Every year, I do an analysis of the RBRVS GPCI values - I think this is the most overlooked aspect of the RVU changes from year to year.
What are the GPCI values? They are the Geographic Practice Cost Indices used by the Feds and private payors to adjust the payments or valuation of CPT codes based on where you work - Long Island is a more expensive locale in which to practice than Alabama, apparently, and insurance payments reflect that fact.
Here are reports from last year, 2018, 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. Hence, my work.
Methodology
I started by looking at the procedures that make up 99% of all ambulatory pediatric revenue and have RVU values - it's about 150 or so. I 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 2019 the Work expense makes up ~46% of pediatric RVU values, Practice Expense is ~50.5%, and Malpractice ~3.5% - 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 2020, these values are in addition. If you're in Montana your RVUs will drop by 2.3% in 2020 whether you like it or not. Arkansas? -2.1% Practices in San Benito County in CA 6.8% boost!
The other thing I did this year is use the pediatric procedure frequency data to calculate the estimated relative value of each location. Yes, a 99213 in Queens, NY gets valued at 118% of Medicare while Mississippi is valued at 90%. Those gaps are HUGE.
Dig in, look up your state. How do you fare? Do your relative RVUs go up or down?
| 2019 | 2020 | 2018-2019 Weighted Difference |
Estimated Relative Value |
||||||
| Locality | Work | PE | MP | Work | PE | MP | |||
| ALABAMA | 0.98 | 0.89 | 0.71 | 1.00 | 0.89 | 0.49 | 0.01% | 92.7% | |
| ALASKA | 1.50 | 1.12 | 0.66 | 1.50 | 1.12 | 0.71 | -0.11% | 127.8% | |
| ARIZONA | 0.99 | 0.96 | 0.85 | 1.00 | 0.97 | 0.83 | -0.90% | 97.1% | |
| ARKANSAS | 0.98 | 0.86 | 0.52 | 1.00 | 0.87 | 0.58 | -2.09% | 90.1% | |
| CA, BAKERSFIELD | 1.03 | 1.08 | 0.67 | 1.02 | 1.07 | 0.60 | 1.33% | 104.6% | |
| CA, CHICO | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, EL CENTRO | 1.03 | 1.08 | 0.60 | 1.02 | 1.07 | 0.57 | 0.92% | 104.0% | |
| CA, FRESNO | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, HANFORD-CORCORAN | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, LA-LONG BEACH-ANAHEIM (LOS ANGELES CNTY) | 1.05 | 1.18 | 0.73 | 1.05 | 1.18 | 0.69 | 0.09% | 110.0% | |
| CA, LA-LONG BEACH-ANAHEIM (ORANGE CNTY), CA | 1.05 | 1.18 | 0.73 | 1.05 | 1.18 | 0.69 | 0.09% | 110.0% | |
| CA, MADERA | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, MERCED | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, MODESTO | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, NAPA | 1.06 | 1.28 | 0.49 | 1.06 | 1.26 | 0.46 | 1.71% | 115.4% | |
| CA, OXNARD-THOUSAND OAKS-VENTURA | 1.03 | 1.18 | 0.70 | 1.02 | 1.18 | 0.67 | 0.23% | 109.0% | |
