Hospitalist RVU Benchmarks and Standards Reviewed.

If you're a hospitalist and you're searching for hospitalist RVU benchmark standards, you've come to the right place.  I've noticed quite a few of you hospitalists finding my site by searching for hospitalist RVU standards.  If you're finding my site for the first time, you can find everything you've ever wanted to know and things you didn't even know you needed to know right here at The Happy Hospitalist  I have a wealth of information in my E/M coding series and my resource center for hospitalists to prevent  others from taking advantage of your highly educated skills.  There you can find a wealth of practice management information including the mandatory understanding of relative value units (RVU) and what that means to your compensation.  

In addition, I have a constantly updating post about the state of the ever rising salaries of hospitalists.   Make sure to review that information in detail to understand how you stand with regards to other programs nationwide.   I'd even go as far as defining some of the salary information as  national benchmarks from which all hospitalist groups should consider for heir compensation packages. Make sure to also review to most up-to-date information on hospital subsidies for hospitalists.  You may be shocked to see how high they have gone.

Now it's time to pull it all together.  As you know by now, the Medicare National Bank pays all encounters based on the RVU system, including the evaluation and management codes (E/M) that will account for greater than 97% of your hospitalist practice.  The value of  one Medicare RVU is defined by Congress under the rules of sustainable growth rate economics.  

The September 14th, 2010 dollar value of one RVU paid for any service provided to Medicare beneficiaries is $36.87. That number changes every year based on complex government formulas.  I have written previously about the historical value of one RVU.     As physicians, we need to stop under coding because we don't know how to document work provided.  Under coding is as much a fraud as over coding. You devalue the work you have trained so hard to achieve and you make bell curve thieves out of educated hospitalists who provide accurate coding for their documentation. 

Work RVU is the intrinsic value of the education and experience a hospitalist has completed in pursuit of their medical training.  It is also the component most commonly used in determining RVU based production bonuses and incentives. How do you and I compare with national hospitalist RVU benchmark standards?  The only way you can know is to ask your business manager or billing account representative to give you documentation of your work RVU production. Any standard electronic billing program should be able to generate either a date of service (the day you  saw the patient ) or date of entry (the date the billing company entered the visit in their system)  RVU report.  And you want to make sure that your billing company is keeping the same report every month.  In other words, reporting RVUs one month for date of entry and then date of service the next makes mashed potatoes out of the data.  It must be consistent.

If you want to keep track of your production, simply ask your billing department to send you a monthly copy of your RVU date of service report.  
  • You'll want it make sure what's being measured is the same as what your benchmarks and compensation goals are in your contract.  In other words, it makes no sense for your group to track total RVUs per year if your contracted production incentives depend only on work RVU.  You always want to compare apples to apples.
  • You'll want to know how many total encounters you're seeing in the month. If you want to do nothing more than keep track of your total monthly encounters on your own, you can use that to verify you are receiving credit from your billing company. Early on in my hospitalist career I helped my billing company sort through multiple points of errors in their process where by other doctors would get credit for work I was performing or bills simply weren't being submitted at all.  My efforts of data mining my own experience have caused the error rate of my billing company to drop below 0.1%, which I think is remarkable considering the volume of claims being submitted.  That's maybe 25 claims a year out of 25,000.
  • Once you know your total monthly encounters and your total monthly work RVUs you can figure out if your contract and incentive structure makes sense, and how it compares with national hospitalist RVU benchmark standards reported by salary survey's available in the link above. 
In classic Happy fashion, I have taken this process to the next level.  If you want a more in depth understanding of your RVU production, read on.  You have to make sure the RVU numbers they give you are consistent with the RVU numbers they are basing your production incentives and bonus structures on.  You see, every CPT® code you bill out from the initial hospital admission code 99221  to the high level hospital follow up code 99233 is worth a predefined totalRVU value as determined by the American Medical Associations RVU committee of subspecialists.  And every totalRVU value is composed of a workRVU + practice expenseRVU + malpractice RVU.  

Most hospitalist groups will use the workRVU, which is usually around 70-80% of the total RVU as the RVU benchmark standards for meeting minimum production incentives.  You need to make sure your group is not collecting work RVU values and reporting them for your performance measure while substituting totalRVUs as the minimum standard.   They must collect apples and report apples to apples.   You need to verify this information.  You'd be surprised how often even the billing and business departments have no idea what they're doing  at times. 

