Every year, I try to 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 previous years (2021, 2020, 2019, 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.
Important in 2024
Two things:
Methodology
I started by looking at the procedures that make up 99% of all ambulatory pediatric revenue and have RVU values - it's about 65 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; 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 2024 the Work expense makes up ~45.7% of pediatric RVU values, Practice Expense is ~51%, and Malpractice ~3.3%. 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.
Keep in mind whatever changes get made to the individual CPT codes in 2024, or to the Medicare multiplier, etc., these values are on top of all that. If you're in Alabama your RVUs will drop by 1.11% in 2024 whether you like it or not. Napa County, CA? You're up 2.3%. Etc.
Further, I used the same weighted data to judge the overall GPCI weighting. If you live in Tennessee, your GPCI will generally deliver RVUs (and, therefore, $$) that is 93.2% of the "national" value. If you live in Washington, DC or the suburbs, you'll get 113% of flat Medicare. Again, based on normal pediatric CPT distribution.
Dig in, look up your state. How do you fare? Do your relative RVUs go up or down?
It looks like Queens, Long Island, Manhattan, and DC take the biggest hits this year, though they are still well ahead of most of the rest of the country. All of the biggest winners were in CA, OR, and WA. Poor Alabama got zapped as well.
| Locality Name | 2023 | 2024 | Diff |
| ALABAMA | 92.9% | 91.9% | -1.11% |
| ALASKA | 126.6% | 125.6% | -0.79% |
| ARIZONA | 97.6% | 98.2% | 0.62% |
| ARKANSAS | 90.8% | 91.3% | 0.49% |
| CA, BAKERSFIELD | 104.3% | 104.4% | 0.15% |
| CA, CHICO | 103.6% | 103.9% | 0.32% |
| CA, EL CENTRO | 103.7% | 104.0% | 0.30% |
| CA, FRESNO | 103.6% | 103.9% | 0.32% |
| CA, HANFORD-CORCORAN | 103.6% | 103.9% | 0.32% |
| CA, LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | 110.6% | 110.8% | 0.19% |
| CA, MADERA | 103.6% | 103.9% | 0.32% |
| CA, MERCED | 103.6% | 103.9% | 0.32% |
| CA, MODESTO | 103.6% | 103.9% | 0.32% |
| CA, NAPA | 114.2% | 116.9% | 2.31% |
| CA, OXNARD-THOUSAND OAKS-VENTURA | 109.4% | 109.4% | -0.06% |
| CA, REDDING | 103.6% | 103.9% | 0.32% |
| CA, RIVERSIDE-SAN BERNARDINO-ONTARIO | 104.7% | 105.0% | 0.28% |
| CA, SACRAMENTO-ROSEVILLE-FOLSOM | 106.3% | 108.1% | 1.63% |
| CA, SALINAS | 108.5% | 108.6% | 0.06% |
| CA, SAN DIEGO-CHULA VISTA-CARLSBAD | 109.1% | 109.6% | 0.46% |
| CA, SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) | 121.0% | 123.6% | 2.10% |
| CA, SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | 121.1% | 123.6% | 2.07% |
| CA, SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) | 123.9% | 125.3% | 1.09% |
| CA, SAN LUIS OBISPO-PASO ROBLES | 105.2% | 105.9% | 0.65% |
| CA, SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | 123.4% | 124.8% | 1.16% |
| CA, SANTA CRUZ-WATSONVILLE | 110.6% | 110.0% | -0.54% |
| CA, SANTA MARIA-SANTA BARBARA | 109.0% | 108.5% | -0.44% |
| CA, SANTA ROSA-PETALUMA | 110.7% | 111.6% | 0.82% |
| CA, STOCKTON | 103.6% | 103.9% | 0.32% |
| CA, VALLEJO | 114.2% | 116.7% | 2.24% |
| CA, VISALIA | 103.6% | 103.9% | 0.32% |
| CA, YUBA CITY | 103.6% | 103.9% | 0.32% |
| CA, REST OF CALIFORNIA | 103.6% | 103.9% | 0.32% |
| COLORADO | 102.1% | 102.5% | 0.38% |