| CA, REDDING | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, RIVERSIDE-SAN BERNARDINO-ONTARIO | 1.03 | 1.08 | 0.83 | 1.02 | 1.07 | 0.69 | 1.27% | 104.8% | |
| CA, SACRAMENTO—ROSEVILLE--ARDEN-ARCADE | 1.03 | 1.08 | 0.57 | 1.03 | 1.09 | 0.56 | 0.34% | 104.3% | |
| CA, SALINAS | 1.05 | 1.12 | 0.57 | 1.02 | 1.09 | 0.56 | 2.47% | 106.7% | |
| CA, SAN DIEGO-CARLSBAD | 1.03 | 1.13 | 0.60 | 1.02 | 1.10 | 0.57 | 2.21% | 106.9% | |
| CA, SF-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY) | 1.08 | 1.33 | 0.44 | 1.08 | 1.33 | 0.42 | 0.17% | 117.9% | |
| CA, SF-OAKLAND-HAYWARD (MARIN CNTY) | 1.07 | 1.31 | 0.46 | 1.06 | 1.28 | 0.46 | 1.95% | 117.2% | |
| CA, SF-OAKLAND-HAYWARD (SAN FRANCISCO CNTY) | 1.08 | 1.33 | 0.44 | 1.08 | 1.33 | 0.42 | 0.17% | 117.9% | |
| CA, SF-OAKLAND-HAYWARD (SAN MATEO CNTY) | 1.08 | 1.33 | 0.44 | 1.08 | 1.33 | 0.42 | 0.17% | 117.9% | |
| CA, SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) | 1.07 | 1.28 | 0.57 | 1.04 | 1.17 | 0.56 | 6.76% | 116.1% | |
| CA, SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA | 1.09 | 1.37 | 0.40 | 1.08 | 1.35 | 0.39 | 0.90% | 120.5% | |
| CA, SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA | 1.03 | 1.09 | 0.57 | 1.02 | 1.08 | 0.56 | 0.70% | 104.1% | |
| CA, SANTA CRUZ-WATSONVILLE | 1.04 | 1.16 | 0.57 | 1.03 | 1.13 | 0.56 | 2.13% | 108.5% | |
| CA, SANTA MARIA-SANTA BARBARA | 1.04 | 1.14 | 0.57 | 1.03 | 1.11 | 0.56 | 2.14% | 107.4% | |
| CA, SANTA ROSA | 1.04 | 1.15 | 0.57 | 1.02 | 1.11 | 0.56 | 2.40% | 107.6% | |
| CA, STOCKTON-LODI | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, VALLEJO-FAIRFIELD | 1.06 | 1.28 | 0.49 | 1.06 | 1.26 | 0.46 | 1.71% | 115.4% | |
| CA, VISALIA-PORTERVILLE | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, YUBA CITY | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| CA, REST OF CALIFORNIA, CA | 1.03 | 1.08 | 0.57 | 1.02 | 1.07 | 0.56 | 0.82% | 103.9% | |
| COLORADO | 1.00 | 1.03 | 0.90 | 1.00 | 1.02 | 1.04 | 0.25% | 101.3% | |
| CONNECTICUT | 1.03 | 1.11 | 1.09 | 1.02 | 1.11 | 1.26 | -0.16% | 107.3% | |
| DC + MD/VA SUBURBS | 1.05 | 1.22 | 1.28 | 1.05 | 1.21 | 1.26 | 0.92% | 114.4% | |
| DELAWARE | 1.01 | 1.02 | 1.02 | 1.01 | 1.02 | 1.12 | -0.31% | 101.4% | |
| FL, FORT LAUDERDALE | 0.99 | 1.01 | 1.83 | 1.00 | 1.01 | 1.80 | -0.63% | 102.8% | |
| FL, MIAMI | 0.99 | 1.03 | 2.60 | 1.00 | 1.03 | 2.57 | -0.37% | 106.7% | |
| FL, REST OF FLORIDA | 0.98 | 0.95 | 1.40 | 1.00 | 0.95 | 1.36 | -0.89% | 98.0% | |
| GA, ATLANTA | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.09 | -0.30% | 99.9% | |
| GA, REST OF GEORGIA | 0.99 | 0.89 | 0.99 | 1.00 | 0.90 | 1.07 | -1.47% | 93.8% | |
| HAWAII, GUAM | 1.01 | 1.14 | 0.64 | 1.00 | 1.15 | 0.61 | 0.24% | 106.2% | |
| IDAHO | 0.98 | 0.89 | 0.46 | 1.00 | 0.90 | 0.51 | -1.99% | 91.5% | |
| IL, CHICAGO | 1.01 | 1.04 | 1.90 | 1.01 | 1.03 | 1.93 | 0.20% | 105.6% | |
| IL, EAST ST. LOUIS | 0.99 | 0.94 | 1.72 | 1.00 | 0.94 | 1.79 | -0.39% | 99.2% | |
