RVU Primer What are RVUs? Developed as RBRVS between 1985-1988 (Harvard’s William Hsiao & Peter Braun) and adopted in 1989 by Medicare as the methodology for physician payment. Examined 3,200 physicians in 18 specialties to analyze work and resources required to perform over 8,000 discrete physician activities. Goal: reliable and high validity way to compare physician work across varied activities. As a balanced measurement, RBRVS assessed as superior to all other available measures (visits, procedures, time, etc)

RVU Primer How are RVUs used around the country? How are RVUs updated? Payment – Medicare, Medicaid, BCBS, most others Budgeting Productivity benchmarking Expense allocation How are RVUs updated? AMA Specialty Society RVU Update Committee (RUC) on contract to CMS reviews RVU values on a continuous cycle with all RVUs updated at least every 5 years. CMS accepts 75-90% RUC recommendations

RVU Primer RVU components Physician work (typically about 52%) – time, technical skill, mental effort, judgement, stress involved with an activity Practice expense (typically about 44%) – nonphysician clinical and non-clinical; labor, building expense, office supplies, etc. Professional liability expense RVUs are not $$s, but payment systems tend to multiply RVUs times a conversion factor to get to payment Coding is key – each CPT code (over 8,000 of them) drives an RVU

Some RVU examples 99213, Level 3 follow up office visit Work RVU: .97 Total RVU (non-facility): 2.05 Total RVU(facility): 1.44 99222, Level 2 hospital admission Work RVU: 2.61 Total RVU: 3.86 99291, 1 hour of ICU care Work RVU: 4.5 Total RVU(non-facility): 7.75 Total RVU(facility): 6.31 59400, Global prenatal and delivery - Vaginal Work RVU: 32.16 Total RVU: 60.17 27245, Hip fracture repair (open treatment, with internal fixation) Work RVU: 18.18 Total RVU: 35.49 47562, Laparoscopic cholecystectomy (bladder removal) Work RVU: 10.47 Total: RVU 19.06

Example RVU Benchmarks

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