Every year, I take apart the newest RBRVS data files from CMS to analyze how the new values will affect physicians, particularly pediatricians.
As far as I know, no one else has really taken to looking specifically at 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 real 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.
| Estimated Pediatric Weighting |
2017-2019 Difference |
2018-2019 Difference |
|||
| Locality name | 2017 | 2018 | 2019 | ||
| Alabama | 0.927 | 0.917 | 0.926 | -0.1% | 1.0% |
| Alaska | 1.271 | 1.273 | 1.273 | 0.2% | 0.0% |
| Arizona | 0.988 | 0.971 | 0.980 | -0.9% | 0.9% |
| Arkansas | 0.918 | 0.907 | 0.919 | 0.2% | 1.4% |
| BAKERSFIELD, CA | 1.041 | 1.036 | 1.036 | -0.5% | 0.0% |
| CHICO, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| EL CENTRO, CA | 1.041 | 1.035 | 1.035 | -0.5% | 0.0% |
| FRESNO, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| HANFORD-CORCORAN, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY), CA | 1.104 | 1.105 | 1.105 | 0.1% | 0.0% |
| LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY), CA | 1.116 | 1.105 | 1.105 | -1.0% | 0.0% |
| MADERA, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| MERCED, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| MODESTO, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| NAPA, CA | 1.153 | 1.144 | 1.144 | -0.8% | 0.0% |
| OXNARD-THOUSAND OAKS-VENTURA, CA | 1.099 | 1.094 | 1.094 | -0.4% | 0.0% |
| REDDING, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| RIVERSIDE-SAN BERNARDINO-ONTARIO, CA | 1.041 | 1.039 | 1.039 | -0.2% | 0.0% |
| SACRAMENTO--ROSEVILLE--ARDEN-ARCADE, CA | 1.041 | 1.043 | 1.043 | 0.2% | 0.0% |
| SALINAS, CA | 1.043 | 1.046 | 1.046 | 0.3% | 0.0% |
| SAN DIEGO-CARLSBAD, CA | 1.046 | 1.051 | 1.051 | 0.5% | 0.0% |
| SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY), CA | 1.168 | 1.188 | 1.188 | 1.7% | 0.0% |
| SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY), CA | 1.153 | 1.159 | 1.159 | 0.5% | 0.0% |
| SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY), CA | 1.206 | 1.188 | 1.188 | -1.5% | 0.0% |
| SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY), CA | 1.201 | 1.188 | 1.188 | -1.1% | 0.0% |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY), CA | 1.066 | 1.093 | 1.093 | 2.6% | 0.0% |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA | 1.206 | 1.206 | 1.206 | 0.0% | 0.0% |
| SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA | 1.041 | 1.038 | 1.038 | -0.3% | 0.0% |
| SANTA CRUZ-WATSONVILLE, CA | 1.053 | 1.068 | 1.068 | 1.4% | 0.0% |
| SANTA MARIA-SANTA BARBARA, CA | 1.047 | 1.056 | 1.056 | 0.9% | 0.0% |
| SANTA ROSA, CA | 1.048 | 1.056 | 1.056 | 0.7% | 0.0% |
| STOCKTON-LODI, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| VALLEJO-FAIRFIELD, CA | 1.153 | 1.144 | 1.144 | -0.8% | 0.0% |