| IL, SUBURBAN CHICAGO | 1.01 | 1.06 | 1.53 | 1.01 | 1.05 | 1.57 | 0.04% | 105.2% | |
| IL, REST OF ILLINOIS | 0.99 | 0.92 | 1.20 | 1.00 | 0.92 | 1.21 | -0.82% | 95.9% | |
| INDIANA | 0.98 | 0.91 | 0.42 | 1.00 | 0.92 | 0.38 | -1.23% | 92.5% | |
| IOWA | 0.98 | 0.91 | 0.42 | 1.00 | 0.91 | 0.42 | -0.77% | 92.5% | |
| KANSAS | 0.98 | 0.91 | 0.54 | 1.00 | 0.91 | 0.62 | -1.27% | 92.9% | |
| KENTUCKY | 0.98 | 0.87 | 0.82 | 1.00 | 0.88 | 0.82 | -1.04% | 92.3% | |
| LA, NEW ORLEANS | 0.99 | 0.95 | 1.40 | 1.00 | 0.97 | 1.27 | -1.05% | 98.2% | |
| LA, REST OF LOUISIANA | 0.98 | 0.88 | 1.25 | 1.00 | 0.89 | 1.20 | -1.11% | 94.0% | |
| ME, SOUTHERN MAINE | 1.00 | 1.00 | 0.66 | 1.00 | 1.01 | 0.67 | -0.50% | 98.7% | |
| ME, REST OF MAINE | 0.98 | 0.91 | 0.66 | 1.00 | 0.92 | 0.67 | -1.57% | 93.4% | |
| MD, BALTIMORE/SURR. CNTYS | 1.03 | 1.10 | 1.30 | 1.02 | 1.10 | 1.30 | 0.16% | 107.1% | |
| MD, REST OF MARYLAND | 1.01 | 1.04 | 1.08 | 1.01 | 1.03 | 1.08 | 0.13% | 102.5% | |
| MA, METROPOLITAN BOSTON | 1.04 | 1.19 | 0.95 | 1.03 | 1.18 | 1.06 | 0.52% | 111.3% | |
| MA, REST OF MASSACHUSETTS | 1.02 | 1.06 | 0.95 | 1.02 | 1.07 | 1.06 | -0.40% | 104.1% | |
| MI, DETROIT | 0.99 | 0.99 | 1.66 | 1.00 | 0.99 | 1.69 | -0.16% | 101.8% | |
| MI, REST OF MICHIGAN | 0.99 | 0.92 | 1.00 | 1.00 | 0.92 | 1.02 | -0.97% | 95.1% | |
| MINNESOTA | 1.00 | 1.01 | 0.36 | 1.00 | 1.01 | 0.36 | 0.01% | 98.3% | |
| MISSISSIPPI | 0.98 | 0.86 | 0.52 | 1.00 | 0.87 | 0.37 | -1.29% | 90.0% | |
| MO, METROPOLITAN KANSAS CITY | 0.99 | 0.96 | 0.98 | 1.00 | 0.96 | 1.07 | -0.97% | 97.4% | |
| MO, METROPOLITAN ST. LOUIS | 0.99 | 0.97 | 0.97 | 1.00 | 0.96 | 1.05 | -0.14% | 98.0% | |
| MO, REST OF MISSOURI | 0.98 | 0.86 | 0.91 | 1.00 | 0.86 | 0.99 | -1.75% | 91.5% | |
| MONTANA | 0.97 | 1.00 | 1.30 | 1.00 | 1.00 | 1.63 | -2.29% | 99.9% | |
| NEBRASKA | 0.99 | 0.91 | 0.28 | 1.00 | 0.91 | 0.32 | -0.93% | 92.2% | |
| NEVADA | 1.00 | 1.00 | 1.13 | 1.00 | 1.02 | 0.91 | 0.02% | 100.6% | |
| NEW HAMPSHIRE | 1.00 | 1.04 | 0.98 | 1.00 | 1.05 | 1.05 | -0.44% | 102.0% | |
| NJ, NORTHERN NJ | 1.05 | 1.19 | 0.95 | 1.04 | 1.18 | 0.94 | 0.64% | 111.4% | |
| NJ, REST OF NEW JERSEY | 1.03 | 1.13 | 0.95 | 1.02 | 1.12 | 0.94 | 0.72% | 107.8% | |
| NEW MEXICO | 0.99 | 0.91 | 1.21 | 1.00 | 0.92 | 1.25 | -1.29% | 95.7% | |
| NY, MANHATTAN | 1.05 | 1.19 | 1.82 | 1.05 | 1.18 | 1.62 | 1.25% | 115.1% | |
| NY, NYC SUBURBS/LONG ISLAND | 1.04 | 1.21 | 2.43 | 1.04 | 1.21 | 2.15 | 1.34% | 117.9% | |
| NY, POUGHKPSIE/N NYC SUBURBS | 1.02 | 1.09 | 1.48 | 1.02 | 1.07 | 1.31 | 1.64% | 107.1% | |
| NY, QUEENS | 1.05 | 1.21 | 2.39 | 1.05 | 1.20 | 2.12 | 1.52% | 118.3% | |
| NY, REST OF NEW YORK | 1.00 | 0.95 | 0.67 | 1.00 | 0.95 | 0.60 | 0.19% | 96.2% | |
| NORTH CAROLINA | 0.99 | 0.93 | 0.76 | 1.00 | 0.93 | 0.70 | -0.39% | 95.1% | |
| NORTH DAKOTA | 0.98 | 1.00 | 0.49 | 1.00 | 1.00 | 0.54 | -0.91% | 97.5% | |
