2025 RVU Analysis Part 1 - GPCI Comparison
Every year, I dig into the latest RVU release to understand how the changes will affect my clients and other independent pediatric practices. Since 2020, it's been a somewhat muted endeavor because all the payors strenuously avoid using any newer RVU year. Why is that? Remember, the federal and AAP effort to move more money into primary care meant that E&Ms were massively improved and that money came out of specialty codes. All those doctors taking Medicare got a real boost. Pediatricians? Not so much. Or nearly at all, frankly.
I like to be prepared, however. In dribs and drabs, practices are being offered RVU contracts years newer than 2020 and we want to know which year to pick. Is 2021 better than 2022? Is 2025 better than 2024? The answer isn't simple (though anything from 2021-2025 is great, really), and this year makes it a little more challenging. Why? Because for the first year in memory, no one gets a GPCI boost. In fact, many locations will recognize a real reduction (>1%) in RVUs moving from 2024 to 2025.
But don't panic, it's not all bad news. And it requires some sophisticated understanding that I'll walk us through. There is a lot of misunderstanding about how RVUs work and a lot of angst when, to be clear, 2025 is STILL a better year for pediatric RVUs than any time before 2021. Let's start with this year's GPCI analysis.
I know this is a lot of preface, but it's important.
Back to the GPCI adjustments. As I've shared year over year over year, the changes to geographical adjustments to RVUs have a small, but subtle effect to your actual RVU - and payment - results. Yes, we know that living in the Bay Area of CA adjusts your RVUs considerably higher and Mobile Bay in AL actually lowers them. The relative changes from year to year, however, are just as interesting. Living in Queens, NY, gives you a nice RVU boost, but did the people living there realize that their actual adjustment was reduced by more than 2% in 2024?
This year is tricky because there is an annual fight over the "Work GPCI Floor of 1.0." Basically, the Feds make sure the minimum Work-RVU adjustment, by location, is always at neutral. Last year, they originally extended that floor to mid-January but later corrected it for the year. In other years, they haven't corrected it until much later. Right now, the floor hasn't been corrected and I haven't heard what the expectation is. So, I have to do TWO estimates - one with the present values, one if they get fixed.
Back to the story. To estimate what your pediatric GPCI impact will be, I take the unit volume for all the procedures our clients perform and determine what the actual weighting of your work is. I do this because the Practice Expense portion of typical pediatric work is greater than it is for the rest of medicine and using the weightings from the Feds isn't accurate for peds.
That's a long preamble for the conclusion I shared to open. In 2025, even if we include the GPCI Floor of 1.0, every practice in the US will receive an additional -1.32% RVU hit. That's right, even with the lower CF. If the GPCI floor doesn't get restored, the hit is even bigger for some locations. Let's take a look - and I've added the impact on GPCIs from 2020 until now:
