Can someone explain RVu to me?

[perita]

Hi everyone, I am in my interview trail for my first job and I have encounter all types of Salary offers.
Something like X or RVU whichever is best
The first 18 months Salary and the last 18 RVU
Salary + production

I have research that Medicare paid 32.75 per RVU , how can a employer pay 60 per RVU? They have to make some money somehow.

I get kind of nervous when they offer RVUs because I have no clue how they are calculated. If I see 25 patients a day, how many RVUs will that be ?

If I work as a Heart Failure Physician, how can they calculate the RVUs?

Thanks

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[cards67]

Hospitals make money from facility fees, private insurance, etc. 25 patients a day could be 50 RVUs, or more or less, depends on new vs follow-up, complexity, inpatient vs outpatient, etc. RVUs are calculated the same whether you're HF, general or whatever, just depends on the work you're doing and how much of it you do.

 

[anonperson]

Hi everyone, I am in my interview trail for my first job and I have encounter all types of Salary offers.
Something like X or RVU whichever is best
The first 18 months Salary and the last 18 RVU
Salary + production

I have research that Medicare paid 32.75 per RVU , how can a employer pay 60 per RVU? They have to make some money somehow.

I get can of nervous when they offers RVUs because I have not clue how they are calculated. If I see 25 patients a day, how many RVUs will that be ?

If I work as a Heart Failure Physician, how can they calculate the RVUs?

Thanks

It's good to ask questions but you need to take a few hours and do research regarding work RVUs so you can understand potential compensation structures.

When health systems are talking about RVUs for physician compensation they are specifically referring to wRVU typically. Total RVUs also take into account malpractice etc.

Office visits are coded into level 3, 4, 5 and depending on either meeting certain criteria or being time based. And whether a patient is new or a return. Each level corresponds to a certain wRVU.

If you take call, you will generate RVUs from consults, reading echos etc.

If you see 25 patients, the amount of RVUs will depend on what level E/M visit. I would expect cardiology to bill at a higher level.

Regarding payment, the health system is not just seeing Medicare patients. They have commercial payors. And like another poster stated, the new scam is huge facility fees which pad the bottom line.

You aren't the first cardiologist in the group. They should be able to provide you historical numbers to get a sense of potential compensation.

Search the board for MGMA data and it will list the conversion rates for wRVUs so you can make sure you aren't being ripped off.

 

[NewYorkDoctors]

RVUs are a way to keep track of employed physicians to make a salary that is less than the direct revenue they generate.
This is reasonable if this is an employed physician as that physician cannot take home 100% of the revenue as there needs to pay overhead, the secretaries , support staff, medical supplies, etc.... but potential "scam" is when the senior partners are taking a cut from the revenue you generate because Godfather rules need tribute etc...

for private practice doctors who are self employed, doing a 99213 is $107.46 here in NYC accounting for copay, coinsurances, or if a secondary insurance/medicaid pays the 20%.

so seeing 10 patients for 99213 in theory generates $1074.60 in revenue

then you decide how to spend that on your staff, utlities, rent, overhead et c...

and pocket the rest

a 99213 generates 1.30 work RVUs

let's say some contract says (just randomly making stuff up)
if you generate 1,300 RVUs will pay you $50,000 for that.

well i just said 99213 is $107.46 so 1.30 RVU is about $140
so 1300 RVUs would in theory generate $140,000
not everyone fully collects on these things due to deductibles that patients don't pay, coinsurances that patients dont pay etc...

but the theoretical question is - would you be happy with doing $140,000 work and only getting $50,000?

this is all napkin math but hopefully this sets a frame of reference for your comparisons

CPT®	2023 Work RVU	Total RVU
99213	1.30	2.68
99214	1.92	3.79

You could search up various CPT codes including your echos, stress tests, caths etc...

Overview of the Medicare Physician Fee Schedule Search | CMS

Overview This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for...

www.cms.gov

then do some napkin math

okay if I did this may patients... this many echos etc.... in theory this is how much revenue I would generate if I were private practice and I collected all the money myself.

then see that ratio of work based on RVUs to whatever salary they give you seems "worth it to you."

 

[dozitgetchahi]

RVUs are a way to keep track of employed physicians to make a salary that is less than the direct revenue they generate.
This is reasonable if this is an employed physician as that physician cannot take home 100% of the revenue as there needs to pay overhead, the secretaries , support staff, medical supplies, etc.... but potential "scam" is when the senior partners are taking a cut from the revenue you generate because Godfather rules need tribute etc...

for private practice doctors who are self employed, doing a 99213 is $107.46 here in NYC accounting for copay, coinsurances, or if a secondary insurance/medicaid pays the 20%.

so seeing 10 patients for 99213 in theory generates $1074.60 in revenue

then you decide how to spend that on your staff, utlities, rent, overhead et c...

and pocket the rest

a 99213 generates 1.30 work RVUs

let's say some contract says (just randomly making stuff up)
if you generate 1,300 RVUs will pay you $50,000 for that.

well i just said 99213 is $107.46 so 1.30 RVU is about $140
so 1300 RVUs would in theory generate $140,000
not everyone fully collects on these things due to deductibles that patients don't pay, coinsurances that patients dont pay etc...

but the theoretical question is - would you be happy with doing $140,000 work and only getting $50,000?

this is all napkin math but hopefully this sets a frame of reference for your comparisons

CPT®	2023 Work RVU	Total RVU
99213	1.30	2.68
99214	1.92	3.79

You could search up various CPT codes including your echos, stress tests, caths etc...

Overview of the Medicare Physician Fee Schedule Search | CMS

Overview This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for...

www.cms.gov

then do some napkin math

okay if I did this may patients... this many echos etc.... in theory this is how much revenue I would generate if I were private practice and I collected all the money myself.

then see that ratio of work based on RVUs to whatever salary they give you seems "worth it to you."

Agree.

Short answer is that RVUs always involve “letting the house take a cut”. In my situation (rheumatology), letting the house take a cut is a total ripoff, and you are quite likely to do better in PP.

 

[NewYorkDoctors]

this is why "procedure is king/queen."

while the doctor is seeing the office visit 99202-99215, the doctor can finish and move onto the next patient while the patient gets their procedures done (which in cardiology needs prior auths outside the treadmill stress test and basic EKG i believe for the other cardiac testing)
a tech sonographer whoever does the testing while the doctor sees the next patients
the procedures then become "passive income" in a sense (though you have to write a report later but that can all be templated)

the only way an internist can generate more revenue or wRVUs is to see more patients but that becomes very tiring very fast.