2014 Pediatric RVU Comparison

I unveiled the beta version of the 2014 RVU Calculator at this weekend’s well attended (and received!) PMI conference and it seems to be in good shape, but I want to do just a little more testing before I release it here. Perhaps Wednesday.

In the meantime, I was able to use the tool to take a look at changes in RVU values for popular pediatric codes.  How does pediatric work fare in 2014?

Description 2014
2014 Medicare
2013 Medicare
90460 Im admin 1st/only component 0.7 $25.08 0.76 $25.86 -8% -3%
90461 Im admin each addl component 0.35 $12.54 0.37 $12.59 -5% 0%
90471 Immunization admin 0.7 $25.08 0.76 $25.86 -8% -3%
90472 Immunization admin each add 0.35 $12.54 0.37 $12.59 -5% 0%
92551 Pure tone hearing test air 0.33 $11.82 0.37 $12.59 -11% -6%
92587 Evoked auditory test limited 0.62 $22.21 0.64 $21.77 -3% 2%
94760 Measure blood oxygen level 0.09 $3.22 0.1 $3.40 -10% -6%
96110 Developmental screen 0.23 $8.24 0.27 $9.19 -15% -11%
99173 Visual acuity screen 0.08 $2.87 0.09 $3.06 -11% -7%
99203 Office/outpatient visit new 3.02 $108.18 3.18 $108.19 -5% 0%
99212 Office/outpatient visit est 1.22 $43.70 1.29 $43.89 -5% 0%
99213 Office/outpatient visit est 2.04 $73.08 2.14 $72.81 -5% 0%
99214 Office/outpatient visit est 3.01 $107.83 3.14 $106.83 -4% 1%
99215 Office/outpatient visit est 4.03 $144.37 4.2 $142.90 -4% 1%
99238 Hospital discharge day 2.03 $72.72 2.08 $70.77 -2% 3%
99391 Per pm reeval est pat infant 2.79 $99.95 2.9 $98.67 -4% 1%
99392 Prev visit est age 1-4 2.98 $106.75 3.1 $105.47 -4% 1%
99393 Prev visit est age 5-11 2.97 $106.39 3.09 $105.13 -4% 1%
99394 Prev visit est age 12-17 3.25 $116.42 3.37 $114.66 -4% 2%
99395 Prev visit est age 18-39 3.32 $118.93 3.44 $117.04 -3% 2%
99460 Init nb em per day hosp 2.65 $94.93 2.61 $88.80 2% 6%

The bottom line is that most pediatric codes lose RVU value in 2014 but the (expected) Medicare conversion factor pushes many of them into the black.  For the record, I don’t like this. Although pediatric codes may have lost fewer RVUs, relatively, than other codes, losing RVU value is always trouble.  I just hate losing ground.

Why the loss in RVU value?  I believe the AMA provided the following explanation (proper citation welcomed), shared with me by the Angel of RVUs at the AAP:

Revisions to the Medicare Economic Index (MEI): CMS has finalized its proposed revisions to the MEI, which are based on the recommendations of a technical advisory panel convened in 2012. These revisions include: moving payroll for non-physician personnel who can bill independently from the practice expense portion to the physician compensation (work) portion of the index; changing the price proxy for physician compensation to wages of professionals instead of all private non-farm workers; creating new categories for clinical labor costs and for other professional services like billing; and changing the price proxy for fixed capital to business office space costs instead of residential costs. In response to commenter concerns about the recommendation to revise the way payroll costs for non-physicians who can bill independently are treated, the final rule provides several explanations for the change, noting for example that direct patient care from non-physician personnel is included in the work component of the RBRVS and that expenses for non-physician clinical personnel who cannot bill independently are not being reclassified. In response to concerns that the productivity adjustment used in the MEI is double the productivity adjustment applied to the hospital market basket, CMS notes that the productivity measure used in the MEI is based on Bureau of Labor Statistics data through 2011 whereas the statute requires the hospital productivity offset to be based on a forecast through calendar year 2014. The final 2014 MEI is 0.8 percent. The revisions to the MEI lead to changes in the cost shares which increase the physician compensation cost share to from 48.3 to 50.9 percent. The non-physician compensation share decreases by the same amount. As it has done previously when MEI cost shares changed, CMS is adjusting the relative value units and geographic indexes to match the new cost shares.

Impacts of adjusting the relative values to match the revised MEI cost shares are similar, ranging from +2 percent to -3 percent but at zero percent or +/-1 percent for many specialties. This change generally increases payments for specialties for which work is a higher proportion of their total relative values, and decreases payments for specialties with a higher practice expense proportion.

Executive summary? Medicare, for a variety of reasons (some reasonable) are removing certain costs from the “practice expense” element and putting them, where appropriate, into the “work” element.  As a result, work that, say, your nurses do for you will be valued slightly less.  Harumph.

2 replies
  1. aixa
    aixa says:

    I will like to know if a non facility revenue Is or shoulb be included in the WRvu of the physician, and if not is this should be pay to the physician in a compensation plan base on WRvu

    • Chip Hart
      Chip Hart says:

      I’m not actually sure what you mean here.

      First, each procedure has either a facility or non-facility value as part of the total RVU, but the wRVU is specifically the OTHER big chunk (of three total pieces). There’s the Physician’s Work (the wRVU), the Practice Expense, and the Malpractice. The wRVU and the Practice Expense aren’t related, AFIAK.

      As for whether or not this should be paid to a physician in a wRVU based model…it totally depends. There are too many other variables to consider. Can you give more detail?


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