for gastroenterologists is mentioned to show that a physician who builds 10,500 RVUs per year is earning more than the average for their specialty, providing a benchmark for understanding physician earnings.

💡Primary Care Physicians

Primary Care Physicians are healthcare providers who typically serve as the first point of contact for patients and provide continuing care. The video contrasts the average number of RVUs billed by primary care physicians with those of specialists, highlighting the disparity in earnings and the challenges faced by primary care in the current RVU-based system.

💡Care Coordination

Care Coordination involves organizing and managing patient care, often involving communication among healthcare providers. The script points out that primary care physicians spend significant time on care coordination, which is not always billable under CPT codes, leading to undercompensation for this essential aspect of their work.

💡CPT Code 99490

CPT Code 99490 is a specific code introduced by Medicare for care coordination services. The video explains that while primary care physicians can bill for care coordination using this code, many commercial insurance companies do not reimburse for it, which affects the income of primary care physicians.

💡Fee-for-Service

Fee-for-Service is a payment model where healthcare providers are paid for each service or procedure they perform. The video argues that the current RVU-based fee-for-service system hinders adequate and effective primary care because it does not compensate for all the work done by primary care physicians, particularly in care coordination.

💡Value-Based Care

Value-Based Care is an approach to healthcare delivery that aims to improve patient outcomes while reducing costs. The video script briefly mentions value-based care in the context of wanting to provide more preventive and chronic disease care, suggesting that the current RVU system may not align well with these goals.

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