The transition to value-based payments raises an important question: What role, if any, will relative value units (RVUs) play in physician reimbursement in the future? After all, aren’t quality-based payment models designed to reward teamwork and care coordination rather than the efforts of any one individual?
Care coordination is important, but it doesn’t negate the need to measure objectively a physician’s work effort and practice and malpractice expenses—all of which are captured in the RVU, says Douglas Leahy, MD, an internist at Summit Medical Group, a physician-owned network of practices in eastern Tennessee. But that’s not their only benefit.
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In the future, payers likely will layer quality-based payments on top of traditional RVU-based reimbursement, says Leahy, who serves on the Relative Value Scale Update Committee (RUC), a multi-specialty, physician-led panel that develops the RVUs associated with the American Medical
Association’s Current Procedural Terminology (CPT) codes.
Physicians who provide quality care ultimately will earn more than those who don’t. Independent physicians who understand how RVUs are calculated can also better prepare doctors for the potential revenue impact of Medicare payment reform and the transition to value-based reimbursement. In addition, RVUs offer a great deal of insight into practice performance if physicians are willing to take the time to dig into the data.
Using RVUs to gain insights
Payers will continue to look closely at RVUs—and so should independent physicians, says Andy Swanson, vice president of consulting services at the Medical Group Management Association (MGMA).
“Independent physicians have said over time that RVUs are a metric that aren’t important,” says Swanson. “But I would argue that they should be important—not from a purely compensation standpoint as it is with system-employed docs—but as a measure of the efficiency of the practice.” They can be a real eye-opener for physicians who feel overworked, he adds.
Often, an analysis reveals that a physician’s total work RVUs are actually below the national or regional annual median for his or her specialty, says Swanson. In the MGMA 2016 Provider Compensation and Production Report, internists report a median number of work RVUs of 4,698 annually. Internists that fall below this median should try to understand why, says Swanson.
Sometimes the answer might be readily apparent. For example, a physician who works only part-time might generate lower-than-average RVUs. More often than not, though, the answer isn’t as straightforward.