| VISALIA-PORTERVILLE, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| YUBA CITY, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| REST OF CALIFORNIA, CA | 1.041 | 1.035 | 1.035 | -0.6% | 0.0% |
| Colorado | 1.010 | 1.009 | 1.011 | 0.1% | 0.2% |
| Connecticut | 1.079 | 1.076 | 1.076 | -0.3% | 0.0% |
| DC + MD/VA Suburbs | 1.138 | 1.136 | 1.136 | -0.1% | 0.0% |
| Delaware | 1.021 | 1.017 | 1.017 | -0.4% | 0.0% |
| Fort Lauderdale, FL | 1.034 | 1.023 | 1.030 | -0.3% | 0.7% |
| Miami, FL | 1.062 | 1.058 | 1.062 | 0.0% | 0.4% |
| Rest of Florida | 0.987 | 0.974 | 0.985 | -0.2% | 1.1% |
| Atlanta, GA | 1.001 | 1.000 | 1.001 | 0.0% | 0.1% |
| Rest of Georgia | 0.946 | 0.940 | 0.949 | 0.3% | 0.9% |
| Hawaii/Guam | 1.071 | 1.066 | 1.066 | -0.4% | 0.0% |
| Idaho | 0.935 | 0.917 | 0.933 | -0.2% | 1.8% |
| Chicago, IL | 1.054 | 1.049 | 1.049 | -0.4% | 0.0% |
| East St. Louis, IL | 0.991 | 0.983 | 0.990 | -0.1% | 0.7% |
| Suburban Chicago, IL | 1.052 | 1.049 | 1.049 | -0.3% | 0.0% |
| Rest of Illinois | 0.961 | 0.955 | 0.963 | 0.2% | 0.8% |
| Indiana | 0.943 | 0.925 | 0.938 | -0.4% | 1.5% |
| Iowa | 0.932 | 0.920 | 0.933 | 0.2% | 1.5% |
| Kansas | 0.940 | 0.926 | 0.941 | 0.1% | 1.6% |
| Kentucky | 0.928 | 0.920 | 0.931 | 0.3% | 1.2% |
| New Orleans, LA | 0.997 | 0.984 | 0.990 | -0.7% | 0.6% |
| Rest of Louisiana | 0.946 | 0.936 | 0.946 | 0.0% | 1.1% |
| Southern Maine | 0.993 | 0.985 | 0.994 | 0.0% | 0.9% |
| Rest of Maine | 0.947 | 0.936 | 0.949 | 0.2% | 1.4% |
| Baltimore/Surr. Cntys, MD | 1.068 | 1.069 | 1.069 | 0.1% | 0.0% |
| Rest of Maryland | 1.025 | 1.024 | 1.024 | -0.1% | 0.0% |
| Metropolitan Boston | 1.097 | 1.111 | 1.111 | 1.3% | 0.0% |
| Rest of Massachusetts | 1.039 | 1.046 | 1.046 | 0.7% | 0.0% |
| Detroit, MI | 1.011 | 1.015 | 1.015 | 0.4% | 0.0% |
| Rest of Michigan | 0.957 | 0.948 | 0.958 | 0.0% | 1.0% |
| Minnesota | 0.989 | 0.986 | 0.987 | -0.2% | 0.1% |
| Mississippi | 0.914 | 0.895 | 0.912 | -0.2% | 1.9% |
| Metropolitan Kansas City, MO | 0.979 | 0.976 | 0.983 | 0.3% | 0.7% |
| Metropolitan St Louis, MO | 0.978 | 0.973 | 0.980 | 0.2% | 0.7% |
| Rest of Missouri | 0.923 | 0.910 | 0.927 | 0.5% | 1.9% |
| Montana | 1.013 | 1.004 | 1.019 | 0.6% | 1.5% |
| Nebraska | 0.932 | 0.919 | 0.932 | 0.0% | 1.4% |
| Nevada | 1.018 | 1.007 | 1.007 | -1.1% | 0.0% |
| New Hampshire | 1.026 | 1.021 | 1.025 | -0.1% | 0.4% |
| Northern NJ | 1.114 | 1.112 | 1.112 | -0.3% | 0.0% |
| Rest of New Jersey | 1.077 | 1.074 | 1.074 | -0.3% | 0.0% |
| New Mexico | 0.964 | 0.958 | 0.966 | 0.2% | 0.8% |
| Manhattan, NY | 1.136 | 1.137 | 1.137 | 0.1% | 0.0% |
| NYC Suburbs/Long I., NY | 1.165 | 1.161 | 1.161 | -0.3% | 0.0% |
| Poughkpsie/N NYC Suburbs, NY | 1.056 | 1.054 | 1.054 | -0.2% | 0.0% |
