2018 RBRVS Analysis For Pediatricians

Written by Chip Hart | Dec 13, 2017 4:27:49 AM

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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