| Locality Name | 2025 – With Floor Intact |
2025 – No GPCI Work Floor |
2024 | 2023 | 2020 | 2024-2025 Change |
Change With Floor Intact |
2020-2025 Change |
|
| ALABAMA | 91.9% | 90.9% | 93.2% | 93.0% | 93.4% | -2.4% | -1.3% | -2.6% | |
| ALASKA | 125.7% | 125.7% | 127.4% | 126.9% | 127.8% | -1.4% | -1.4% | -1.6% | |
| ARIZONA | 98.2% | 97.4% | 99.6% | 97.6% | 97.5% | -2.2% | -1.4% | -0.1% | |
| ARKANSAS | 91.3% | 89.2% | 92.5% | 90.9% | 91.2% | -3.6% | -1.3% | -2.2% | |
| BAKERSFIELD | 104.4% | 104.4% | 105.8% | 104.2% | 103.8% | -1.3% | -1.3% | 0.6% | |
| CHICO | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| EL CENTRO | 104.0% | 104.0% | 105.4% | 103.5% | 103.2% | -1.3% | -1.3% | 0.7% | |
| FRESNO | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| HANFORD-CORCORAN | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | 110.8% | 110.8% | 112.3% | 110.4% | 110.0% | -1.3% | -1.3% | 0.7% | |
| MADERA | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| MERCED | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| MODESTO | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| NAPA | 116.9% | 116.9% | 118.4% | 114.0% | 112.4% | -1.3% | -1.3% | 4.0% | |
| OXNARD-THOUSAND OAKS-VENTURA | 109.4% | 109.4% | 110.8% | 109.3% | 109.1% | -1.3% | -1.3% | 0.3% | |
| REDDING | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| RIVERSIDE-SAN BERNARDINO-ONTARIO | 105.0% | 105.0% | 106.5% | 104.7% | 104.0% | -1.4% | -1.4% | 1.0% | |
| SACRAMENTO-ROSEVILLE-FOLSOM | 108.1% | 108.1% | 109.5% | 106.2% | 103.9% | -1.3% | -1.3% | 4.0% | |
| SALINAS | 108.6% | 108.6% | 110.0% | 108.4% | 106.5% | -1.3% | -1.3% | 2.0% | |
| SAN DIEGO-CHULA VISTA-CARLSBAD | 109.6% | 109.6% | 111.1% | 108.9% | 106.6% | -1.3% | -1.3% | 2.8% | |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) | 123.5% | 123.5% | 125.2% | 120.7% | 117.9% | -1.3% | -1.3% | 4.8% | |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | 123.6% | 123.6% | 125.3% | 120.8% | 116.3% | -1.3% | -1.3% | 6.3% | |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) | 125.3% | 125.3% | 127.0% | 123.6% | 115.8% | -1.3% | -1.3% | 8.2% | |
| SAN LUIS OBISPO-PASO ROBLES | 105.9% | 105.9% | 107.4% | 105.1% | 103.8% | -1.3% | -1.3% | 2.1% | |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | 124.8% | 124.8% | 126.5% | 123.1% | -1.3% | -1.3% | |||
| SANTA CRUZ-WATSONVILLE | 110.0% | 110.0% | 111.5% | 110.4% | 108.3% | -1.3% | -1.3% | 1.6% | |
| SANTA MARIA-SANTA BARBARA | 108.5% | 108.5% | 109.9% | 108.8% | 107.1% | -1.3% | -1.3% | 1.2% | |
| SANTA ROSA-PETALUMA | 111.6% | 111.6% | 113.1% | 110.5% | 107.4% | -1.3% | -1.3% | 3.9% | |
| STOCKTON | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| VALLEJO | 116.7% | 116.7% | 118.3% | 113.9% | 112.4% | -1.3% | -1.3% | 3.8% | |
| VISALIA | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| YUBA CITY | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| REST OF CALIFORNIA | 103.9% | 103.9% | 105.3% | 103.5% | 103.1% | -1.3% | -1.3% | 0.8% | |
| COLORADO | 102.5% | 102.5% | 103.9% | 102.0% | 101.3% | -1.3% | -1.3% | 1.2% | |
| CONNECTICUT | 106.3% | 106.3% | 107.8% | 106.7% | 107.4% | -1.4% | -1.4% | -1.0% | |