| CONNECTICUT | 106.8% | 106.3% | -0.44% |
| DC + MD/VA SUBURBS | 114.2% | 113.0% | -1.12% |
| DELAWARE | 100.5% | 99.8% | -0.63% |
| FL, FORT LAUDERDALE | 102.6% | 102.4% | -0.19% |
| FL, MIAMI | 106.4% | 106.3% | -0.10% |
| FL, REST OF FLORIDA | 98.4% | 98.5% | 0.05% |
| GA, ATLANTA | 100.0% | 100.3% | 0.32% |
| GA, REST OF GEORGIA | 94.0% | 94.4% | 0.49% |
| HAWAII, GUAM | 106.3% | 106.2% | -0.16% |
| IDAHO | 92.7% | 93.5% | 0.90% |
| IL, CHICAGO | 105.2% | 104.9% | -0.34% |
| IL, EAST ST. LOUIS | 98.8% | 98.4% | -0.42% |
| IL, SUBURBAN CHICAGO | 104.9% | 104.6% | -0.26% |
| IL, REST OF ILLINOIS | 96.4% | 96.8% | 0.34% |
| INDIANA | 93.7% | 94.3% | 0.63% |
| IOWA | 93.6% | 93.8% | 0.22% |
| KANSAS | 93.6% | 93.7% | 0.09% |
| KENTUCKY | 93.1% | 93.4% | 0.37% |
| LA, NEW ORLEANS | 97.6% | 97.2% | -0.42% |
| LA, REST OF LOUISIANA | 94.2% | 93.9% | -0.30% |
| ME, SOUTHERN MAINE | 99.1% | 99.5% | 0.37% |
| ME, REST OF MAINE | 94.0% | 94.4% | 0.43% |
| MD, BALTIMORE/SURR. CNTYS | 106.6% | 105.9% | -0.61% |
| MD, REST OF MARYLAND | 102.0% | 101.3% | -0.66% |
| MA, METROPOLITAN BOSTON | 111.8% | 111.6% | -0.18% |
| MA, REST OF MASSACHUSETTS | 103.5% | 103.2% | -0.29% |
| MI, DETROIT | 101.8% | 101.8% | -0.01% |
| MI, REST OF MICHIGAN | 95.7% | 96.0% | 0.33% |
| MINNESOTA | 98.7% | 99.0% | 0.22% |
| MISSISSIPPI | 91.3% | 91.7% | 0.45% |
| MO, METROPOLITAN KANSAS CITY | 97.4% | 97.3% | -0.04% |
| MO, METROPOLITAN ST. LOUIS | 98.0% | 97.5% | -0.45% |
| MO, REST OF MISSOURI | 92.3% | 92.7% | 0.48% |
| MONTANA | 99.9% | 99.9% | 0.00% |
| NEBRASKA | 93.2% | 93.5% | 0.34% |
| NEVADA | 100.3% | 99.5% | -0.84% |
| NEW HAMPSHIRE | 101.5% | 101.4% | -0.13% |
| NJ, NORTHERN NJ | 112.0% | 111.8% | -0.20% |
| NJ, REST OF NEW JERSEY | 108.2% | 107.6% | -0.55% |
| NEW MEXICO | 95.6% | 95.9% | 0.33% |
| NY, MANHATTAN | 115.0% | 113.6% | -1.18% |
| NY, NYC SUBURBS/LONG ISLAND | 117.7% | 116.2% | -1.28% |
| NY, POUGHKPSIE/N NYC SUBURBS | 108.5% | 108.4% | -0.11% |
| NY, QUEENS | 117.1% | 114.4% | -2.27% |
| NY, REST OF NEW YORK | 96.7% | 96.5% | -0.19% |
| NORTH CAROLINA | 95.4% | 95.1% | -0.32% |
| NORTH DAKOTA | 98.3% | 98.4% | 0.14% |
| OHIO | 95.7% | 95.6% | -0.16% |
| OKLAHOMA | 93.5% | 93.8% | 0.33% |
| OR, PORTLAND | 103.8% | 104.8% | 1.00% |
| OR, REST OF OREGON | 96.9% | 98.1% | 1.24% |
| PA, METROPOLITAN PHILADELPHIA | 105.1% | 104.4% | -0.72% |
| PA, REST OF PENNSYLVANIA | 96.3% | 96.0% | -0.25% |
| PUERTO RICO | 100.4% | 100.3% | -0.06% |
| RHODE ISLAND | 103.0% | 102.6% | -0.37% |
| SOUTH CAROLINA | 94.5% | 95.0% | 0.48% |
| SOUTH DAKOTA | 97.9% | 98.0% | 0.06% |
| TENNESSEE | 93.0% | 93.2% | 0.20% |
| TX, AUSTIN | 101.8% | 102.1% | 0.26% |
| TX, BEAUMONT | 95.3% | 94.9% | -0.44% |
| TX, BRAZORIA | 100.7% | 100.3% | -0.41% |
| TX, DALLAS | 100.7% | 100.5% | -0.23% |
| TX, FORT WORTH | 99.5% | 100.1% | 0.61% |
| TX, GALVESTON | 100.7% | 100.2% | -0.57% |
| TX, HOUSTON | 102.4% | 102.1% | -0.23% |
| TX, REST OF TEXAS | 96.7% | 97.0% | 0.33% |
| UTAH | 95.8% | 96.4% | 0.60% |
| VERMONT | 98.3% | 98.1% | -0.29% |
| VIRGINIA | 98.9% | 98.5% | -0.45% |
| VI, VIRGIN ISLANDS | 100.4% | 100.3% | -0.06% |
| WA, SEATTLE (KING CNTY) | 111.7% | 112.7% | 0.87% |
| WA, REST OF WASHINGTON | 100.8% | 101.7% | 0.94% |
| WEST VIRGINIA | 93.7% | 94.1% | 0.34% |
| WISCONSIN | 95.2% | 95.6% | 0.43% |
| WYOMING | 99.3% | 99.1% | -0.17% |