2018 RBRVS Analysis For Pediatricians

    Last week, I posted my 2018 GPCI analysis - good news to those of you in Massachusetts, bad news for Idaho. Look up your location.

    The next step of my analysis is to take next year's projected RVU values and estimate their true impact on pediatricians. The process is simple, though it takes some work. Every year, I expect someone else to do this work, but it looks like PCC is your only source for this kind of info again - sorry about that! [At least the AAP does their bit.]

    Here's what the process looks like:

    • Grab all of the procedures performed by PCC clients in 2016*, clean them, and sort them both by volume and by revenue volume. That is, I want to be able to examine the procedures that represent at least 95% of pediatric revenue volume - not just the top 20.
    • 95% of pediatric volume puts us out at about 100 codes. I then strip off all the "non-RVU" codes, like imms and labs. We're left with about 37 codes at this point. Any additional codes with RVU values represent less than .1% or .2% of pediatric revenue, so I'm not worried about anything after this.
    • Once I have my magic list - which you'll see below - I then calculate their relative RVU contribution to the whole. For example, by PCC's calculations, the 90460 CPT code (imms admin) represents 21.6% of all "RVU valid" procedures performed by our clients in 2016 but 15.6% of all RVUs performed. You can see this below.
    • I then compare the 2017 values to the 2018 values. For example, the aforementioned 90460 RVU value drops by 19.4% in 2018 - a big deal when you consider how commonly it's used.
    • Using the relative volumes of each procedure as weighting, I then extrapolate: in 2018, all else being equal, pediatricians will generate 2.2% fewer RVUs for the same CPT distribution performed. In other words, if pediatricians do in 2018 what they did in 2017, their RVUs will drop 2.2% (and then add the GPCI!).

    Why is this important?

    Every pediatrician has, in effect, RVU-based contracts. One way or another. So when it's time to renew your fee schedule, using the 2018 RBRVS data will automatically lower your "performance" by 2.2% relative to 2017. If you don't care about fee schedules because you are employed doc...realize that your work RVUs, which are used to measure your productivity, are primarily responsible for this drop, so you are in trouble, too!

    Let's take a look at the data.

