RVUs in Neurology

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undecided3yr

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Im just starting to look into the job market and seeing some high amounts of compensation mentioned, but of course things that seem too good to be true usually are. I am trying to find a way to compare apples to apples in terms of expectations.

Many positions quote compensation based on projected RVU amounts such as 5000-5500 RVUs. What exactly is a neurologist working to produce 5000 RVUs? I am familiar with the term and basic principle behind it, inpatient consults and procedures generate more RVUs than outpt visits, but do not know how much work someone has to do in order to produce a RVU.

Is 5000 RVUs comparable to seeing 10-15 return patients, +4-5 new patients daily as an outpatient or 10 inpatient consults daily? Is 5000 RVUs annually comparable to residency hour workload? (I suspect more)

Any help is appreciated
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The annual RVU target for a procedural Neurologist (EEG, EMU, Sleep or EMG) is 6,973. That is supposed to be a median number. About 5,000 is the median for a neurologist.

Gross collections depend on your patient mix. It should be about $ 40 - 80 / RVU. The lower number would include a much higher proportion of Medicaid or capitated Medicare patients.

 
how are you looking for positions?

just curious... this hasn't been discussed on here much, and when someone posts, hundreds of people benefit over time..

certainly it's easiest to stay where you are, since you likely know people and have connections.

but in terms of looking for other positions, what have people done? recruiters? usually academic places don't have the $ to hire recruiters. i know of people who have gotten academic positions simply by contacting the chair to see if they were hiring.. seems like AAN/Dendrite/green journal is also a good resource for both private and academic.

anyone have any experiences they can share? other resources?
 
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I havent begun to seriously start looking, just starting to test the water.

At the moment, I have only been searching online and though openings sent to the residents through our program. I have also been told that word of mouth is the best way to get a job out of residency as most positions are taken before the need to advertise.

I became curious about how RVUs translate into workload since that can give an idea of how much will be demanded to earn that reported salary figure.
 
Thought this might be helpful.
Link
 
This is more of a question for attendings, but what is the typical work week for a Neurologist producing 5000 work RVUs annually?
 
This is old but still useful: http://www.neurology.org/cgi/reprint/56/5/586

Medicare is abolishing outpatient consultation codes (higher reimbursement).
Here are these changes: http://www.aan.com/globals/axon/assets/6546.pdf
This is a really big deal for Neurologists. A quote from an article in the MGMA website indicates that "Neurologists code nearly 90 percent of their new outpatients and more than 90 percent of their initial inpatient work as consultations, according to Medicare Part B physician supplier national data from 2006."

This is a bit more recent but useful: http://www.neurology.org/cgi/reprint/71/23/1907.pdf

This is a bit dated but explains Medicare system:
http://www.medscape.com/viewarticle/433293_2

Now assume an outpatient practice with:
10 new patients / wk (level IV - 99204) = 24.3 x 48 wks = 1166 RVUs
80 established pt / wk (level III - 99213) = 77.6 x 48 wks = 3725 RVUs
That is 4891 RVUs. You will get to 5000-5500 with the frequent level IV established, and your level V new patients.
This is no different in academia, where we need to produce our salaries with a worse patient mix than in private practice.

For other codes, see:
http://www.rheumatology.org/practice/document_code/09rvu.asp
 
So lets say you are able do 5000 RVU's a year. How much, percentage wise, are you able to keep as far $$
 
wow. is there no light at the end?:rolleyes:
 
neurologist said:
To answer your question in general, my salary is approximatly 50% of the revenue collections that I generate (I work for a hospital, this may vary among groups).
Click to expand...

Isn't the current RVU conversion factor $36? So, the average neurologist brings in around $180,000 a year, and you only see half of it? Am I missing something because this doesn't seem quite right...
 
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GoodmanBrown said:
Isn't the current RVU conversion factor $36?
Click to expand...

I have no idea where you are getting this number. Source?

So, the average neurologist brings in around $180,000 a year, and you only see half of it? Am I missing something because this doesn't seem quite right...
Click to expand...

The average neurologist's take-home salary is over $180,000 a year. Look at any physician salary survey to confirm. You have to "bring in" a significant amount more to the practice to cover overhead and have that as a leftover take-home net income.
 
neurologist said:
I have no idea where you are getting this number. Source?

The average neurologist's take-home salary is over $180,000 a year. Look at any physician salary survey to confirm. You have to "bring in" a significant amount more to the practice to cover overhead and have that as a leftover take-home net income.
Click to expand...

My source was a page called "Physician Fee Schedules" on a CMS website.

Though it does look like it's some sort of Facility RVU. Within a given reimbursement system (in this case Medicare), I wasn't aware that there were different RVU conversion factors. I thought each procedure, office visit, etc. had a certain RVU and they were all reimbursed at the same amount.

