[Update - I noticed that I made a mistake in the original data I posted here...yikes! This post has been updated to reflect the accurate values.]
The 2018 RBRVS Final Rules got published last month, so we can start to pick apart the results and make some predictions. It's not all set in stone, but I can start with the geographic comparisons today and then move into what I think the global impact of the RVU updates will be for independent pediatric practices. I assume the AAP will have something interesting to say, as soon as they finish moving.
Every year, I do an analysis of the GPCI values - I think this is the most overlooked aspect of the RVU changes from year to year. Here's 2017, 2014, 2012 if you want to have some fun. As you will see, some localities have had massive swings in RVU value over the last decade, you really need to look at them over time. You also may recall that last year introduced a giant update with the inclusion of almost three dozen new CA-based locations, so the comparison is a little easier this year now that they are in place.
Methodology
I start by looking at the procedures that make up 95% of all ambulatory pediatric revenue - it's about 100 or so. I then remove all of the non-RVU procedures (labs, imms, etc.). This leaves me with the highest volume and revenue RVU-based procedures performed by pediatricians - I can then look at their relative volume and determine two things: first, I can see what the expected impact will be on RVUs for all pediatricians (that's coming shortly); second, I can determine a rough "weighting" of the Work/PE/MP expenses for pediatricians in order to estimate the impact of the GPCI scores. In my calculations, in 2017 the Work expense makes up ~43% of pediatric RVU values, Practice Expense is 54%, and Malpractice 3% - of course, this varies by practice, but not much in my experience. I can then apply those weights to the GPCI scores and get the results below.
The thing to keep in mind here is that whatever changes get made to the individual CPT codes in 2018, these values are on top of that. If you're in Mississippi your RVUs will drop by 2.1% in 2018 whether you like it or not. Idaho? -2% Practices in Puerto Rico get a 9.8% boost!
| Estimated Pediatric Weighting |
2017-2018 Difference |
||
| Locality name | 2017 | 2018 | |
| Alabama | 0.927 | 0.917 | -1.1% |
| Alaska | 1.271 | 1.273 | 0.2% |
| Arizona | 0.988 | 0.971 | -1.8% |
| Arkansas | 0.918 | 0.907 | -1.2% |
| BAKERSFIELD, CA | 1.041 | 1.036 | -0.5% |
| CHICO, CA | 1.041 | 1.035 | -0.6% |
| EL CENTRO, CA | 1.041 | 1.035 | -0.5% |
| FRESNO, CA | 1.041 | 1.035 | -0.6% |
| HANFORD-CORCORAN, CA | 1.041 | 1.035 | -0.6% |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY), CA | 1.104 | 1.105 | 0.1% |
| LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY), CA | 1.116 | 1.105 | -1.0% |
| MADERA, CA | 1.041 | 1.035 | -0.6% |
| MERCED, CA | 1.041 | 1.035 | -0.6% |
| MODESTO, CA | 1.041 | 1.035 | -0.6% |
| NAPA, CA | 1.153 | 1.144 | -0.8% |
| OXNARD-THOUSAND OAKS-VENTURA, CA | 1.099 | 1.094 | -0.4% |
| REDDING, CA | 1.041 | 1.035 | -0.6% |
| RIVERSIDE-SAN BERNARDINO-ONTARIO, CA | 1.041 | 1.039 | -0.2% |
| SACRAMENTO--ROSEVILLE--ARDEN-ARCADE, CA | 1.041 | 1.043 | 0.2% |
| SALINAS, CA | 1.043 | 1.046 | 0.3% |
| SAN DIEGO-CARLSBAD, CA | 1.046 | 1.051 | 0.5% |
| SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY), CA | 1.168 | 1.188 | 1.7% |
| SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY), CA | 1.153 | 1.159 | 0.5% |
| SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY), CA | 1.206 | 1.188 | -1.5% |
| SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY), CA | 1.201 | 1.188 | -1.1% |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY), CA | 1.066 | 1.093 | 2.6% |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA | 1.206 | 1.206 | 0.0% |
| SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA | 1.041 | 1.038 | -0.3% |
| SANTA CRUZ-WATSONVILLE, CA | 1.053 | 1.068 | 1.4% |
| SANTA MARIA-SANTA BARBARA, CA | 1.047 | 1.056 | 0.9% |
