wRVU Value Change

[Major Payne]

Hey guys,

Was wondering if anyone out there in a hospital employed setting (or any wRVU compensation model) has switched over to the newer CMS wRVU values that they changed a few years ago? The hospital I am at currently has been going off old values since I started working there 2 years ago and has decided they will be switching over to the new values starting in the summer. They are meeting with me soon to discuss this and I anticipate them to decrease my pay per wRVU given that the outpatient visit codes increased in wRVU value and, to my knowledge, most or all of the procedure codes have not had a significant change in the wRVU values (except RFAs from what I've seen did decrease slightly). This of course means I will be paid less for procedures but depending on how much they will be bringing my pay rate down, it may be a wash since my clinic RVUs will be going up. Currently I am in clinic 3 days a week and procedures 2 days a week. Has anyone made this change recently and if so, how much lower RVU pay should I anticipate?

The second question I had revolves around equal pay. I joined this hospital and they had 1 other physician who had been working for them for about 3 years. I have no idea what his wRVU pay rate is and we haven't really discussed it together as I felt he may not be comfortable doing so. We are both 5+ years out of training, he is a few years ahead of me. The meeting they scheduled to discuss wRVU rate change is only with me and administration and to my knowledge he will not be there. Is there an appropriate way to ask if my pay rate is the same as his? Maybe ask "is this the pay rate for the department?" Or should I just avoid bringing this up and just try to do my own negotiating without bringing him into it?

Appreciate any input!

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[Laryngospasm]

cant answer some of your questions but most likely the other persons pay rate is tied to the same metrics as yours. If it were higher I’m sure they would just bring them down. They are always looking to take more money from docs.

 

[DOctorJay]

1. we made this adjustment a couple years ago now although I'm not paid on a straight $/wRVU (we're based on productivity percentiles). the increase value of follow up visits has decreased our bonuses as the percentile benchmarks we use have gone up significantly along with total wRVU numbers. (if you look just at MGMA numbers what I wrote won't make sense but we use a "blended" data scheme that includes AMGA and Sullivan Cotter.)

we had an adjustment that essentially kept our comp flat even though our production increased slightly. with benchmarks increasing again a lot of us are looking at increasing our follow up visit numbers even more since 99214 = 1.92 wRVUs (64483 = 1.90). I imagine whatever decrease to your $/wRVU they propose would try to keep you at the same salary level.

I'm curious if other HOPD docs have decreased procedure time at all in favor of more follow up visits.

2. if you're on good terms with the other doc and your practices are fairly similar it would make sense to at least pose the question. bring it to him as a mentee to mentor type question and maybe ask him if he's had any success with negotiations in the past and any pointers. this is one area physicians really need to be more open with each other so we can all benefit. God knows the hospitals are making plenty of money off of us.

 

[Ducttape]

the number of wRVUs did not change appreciably in my case.

there wasnt a significant decrease in the wRVU for procedures to my knowledge.

i wouldnt get too in to the "how much does he make" scenario. it breeds distrust.

just remember he is in the same situation you are in.

they would much rather meet with just you - and at some other time, just him - to divide and conquer.

 

[Ducttape]

we had an adjustment that essentially kept our comp flat even though our production increased slightly

i suspect thats why there wasnt a great change in my part.
systems will do its darnedest to keep the pay unchanged.



and i agree - its better to be open and to be colleagues and, if possible, friends together. you two have much more alike than anyone else.

 

[BobBarker]

My little hospital implemented the change in values immediately and left everyone’s conversion rate the same. We all got big raises essentially.

 

[RoloTomassi]

So the government, in a rare moment, increases the value of some of our services. The hospital, instead of wanting to benefit along with you at the same split you had agreed on, wants to take everything off the top so you don't get a penny more? F that, I would be livid.

 

[DOctorJay]

So the government, in a rare moment, increases the value of some of our services. The hospital, instead of wanting to benefit along with you at the same split you had agreed on, wants to take everything off the top so you don't get a penny more? F that, I would be livid.

you see all this stuff on social media about contacting government representatives to fight against physician fee decreases and lack of at least inflationary increases- and I think about it and figure that even if they did increase the physician fees the hospitals would find some way not to share the increase with us.

 

[gaspasser127]

The health system I was previously employed by gave us an RVU conversion rate of $63

I just heard the docs were asked (read: forced) to sign an addendum because the hospital is now adopting the updated RVU values and the new conversion rate is $58

That’s an 8% reduction

Medicare increased level 4 new visit (99204) RVU values from 2.43 to 2.6 which is a 6% increase

As we all know - the procedure RVU values did not change

They all literally got a pay cut lol

Glad i left when i did

 

[paindoc007]

They will never love you back

 

[kstarm]

We adopted the changes right away. Had an initial decrease in WRVu and then after 6 mon or a year they increased it slightly (not back to origingal though) to try and keep comp neutral. Of course individual practices were affected differently. Inpatient consults already are not as lucrative, this just made it worse for me (that has since changed). As mentioned procedure heavy partners took a hit too. Overall my pay at the end of the year was up however.

 

[so55b]

I managed to increase by 2$ of my $/RVU after my first 3-year contract last year. We also adopted new CMS RVU values which raised my salary by about 30% at once. My hospital is about 40 minutes from the bigger city in the Midwest so I guess I have more negotiation power than people in the big cities.

 

[Status Sciaticus]

What are yall's $/wRVU looking like?