    2017 Values 2018 Values
    CPT Description Work
    RVU    		 Non-Fac
    PE RVU    		 MP
    RVU    		 Total
    RVUs    		 Medicare
    Rate    		 Relative
    Volume    		 Relative
    RVUs    		 Total
    RVUs    		 Difference
    69210 Remove impacted ear wax uni 0.61 0.71 0.07 1.39 $49.89 0.2% 0.3% 1.38 -0.7%
    86580 Tb intradermal test 0 0.22 0.01 0.23 $8.25 0.2% 0.0% 0.23 0.0%
    90460 Im admin 1st/only component 0.17 0.54 0.01 0.72 $25.84 21.6% 15.6% 0.58 -19.4%
    90461 Im admin each addl component 0.15 0.2 0.01 0.36 $12.92 13.1% 4.7% 0.36 0.0%
    90471 Immunization admin 0.17 0.54 0.01 0.72 $25.84 2.9% 2.1% 0.58 -19.4%
    90472 Immunization admin each add 0.15 0.2 0.01 0.36 $12.92 1.2% 0.4% 0.36 0.0%
    92551 Pure tone hearing test air 0 0.33 0.01 0.34 $12.20 2.5% 0.8% 0.35 2.9%
    92552 Pure tone audiometry air 0 0.88 0.01 0.89 $31.94 1.2% 1.0% 0.9 1.1%
    92567 Tympanometry 0.2 0.2 0.01 0.41 $14.71 0.2% 0.1% 0.41 0.0%
    92587 Evoked auditory test limited 0.35 0.24 0.02 0.61 $21.89 0.6% 0.4% 0.52 -14.8%
    94640 Airway inhalation treatment 0 0.51 0.01 0.52 $18.66 0.6% 0.3% 0.53 1.9%
    94664 Evaluate pt use of inhaler 0 0.48 0.01 0.49 $17.59 0.2% 0.1% 0.49 0.0%
    94760 Measure blood oxygen level 0 0.08 0.01 0.09 $3.23 1.5% 0.1% 0.08 -11.1%
    95004 Percut allergy skin tests 0.01 0.17 0.01 0.19 $6.82 0.5% 0.1% 0.15 -21.1%
    96110 Developmental screen w/score 0 0.26 0.01 0.27 $9.69 4.0% 1.1% 0.29 7.4%
    96127 Brief emotional/behav assmt 0 0.15 0.01 0.16 $5.74 2.0% 0.3% 0.18 12.5%
    96372 Ther/proph/diag inj sc/im 0.17 0.54 0.01 0.72 $25.84 0.3% 0.2% 0.58 -19.4%
    99173 Visual acuity screen 0 0.08 0.01 0.09 $3.23 3.7% 0.3% 0.09 0.0%
    99203 Office/outpatient visit new 1.42 1.48 0.15 3.05 $109.46 0.4% 1.1% 3.05 0.0%
    99204 Office/outpatient visit new 2.43 1.98 0.22 4.63 $166.16 0.2% 0.7% 4.65 0.4%
    99211 Office/outpatient visit est 0.18 0.38 0.01 0.57 $20.46 0.3% 0.2% 0.61 7.0%
    99212 Office/outpatient visit est 0.48 0.71 0.04 1.23 $44.14 1.2% 1.4% 1.24 0.8%
    99213 Office/outpatient visit est 0.97 1.02 0.07 2.06 $73.93 16.6% 34.3% 2.06 0.0%
    99214 Office/outpatient visit est 1.5 1.43 0.1 3.03 $108.74 7.1% 21.7% 3.04 0.3%
    99215 Office/outpatient visit est 2.11 1.82 0.15 4.08 $146.43 0.5% 1.8% 4.1 0.5%
    99238 Hospital discharge day 1.28 0.69 0.08 2.05 $73.57 0.4% 0.9% 2.07 1.0%
    99381 Init pm e/m new pat infant 1.5 1.52 0.09 3.11 $111.61 0.3% 1.0% 3.13 0.6%
    99382 Init pm e/m new pat 1-4 yrs 1.6 1.56 0.09 3.25 $116.64 0.2% 0.6% 3.27 0.6%
    99383 Prev visit new age 5-11 1.7 1.59 0.1 3.39 $121.66 0.2% 0.8% 3.4 0.3%
    99391 Per pm reeval est pat infant 1.37 1.34 0.08 2.79 $100.13 4.1% 11.5% 2.81 0.7%
    99392 Prev visit est age 1-4 1.5 1.39 0.09 2.98 $106.95 4.4% 13.1% 3 0.7%
    99393 Prev visit est age 5-11 1.5 1.38 0.09 2.97 $106.59 3.7% 11.0% 2.99 0.7%
    99394 Prev visit est age 12-17 1.7 1.46 0.1 3.26 $117.00 2.5% 8.0% 3.28 0.6%
    99395 Prev visit est age 18-39 1.75 1.48 0.1 3.33 $119.51 0.4% 1.3% 3.35 0.6%
    99401 Preventive counseling indiv 0.48 0.51 0.03 1.02 $36.61 0.2% 0.2% 1.07 4.9%
    99460 Init nb em per day hosp 1.92 0.79 0.12 2.83 $101.57 0.4% 1.2% 2.71 -4.2%
    99462 Sbsq nb em per day hosp 0.84 0.37 0.05 1.26 $45.22 0.3% 0.4% 1.18 -6.3%
    G0447 Behavior counsel obesity 15m 0.45 0.25 0.03 0.73 $26.20 0.2% 0.1% 0.73 0.0%

    Look carefully at each CPT code - some doozy changes in there!

    Comments, thoughts?

    * Why 2016? Because 2017 isn't done yet and I haven't gathered that data. 2017 will definitely be more accurate, but I know already the needle isn't going to move much when I push that data in here. The one item I wondered about are the codes that are valid in 2017 but weren't used in 2016 (96160/96161, 96127). Ultimately, it's a mixed bag and their volume is sporadic and small.

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