If you want to track your hospitalist RVU production more indepth, you need to get informed.  What are the work RVU amounts for the most common hospitalist E/M codes?  I have provided you with a  table here listing the work and total RVU values for all common hospitalist CPT® codes.    You must understand what this data means if you are going to understand your hospitalist contract and whether you are being fairly compensated for the work you are providing.  

The work RVUs in this table will  account for the vast majority of your daily practice CPT® codes you submit.  You can ask your practice manager for work and total RVU values for any other CPT® codes you use.  In fact, these values have a tendency to remain quite static  from year to year with small changes, so if you're keeping track of your RVUs (total or work), realize that the value of the work you are doing is constantly changing as well. If your practice manager says they can't get you this information, they're lying to you.  The software programs they use to submit your CPT® charges for you have all this information built in.  If they say it doesn't, they're lying to you and if they aren't lying to you, you need to find another billing company or find another job, because they're lying to you and in all likelihood, taking advantage of you.

Once you understand the data you are tracking, what do you do with it? If you understand what's being measured then you can understand if the production incentives and bonus structures in place make sense and are achievable or are just pie in the sky get rich quick nonsense. You can figure out if your experience is similar in expectations to hospitalist RVU production benchmarks by other groups all across the country

According to the SHM/MGMA 2010 compensation survey, the average hospitalist generated 4,100 work RVUs and 1.86 workRVUs per encounter. That's your national bench mark people.  If you do the math, that's an average of about 2,200 total encounters per year.  If you divide that by 200 ten hour shifts a year, across all day and night shifts, the average hospitalist will see 11 total encounters per shift.  The national data also suggests that each average encounter is paying 1.86 work RVU * $45 or just under $84 per encounter.  

If your compensation is based entirely on how much you collect, realize that the average hospitalist collects $84 for every encounter they see.  And that does not include the subsidy now of $110,000 per year per hospitalist (2010 data).  If you divide that subsidy over the average 2,200 patients a year, you would see that the hospital subsidizes every patient the hospitalist sees to the tune of $50.    Even if just 1/2 the $50 went to practice expenses (although that expense has already been paid for in the total RVU formula) , you can see that every encounter a hospitalist sees is worth at least $110 in compensation and benefits.   That's at least $110 for every level one follow up and $110 for every high level admission.

If you know how many work RVUs you are generating in a year and how much each Medicare RVU is worth, then you can tell whether or not you're getting taken advantage of.  And remember, the  $36 RVU  value is only for Medicare patients.  Many other private insurance companies pay more.  According to the 2010 SHM/MGMA survey, the average collected payment for one RVU in the 2010 salary survey was actually around $45, a 25% premium to Medicare's rate, which is an obscenely low  rate by just about any professional standard. 

I kept diligent track of my own hospitalist productivity for several years, long before I knew of any national hospitalist RVU benchmarks.    In fact, I have created a spread sheet program that allows me to accurately define my productivity across a whole spectrum of  different hospitalist shifts to help me  understand where staffing needs are most pressing and to help me understand how  I compare in productivity and efficiency with other hospitalists in practice. 

I am able to accurately describe encounters per day shift (short or long), encounters per night shift, RVU per encounter (day and night shifts), RVU per shift, month and year, encounters per shift, month and year, my ratio of level 2 to level 3 hospital follow codes, how often I bill critical care and how much of those are admit critical care and how much are follow up critical care codes.  

I have even created my own hospitalist efficiency ratio (all follow up codes divided by all admission codes) to help me and my group understand who keeps patients in the hospital the longest and who gets them discharged the quickest. The lower the number, the more efficient I am.   In a group where hospitalists do not follow their own patients from admit to discharge, this is the best possible marker I have found, assuming everyone works the same type of shifts, to help members understand how they compare with their peers in efficiency of discharge. 

If you want to know whether you are working under a fair contract when compared with your peers, I recommend you study the many resources I have listed above and occasionally check back as I am constantly updating information at The Happy Hospitalist.  Good luck with your Hospitalist career.  


LINK TO E/M POCKET REFERENCE CARD POST


EM Pocket Reference Cards Using Marshfield Clinic Point Audit



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