| SANTA ROSA, CA | 1.048 | 1.056 | 0.7% |
| STOCKTON-LODI, CA | 1.041 | 1.035 | -0.6% |
| VALLEJO-FAIRFIELD, CA | 1.153 | 1.144 | -0.8% |
| VISALIA-PORTERVILLE, CA | 1.041 | 1.035 | -0.6% |
| YUBA CITY, CA | 1.041 | 1.035 | -0.6% |
| REST OF CALIFORNIA, CA | 1.041 | 1.035 | -0.6% |
| Colorado | 1.010 | 1.009 | -0.1% |
| Connecticut | 1.079 | 1.076 | -0.3% |
| DC + MD/VA Suburbs | 1.138 | 1.136 | -0.1% |
| Delaware | 1.021 | 1.017 | -0.4% |
| Fort Lauderdale, FL | 1.034 | 1.023 | -1.1% |
| Miami, FL | 1.062 | 1.058 | -0.4% |
| Rest of Florida | 0.987 | 0.974 | -1.3% |
| Atlanta, GA | 1.001 | 1.000 | -0.1% |
| Rest of Georgia | 0.946 | 0.940 | -0.7% |
| Hawaii/Guam | 1.071 | 1.066 | -0.4% |
| Idaho | 0.935 | 0.917 | -2.0% |
| Chicago, IL | 1.054 | 1.049 | -0.4% |
| East St. Louis, IL | 0.991 | 0.983 | -0.8% |
| Suburban Chicago, IL | 1.052 | 1.049 | -0.3% |
| Rest of Illinois | 0.961 | 0.955 | -0.6% |
| Indiana | 0.943 | 0.925 | -1.9% |
| Iowa | 0.932 | 0.920 | -1.3% |
| Kansas | 0.940 | 0.926 | -1.4% |
| Kentucky | 0.928 | 0.920 | -1.0% |
| New Orleans, LA | 0.997 | 0.984 | -1.2% |
| Rest of Louisiana | 0.946 | 0.936 | -1.1% |
| Southern Maine | 0.993 | 0.985 | -0.8% |
| Rest of Maine | 0.947 | 0.936 | -1.2% |
| Baltimore/Surr. Cntys, MD | 1.068 | 1.069 | 0.1% |
| Rest of Maryland | 1.025 | 1.024 | -0.1% |
| Metropolitan Boston | 1.097 | 1.111 | 1.3% |
| Rest of Massachusetts | 1.039 | 1.046 | 0.7% |
| Detroit, MI | 1.011 | 1.015 | 0.4% |
| Rest of Michigan | 0.957 | 0.948 | -1.0% |
| Minnesota | 0.989 | 0.986 | -0.3% |
| Mississippi | 0.914 | 0.895 | -2.1% |
| Metropolitan Kansas City, MO | 0.979 | 0.976 | -0.4% |
| Metropolitan St Louis, MO | 0.978 | 0.973 | -0.5% |
| Rest of Missouri | 0.923 | 0.910 | -1.4% |
| Montana | 1.013 | 1.004 | -0.9% |
| Nebraska | 0.932 | 0.919 | -1.4% |
| Nevada | 1.018 | 1.007 | -1.1% |
| New Hampshire | 1.026 | 1.021 | -0.5% |
| Northern NJ | 1.114 | 1.112 | -0.3% |
| Rest of New Jersey | 1.077 | 1.074 | -0.3% |
| New Mexico | 0.964 | 0.958 | -0.6% |
| Manhattan, NY | 1.136 | 1.137 | 0.1% |
| NYC Suburbs/Long I., NY | 1.165 | 1.161 | -0.3% |
| Poughkpsie/N NYC Suburbs, NY | 1.056 | 1.054 | -0.2% |
| Queens, NY | 1.163 | 1.163 | -0.1% |
| Rest of New York | 0.963 | 0.956 | -0.7% |
| North Carolina | 0.955 | 0.943 | -1.3% |
| North Dakota | 0.986 | 0.977 | -1.0% |
| Ohio | 0.957 | 0.952 | -0.5% |
| Oklahoma | 0.934 | 0.924 | -1.2% |
| Portland, OR | 1.023 | 1.027 | 0.3% |
| Rest of Oregon | 0.975 | 0.972 | -0.3% |
| Metropolitan Philadelphia, PA | 1.062 | 1.060 | -0.2% |
| Rest of Pennsylvania | 0.965 | 0.963 | -0.2% |
| Puerto Rico | 0.913 | 1.003 | 9.8% |
| Rhode Island | 1.035 | 1.038 | 0.3% |
| South Carolina | 0.942 | 0.930 | -1.3% |
| South Dakota | 0.982 | 0.965 | -1.8% |
| Tennessee | 0.933 | 0.923 | -1.1% |
| Austin, TX | 1.003 | 1.001 | -0.2% |
| Beaumont, TX | 0.951 | 0.948 | -0.3% |
| Brazoria, TX | 1.003 | 1.002 | 0.0% |
| Dallas, TX | 1.006 | 1.006 | 0.0% |
| Fort Worth, TX | 0.991 | 0.988 | -0.3% |
| Galveston, TX | 1.012 | 1.010 | -0.2% |
| Houston, TX | 1.012 | 1.013 | 0.1% |
| Rest of Texas | 0.957 | 0.957 | 0.0% |
| Utah | 0.965 | 0.957 | -0.8% |
| Vermont | 0.994 | 0.987 | -0.8% |
| Virginia | 0.988 | 0.986 | -0.2% |
| Virgin Islands | 1.003 | 1.003 | 0.0% |
| Seattle (King Cnty), WA | 1.083 | 1.087 | 0.4% |
| Rest of Washington | 0.998 | 1.002 | 0.4% |
| West Virginia | 0.928 | 0.918 | -1.0% |
| Wisconsin | 0.960 | 0.950 | -1.1% |
| Wyoming | 1.002 | 0.989 | -1.3% |
There's an important consideration with these values - because the overhead in a pediatric practice doesn't change with these new values, but the revenue will, the effects here are multiplied. Using a typical pediatric practice with a 65% overhead, you can essentially triple the value in the "Difference" column to estimate the impact on your personal income. Practice in Nevada? That -1.1% comes right out of your owner income, so that's a ~3.3% hit to your W2/K1. 1.1% of $600,000 of revenue is worth almost $7,000 to your personal income. Good luck with that.