| Queens, NY | 1.163 | 1.163 | 1.163 | -0.1% | 0.0% |
| Rest of New York | 0.963 | 0.956 | 0.961 | -0.1% | 0.6% |
| North Carolina | 0.955 | 0.943 | 0.954 | -0.1% | 1.2% |
| North Dakota | 0.986 | 0.977 | 0.986 | 0.0% | 1.0% |
| Ohio | 0.957 | 0.952 | 0.956 | 0.0% | 0.5% |
| Oklahoma | 0.934 | 0.924 | 0.941 | 0.7% | 1.9% |
| Portland, OR | 1.023 | 1.027 | 1.027 | 0.3% | 0.0% |
| Rest of Oregon | 0.975 | 0.972 | 0.976 | 0.1% | 0.4% |
| Metropolitan Philadelphia, PA | 1.062 | 1.060 | 1.060 | -0.2% | 0.0% |
| Rest of Pennsylvania | 0.965 | 0.963 | 0.967 | 0.2% | 0.5% |
| Puerto Rico | 0.913 | 1.003 | 1.003 | 9.9% | 0.1% |
| Rhode Island | 1.035 | 1.038 | 1.038 | 0.3% | 0.0% |
| South Carolina | 0.942 | 0.930 | 0.940 | -0.3% | 1.1% |
| South Dakota | 0.982 | 0.965 | 0.982 | 0.0% | 1.8% |
| Tennessee | 0.933 | 0.923 | 0.933 | 0.1% | 1.1% |
| Austin, TX | 1.003 | 1.001 | 1.004 | 0.0% | 0.3% |
| Beaumont, TX | 0.951 | 0.948 | 0.955 | 0.4% | 0.7% |
| Brazoria, TX | 1.003 | 1.002 | 1.002 | 0.0% | 0.0% |
| Dallas, TX | 1.006 | 1.006 | 1.006 | 0.0% | 0.0% |
| Fort Worth, TX | 0.991 | 0.988 | 0.988 | -0.3% | 0.0% |
| Galveston, TX | 1.012 | 1.010 | 1.010 | -0.2% | 0.0% |
| Houston, TX | 1.012 | 1.013 | 1.013 | 0.1% | 0.0% |
| Rest of Texas | 0.957 | 0.957 | 0.961 | 0.5% | 0.5% |
| Utah | 0.965 | 0.957 | 0.966 | 0.1% | 0.9% |
| Vermont | 0.994 | 0.987 | 0.996 | 0.1% | 0.9% |
| Virginia | 0.988 | 0.986 | 0.990 | 0.2% | 0.4% |
| Virgin Islands | 1.003 | 1.003 | 1.003 | 0.0% | 0.1% |
| Seattle (King Cnty), WA | 1.083 | 1.087 | 1.087 | 0.4% | 0.0% |
| Rest of Washington | 0.998 | 1.002 | 1.003 | 0.5% | 0.1% |
| West Virginia | 0.928 | 0.918 | 0.933 | 0.6% | 1.6% |
| Wisconsin | 0.960 | 0.950 | 0.958 | -0.3% | 0.8% |
| Wyoming | 1.002 | 0.989 | 0.996 | -0.5% | 0.8% |
Interesting Results
Shocking results this year. First...not a single GPCI decreased in 2019. Someone please check my work, but it looks like the Feds chose not to use the GPCI to draw any of the budget down. Last year, literally 1/2 of the localities had their GPCIs lowered, even by just a little. This year: none. Never seen that before.
This year, about 10% of the localities had increases of 1% or more. Roughly speaking, for a pediatrician who generates $600K in revenue in a year, that change will add ~$7K to your personal income. Real money.
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, I used millions of CPT code data points from pediatricians to identify that 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 to estimate what the general impact is on most practices.
The thing to keep in mind here is that whatever changes get made to the individual CPT codes in 2019, these values are on top of that. I'll be back with a more thorough analysis later.