As described in my linked posts above, 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 on only 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 the 2010 compensation survey I linked 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 hospitalist 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. I experienced that first hand.
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 in 2010? Here's one of the most important lists you can hold on to if you want to verify your own production RVUs are being accurately reported by those in control of your incentive structure.
CPT® 99221, low level hospital admission: 1.92 workRVU
CPT® 99222, mid level hospital admission: 2.61 work RVU
CPT® 99223, high level hospital admission: 3.86 work RVU
CPT® 99231, low level hospital follow up: 0.76 work RVU
CPT® 99232, mid level hospital follow up: 1.29 work RVU
CPT® 99233, high level hospital follow up: 2.0 work RVU
CPT® 99238, discharge 30 minutes or less: 1.28 work RVU
CPT® 99239, discharge > than 30 minutes: 1.9 work RVU
CPT® 99291 30-74 minutes of critical care: 4.5 work RVU
CPT® 99292, extra 30 min CC 2.25 work RVU
Here is more in depth list of common E/M hospitalist codes with their
2011 and 2012 RVU values (work and total).
These 10 codes will account for the vast majority of your 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 change a bit from year to year, 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 what you're 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. And 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. That's right in line with what I've seen with my own data over the years. 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 of $110,000 per year per hospitalist. 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 far more. According the the 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 have kept diligent track of my own
hospitalist productivity for several years now, 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 my group understand where our staffing needs are most pressing and to help me understand how I compare in productivity and efficiency with other members of my group.
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. We actually have an efficiency ratio for our group and for every individual doctor to help them understand where they fall on the spectrum.
For 2008, I had 2,708 encounters and 5,713 work RVUs spread over 2,244 hours, spread over 226 shifts for just under 43 hours per week, on average. I generated 36 w RVUs per 12 hour day long shift (about 15.5 total encounters), 22 wRVU per 8 hour day short shift (about 12.5 encounters), 18 wRVUs per night shift (about 5.5 encounters), My 2008 wRVU/encounter average was 2.12, which is quite a bit higher than even the 2010 survey results from this year. That's because I know what I'm doing when it comes to billing and coding E/M. Across all shifts, I had an average of 1.2 encounters/ hour generating 2.55 wRVU/hour.
I did not track my 2009 data. I am, however, currently tracking 2010 data for my group. Through June of this year I am averaging 2.24 RVU/encounter with 2,600 work RVUs over 1,200 encounters. Let me show you the importance of knowing your E/M coding rules. Using 2008 data, you'll notice I saw 2,708 encounters. Let's assume I see that many this year. The 2010 national average wRVU/encounter is 1.86. If all the hospitalist in this country would bring their work/RVU per encounter up to my level (which represents accurate billing and coding), every hospitalist in the country could generate an additional 0.38 RVU/encounter.
Over 2,700 encounters every hospitalist in this country could generate an additional 1,000 workRVUs per year. If the average collection is about $45 per wRVU, the average hospitalist could generate an additional $45,000 a year in revenue for work RVU, not to mention an additional $10K for practice expense and malpractice expense RVUs, if they knew what they were doing.
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