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?
|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%|
|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%|
|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.