Pediatric Utilization and RVU 2008

As promised – or threatened, I suppose – here is a breakdown of the expected impact of the 2008 coding changes based on pediatric utilization.

I logged back in to add the punchline, which I forgot to add in my spreadsheet nerdiness: if it weren’t for the expected 10% Medicare cut, pediatricians would see an approximately .83% increase in expect RVU production in 2008. That’s lower, obviously, than last years’ 2% increase.

At least we can look forward to 50-80 years from now when, at this rate, we’ll be about right. OK, back to it.
I took the top ~200 codes, about 1/2 of which have RVU values, performed by our pediatric clients and calculated their average usage by FTE physician (for example: an average PCC doctor performed 1843 unmodified 99213s last year, 85 87081s, etc.). I then compared the pricing of each CPT code for 2007 vs. 2008 and calculated the total effect.
There are many different variables that can/should go into this analysis, some of which I left out. For example, I left out the GCPI calculations. This is all at 100% of Medicare. I looked only at Transitional Medicare rates. Here’s what I learned:

2007 2008 Difference
Expected RVUs Performed 9,063 9,130 +.83%
Expected $$$ Charged
Medicare Cuts Upheld
$343,140 $311,059 -$32,080 (-10.3%)

The CPT with the largest total RVU cut: 51701, the bladder catheter insert. It loses about 7% of its value, or about $5 in 2007 terms. However, if you look at true pediatric utilization, the real crime is apparent: the bread and butter of pediatric coding takes the biggest hits! The codes with the largest RVU decrease, based on utilization are, in order: 99392, 99391, 99393, 99394, 90466, 99381, etc. Each of which drops between 2-5%. If you look at the total $$ lost, the 99213 obviously beats the pack, with an approximate $10,500 hit next year.
To restate: without even looking at your (negative) GCPI adjustments, you can expect a $10K hit on just your 99213s in 2008 RVU terms. Your 99214s (-$3.5K), 99392s (-2.9K), etc., don’t fare much better.
On the flip side, there are some “winners.” That’s why it’s “only” a 10.8% average decrease and not more. Circumcisions jump by nearly 50% (to $196). The 92587 (Evoked Auditory Test) goes up 5x (from .2 to 1.26) and there’s the arrival of the Physician Phone Consultations, which are worth $0 until Jan, when they get a $35 value! (I know most folks won’t see it for a while…but imagine!). In fact, an entire stack of procedural items get decent boosts – look closely and you might see some interesting items: 92587, 54150, 94010, 99371, 95004.
Now that I’ve taken the time to build this gnarly spreadsheet, let me know if there’s some other data you’d like me to extract from it.

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