Obviously private insurances, Medicare, Medicaid, etc. would have different conversion factors (and possibly slightly different RVU assignments), but my understanding was each system would have its own conversion factor and be consistent within itself. Is this not the case?

Also, I know that neurologists take home more than $90,000/yr. I was just confused and thus, asking why and where things didn't add up. Thanks!
 
Starting to look at some practice opportunities and was interested in seeing what people feel a realistic number for working rvu's to obtain for a primarily outpatient general neurologist that does some emg/ncs as well.

Many of the positions offer a salary off of RVU production, but I have no idea what is considered a realistic goal for a general neurologist as stated above, 4000? 5000? 6000?


Thanks!
 
Just to clarify, I am referring to working rvu's.

Thanks
 
Just to clarify, I am referring to working rvu's.

Thanks
 
To LL:
As you are going to be fresh out of residency, I would consider risky taking jobs with this particular requirement to make certain numbers of RVUs.
There is plenty of jobs out there with a good base salary and bonus compensations.
Don't tangle yourself in RVUs. They are ever-changing and payers pay different amount for a similar service. The hospital jobs on paper should pay more!
 
RAD345 said:
To LL:
As you are going to be fresh out of residency, I would consider risky taking jobs with this particular requirement to make certain numbers of RVUs.
There is plenty of jobs out there with a good base salary and bonus compensations.
Don't tangle yourself in RVUs. They are ever-changing and payers pay different amount for a similar service. The hospital jobs on paper should pay more!
Click to expand...

just bumping around on this forum, and im not a neuologist, but the above is awful advice.

if you work for a hospital, you want an RVU-based system.

"dont tangle yourself in RVUs"? what is that supposed to mean?

RVUs are just a fudge factor for $$$, but you dont have to really worry about the type of insurance.
 
Thanks for the input. I am looking at different positions, some offer a base salary with bonus compensation once you hit 5000 wrvus, while a few other offer a little bit of a higher base salary regardless of how many wrvu's I would generate. As this will be my first year out of training, I am not sure how many wrvu's I can expect. The positions are basically general neurology positions (outpatient) with roughly 10-15 emgs a week.
 
I work for RVUs in a hospital-based system, doing all NCC. The department or practice manager should be able to give you projections for what people in your position and case mix should be able to generate. If they can't, then I would be a bit suspicious. It doesn't hurt to ask.

A hospital across town does things differently, with an established base salary and a couple of bonuses for each level of RVU incentives you cross. I think this is a less helpful alternative than the eat-what-you-kill setup, because you have to work your a** off to get the bonuses and they overall are less than what you would have made if you just billed for yourself in the first place. The only upside is that you won't get caught with your pants down if your RVU generation is far below the projections. They certainly also help the divisions with lower RVU generation, like cognitive etc.

I would recommend asking for a guaranteed base salary in your first year in order to figure out your comfortable RVU generation. But beyond that, you will probably be in a better financial position in the long run if you can take home your own RVUs in a stable practice environment.

Just my two cents. Others may see things very differently.
 
SSdoc33 said:
just bumping around on this forum, and im not a neuologist, but the above is awful advice.



"dont tangle yourself in RVUs"? what is that supposed to mean?

RVUs are just a fudge factor for $$$, but you dont have to really worry about the type of insurance.
Click to expand...

I agree with you but as a fresh graduate its very difficult to estimate yearly RVUs. It's easier to start with a base salary, so if there's a need to spend 1-2 hour on a pt, they don't get stressed out for the RVU, especially as a nerurohospitalist.
Down the road it's totally different story to build RVU for your own benefits when someone has more experience.
To me, the ideal model is the cash only system, when someone is well known and respected in the community.
 
RAD345 said:
I agree with you but as a fresh graduate its very difficult to estimate yearly RVUs. It's easier to start with a base salary, so if there's a need to spend 1-2 hour on a pt, they don't get stressed out for the RVU, especially as a nerurohospitalist.
Down the road it's totally different story to build RVU for your own benefits when someone has more experience.
To me, the ideal model is the cash only system, when someone is well known and respected in the community.
Click to expand...

i guess. money is money. call it RVUs or call it collections. either way, you are gonna have to earn your keep, or get paid like crap.
 
Greetings, colleagues.

I am a busy employed procedural Neurologist with 20 years experience working for a large hospital corporation. My schedule is booked four months in advance.

My wRVU's range from 450 - 800 per month. For the past two years, I have been reimbursed $31 per RVU. I realize this is low, but I have a relatively high Medicare mix.

My contract is up for renegotiation. What should I ask for in terms of reimbursement per RVU?

Otherwise, I have excellent benefits, but I believe that I could be doing better.

Thanks for the advice.

Southern Summer
 
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