I'm interviewing at some places in the south and the numbers just seem off to me. MGMA shows the south at $50ish/wRVU??
I was under the impression the average would be around $65-70/wRVU

 

[Major Payne]

The health system I was previously employed by gave us an RVU conversion rate of $63

I just heard the docs were asked (read: forced) to sign an addendum because the hospital is now adopting the updated RVU values and the new conversion rate is $58

That’s an 8% reduction

Medicare increased level 4 new visit (99204) RVU values from 2.43 to 2.6 which is a 6% increase

As we all know - the procedure RVU values did not change

They all literally got a pay cut lol

Glad i left when i did

Yeah so I think the problem is it really comes back to what your breakdown of types of patient visits/procedures is. New level 4 did only increase 6% but follow up level 4 went up from 1.5 to 1.9 so that is about 27%. Follow up level 3 also went up about 34%. So if your clinic is mostly new patients then dropping 8% in RVU rate is a hit but if you are seeing a fair amount of follow ups then even with an 8% rate decrease in RVU pay you still come out on top potentially. Again, it is unfortunate because no matter how you spin it, you take a hit on procedure reimbursement no matter what your procedure volume is.

 

[Major Payne]

What are yall's $/wRVU looking like?

I'm interviewing at some places in the south and the numbers just seem off to me. MGMA shows the south at $50ish/wRVU??
I was under the impression the average would be around $65-70/wRVU

Currently at $65 in the south but stay tuned for what they are changing me to lol

 

[Major Payne]

My little hospital implemented the change in values immediately and left everyone’s conversion rate the same. We all got big raises essentially.

That is awesome. That's how it should be as I assume with higher RVU values the hospital systems are also getting reimbursed more? Probably not to the same relative extent as the increase in wRVU value but still

 

[DOctorJay]

yes, the hospitals always get more

 

[callmeanesthesia]

yes, the hospitals always get more

View attachment 383265

Most of what is wrong with medicine, in one chart.

 

[drusso]

So the government, in a rare moment, increases the value of some of our services. The hospital, instead of wanting to benefit along with you at the same split you had agreed on, wants to take everything off the top so you don't get a penny more? F that, I would be livid.

If my employer did that to me, I'd be pissed...

 

[stsa84]

Just found out our hospital is still using 2020 values. I was told that they use the 2024 fee schedule for everything else, but the 2020 fee schedule for E/M. Was told "this was the direction management decided to go", back in 2021 when the new E/M fee schedule came out. So they're just pocketing the difference? I keep track of my RVU's, and I consistently document 30-50 RVU more each month than what the hospital tells me I have. Just realized I was stupidly assuming we were using an up to date fee schedule. That's about $30k each of the past 3 years...

 

[stsa84]

So, a day after I emailed payroll asking why we're using the 2020 fee schedules, our hospital CEO (of a massive state wide system) sends out an email that we're changing to the 2024 schedule. It was obvious this had been in the works for a while, but the timing was uncanny. We'll see if it works out for or against us. There was language in the email about evaluating total compensation, which may be ominous...

 

[Status Sciaticus]

So, a day after I emailed payroll asking why we're using the 2020 fee schedules, our hospital CEO (of a massive state wide system) sends out an email that we're changing to the 2024 schedule. It was obvious this had been in the works for a while, but the timing was uncanny. We'll see if it works out for or against us. There was language in the email about evaluating total compensation, which may be ominous...

did you ask to get your discrepant pay difference? Seems like a clear case of wage theft....

 

[stsa84]

You mean the difference of my calculated rvu's vs theirs? I figure the difference is mostly related to the fact that I was using 2021 E/M wrvu values while they've been still been using 2020. I don't know whether the new fee schedules are something that need to be followed by hospital systems.

 

[Status Sciaticus]

You mean the difference of my calculated rvu's vs theirs? I figure the difference is mostly related to the fact that I was using 2021 E/M wrvu values while they've been still been using 2020. I don't know whether the new fee schedules are something that need to be followed by hospital systems.

If theyre collecting 2023 RVUs from the insurance companies, but paying you on the 2020 RVU scale, then theyre pocketing the difference. That by definition would be wage theft. This assumes that your contract is based on RVU reimbursement and not a flat $/RVU.

 

[stsa84]

If theyre collecting 2023 RVUs from the insurance companies, but paying you on the 2020 RVU scale, then theyre pocketing the difference. That by definition would be wage theft. This assumes that your contract is based on RVU reimbursement and not a flat $/RVU.

I gotcha. I am flat $/RVU.

 

[clubdeac]

I gotcha. I am flat $/RVU.

Doesn’t matter if your contract says you get x amount of $/wRVU. It’s still based on whatever the going Rvu is for whichever service you’re providing.

If CMS says a 99213 is 1.3 wRVUs but they’re still paying you 0.9 wRVUs then technically they’re committing wage theft. Would others agree? Our hospital did this for 3 years.

 

[BobBarker]

Fun fact: the hospital get paid on units from Medicare also. Their conversion rate is around $33 I think. But they get total rvu. So if the wrvu went up, they also received more for that code but due to budget neutrality their conversion rate may have been adjusted down.

 

[Tboned]

Doesn’t matter if your contract says you get x amount of $/wRVU. It’s still based on whatever the going Rvu is for whichever service you’re providing.

If CMS says a 99213 is 1.3 wRVUs but they’re still paying you 0.9 wRVUs then technically they’re committing wage theft. Would others agree? Our hospital did this for 3 years.

What happened in the end? Did the hospital pay you the difference?

 

[clubdeac]

What happened in the end? Did the hospital pay you the difference?

Nope, they finally switched to the 2021 changes and then to make up for the increase in rvus, they decreased our dollar per rvu. Absolute evil