| OHIO | 0.99 | 0.91 | 1.05 | 1.00 | 0.92 | 1.01 | -0.34% | 95.5% | |
| OKLAHOMA | 0.98 | 0.89 | 0.87 | 1.00 | 0.89 | 0.95 | -1.60% | 92.8% | |
| OR, PORTLAND | 1.02 | 1.06 | 0.66 | 1.01 | 1.05 | 0.78 | 0.06% | 102.5% | |
| OR, REST OF OREGON | 0.99 | 0.96 | 0.66 | 1.00 | 0.97 | 0.78 | -1.33% | 96.3% | |
| PA, METROPOLITAN PHILADELPHIA | 1.02 | 1.08 | 1.29 | 1.02 | 1.07 | 1.38 | -0.09% | 106.0% | |
| PA, REST OF PENNSYLVANIA | 0.99 | 0.94 | 0.96 | 1.00 | 0.94 | 1.03 | -0.53% | 96.4% | |
| PUERTO RICO | 1.00 | 1.01 | 0.99 | 1.00 | 1.01 | 0.99 | -0.03% | 100.3% | |
| RHODE ISLAND | 1.02 | 1.05 | 0.99 | 1.03 | 1.05 | 1.00 | -0.22% | 103.5% | |
| SOUTH CAROLINA | 0.99 | 0.91 | 0.62 | 1.00 | 0.91 | 0.55 | -0.70% | 93.3% | |
| SOUTH DAKOTA | 0.98 | 1.00 | 0.37 | 1.00 | 1.00 | 0.39 | -1.24% | 96.6% | |
| TENNESSEE | 0.99 | 0.90 | 0.51 | 1.00 | 0.90 | 0.53 | -0.99% | 92.4% | |
| TX, AUSTIN | 1.00 | 1.04 | 0.64 | 1.00 | 1.02 | 0.75 | 0.60% | 100.7% | |
| TX, BEAUMONT | 0.99 | 0.93 | 0.69 | 1.00 | 0.92 | 0.84 | -0.30% | 95.3% | |
| TX, BRAZORIA | 1.03 | 1.01 | 0.69 | 1.02 | 1.00 | 0.84 | 0.40% | 100.6% | |
| TX, DALLAS | 1.02 | 1.02 | 0.66 | 1.01 | 1.01 | 0.77 | 0.16% | 100.6% | |
| TX, FORT WORTH | 1.01 | 0.99 | 0.64 | 1.01 | 0.99 | 0.75 | 0.05% | 98.8% | |
| TX, GALVESTON | 1.03 | 1.02 | 0.69 | 1.02 | 1.01 | 0.84 | 0.13% | 101.0% | |
| TX, HOUSTON | 1.03 | 1.02 | 0.92 | 1.02 | 1.01 | 0.94 | 0.62% | 101.9% | |
| TX, REST OF TEXAS | 1.00 | 0.95 | 0.69 | 1.00 | 0.94 | 0.80 | -0.15% | 96.0% | |
| UTAH | 0.99 | 0.92 | 0.98 | 1.00 | 0.93 | 1.17 | -1.59% | 95.4% | |
| VERMONT | 0.99 | 1.01 | 0.58 | 1.00 | 1.02 | 0.60 | -0.81% | 98.5% | |
| VIRGINIA | 1.00 | 0.99 | 0.90 | 1.00 | 0.99 | 0.91 | 0.19% | 99.2% | |
| VIRGIN ISLANDS | 1.00 | 1.01 | 0.99 | 1.00 | 1.01 | 0.99 | -0.03% | 100.3% | |
| WA SEATTLE (KING CNTY) | 1.03 | 1.17 | 0.85 | 1.03 | 1.15 | 0.93 | 1.05% | 109.5% | |
| WA, REST OF WASHINGTON | 1.00 | 1.01 | 0.82 | 1.00 | 1.01 | 0.90 | -0.23% | 100.0% | |
| WEST VIRGINIA | 0.98 | 0.86 | 1.25 | 1.00 | 0.86 | 1.30 | -1.13% | 92.8% | |
| WISCONSIN | 0.99 | 0.95 | 0.32 | 1.00 | 0.96 | 0.35 | -0.99% | 94.5% | |
| WYOMING | 0.98 | 1.00 | 0.86 | 1.00 | 1.00 | 0.88 | -0.77% | 98.8% | |
If you don't think that the GPCI values are important, consider this: because the overhead in a pediatric practice doesn't change with these new values, but the revenue will, the effects here are multiplied on your personal income.
Let's walk through this. We'll use a typical pediatric practice with a 65% overhead, practicing in Montana (-2.29% in 2020 vs 2019). That -2.29% comes right out of your owner income - the money AFTER your overhead - so that's an 8.3% hit to your W2/K1/take home. A reduction of 2.29% off the top $600,000 of revenue is potentially worth more than $17,000 to your personal income. Good luck with that. If this math doesn't make sense, speak up and we'll do the math out loud.