| DC + MD/VA SUBURBS | 112.9% | 112.9% | 114.5% | 114.1% | 114.4% | -1.4% | -1.4% | -1.2% | |
| DELAWARE | 99.8% | 99.8% | 101.2% | 100.5% | 101.4% | -1.4% | -1.4% | -1.6% | |
| FORT LAUDERDALE | 102.4% | 101.5% | 103.9% | 102.7% | 103.3% | -2.3% | -1.4% | -1.8% | |
| MIAMI | 106.3% | 105.6% | 107.8% | 106.6% | 107.1% | -2.1% | -1.4% | -1.4% | |
| REST OF FLORIDA | 98.5% | 97.1% | 99.9% | 98.5% | 98.7% | -2.8% | -1.4% | -1.7% | |
| ATLANTA | 100.3% | 100.1% | 101.7% | 100.0% | 99.9% | -1.5% | -1.4% | 0.2% | |
| REST OF GEORGIA | 94.5% | 93.0% | 95.8% | 94.1% | 94.4% | -2.9% | -1.4% | -1.5% | |
| HAWAII, GUAM | 106.1% | 106.0% | 107.6% | 106.2% | 106.2% | -1.5% | -1.3% | -0.3% | |
| IDAHO | 93.5% | 91.6% | 94.8% | 92.7% | 92.5% | -3.4% | -1.3% | -1.0% | |
| CHICAGO | 104.8% | 104.8% | 106.3% | 105.3% | 105.6% | -1.4% | -1.4% | -0.7% | |
| EAST ST. LOUIS | 98.4% | 97.5% | 99.8% | 99.0% | 99.5% | -2.3% | -1.4% | -2.1% | |
| SUBURBAN CHICAGO | 104.6% | 104.6% | 106.1% | 104.9% | 105.2% | -1.4% | -1.4% | -0.5% | |
| REST OF ILLINOIS | 96.8% | 95.5% | 98.1% | 96.6% | 96.5% | -2.7% | -1.4% | -1.0% | |
| INDIANA | 94.3% | 93.1% | 95.6% | 93.7% | 93.4% | -2.6% | -1.3% | -0.3% | |
| IOWA | 93.8% | 92.3% | 95.1% | 93.6% | 93.3% | -2.9% | -1.3% | -1.0% | |
| KANSAS | 93.7% | 92.1% | 95.0% | 93.6% | 93.8% | -3.0% | -1.3% | -1.8% | |
| KENTUCKY | 93.5% | 91.7% | 94.7% | 93.2% | 93.0% | -3.3% | -1.4% | -1.5% | |
| NEW ORLEANS | 97.2% | 96.1% | 98.6% | 97.7% | 98.8% | -2.4% | -1.4% | -2.7% | |
| REST OF LOUISIANA | 93.9% | 92.3% | 95.2% | 94.3% | 94.8% | -3.0% | -1.4% | -2.6% | |
| SOUTHERN MAINE | 99.5% | 98.5% | 100.8% | 99.1% | 98.9% | -2.3% | -1.3% | -0.4% | |
| REST OF MAINE | 94.4% | 92.7% | 95.7% | 94.0% | 94.3% | -3.1% | -1.4% | -1.6% | |
| BALTIMORE/SURR. CNTYS | 105.9% | 105.9% | 107.4% | 106.5% | 107.1% | -1.4% | -1.4% | -1.1% | |
| REST OF MARYLAND | 101.3% | 101.3% | 102.7% | 101.9% | 102.5% | -1.4% | -1.4% | -1.2% | |
| METROPOLITAN BOSTON | 111.6% | 111.6% | 113.1% | 111.7% | 111.3% | -1.3% | -1.3% | 0.3% | |
| REST OF MASSACHUSETTS | 103.2% | 103.2% | 104.6% | 103.5% | 104.1% | -1.3% | -1.3% | -0.9% | |
| DETROIT | 101.8% | 101.8% | 103.2% | 101.9% | 102.0% | -1.4% | -1.4% | -0.2% | |
| REST OF MICHIGAN | 96.0% | 94.9% | 97.4% | 95.8% | 95.7% | -2.6% | -1.4% | -0.9% | |
| MINNESOTA | 99.0% | 98.8% | 100.3% | 98.6% | 98.3% | -1.5% | -1.3% | 0.5% | |
| MISSISSIPPI | 91.7% | 89.4% | 93.0% | 91.4% | 91.0% | -3.8% | -1.4% | -1.8% | |
| METROPOLITAN KANSAS CITY | 97.3% | 96.5% | 98.7% | 97.4% | 97.9% | -2.2% | -1.4% | -1.4% | |
| METROPOLITAN ST. LOUIS | 97.5% | 96.7% | 98.9% | 98.0% | 98.3% | -2.2% | -1.4% | -1.6% | |
| REST OF MISSOURI | 92.7% | 90.7% | 94.0% | 92.4% | 92.5% | -3.5% | -1.4% | -1.9% | |
| MONTANA | 99.9% | 98.2% | 101.3% | 99.9% | 101.1% | -3.0% | -1.4% | -2.8% | |
| NEBRASKA | 93.5% | 92.2% | 94.8% | 93.1% | 92.8% | -2.7% | -1.3% | -0.7% | |
| NEVADA | 99.5% | 98.9% | 100.9% | 100.3% | 100.7% | -1.9% | -1.4% | -1.7% | |
| NEW HAMPSHIRE | 101.4% | 101.1% | 102.8% | 101.5% | 102.1% | -1.7% | -1.4% | -1.0% | |
| NORTHERN NJ | 111.8% | 111.8% | 113.3% | 111.9% | 111.4% | -1.4% | -1.4% | 0.3% | |
| REST OF NEW JERSEY | 107.5% | 107.5% | 109.0% | 108.1% | 107.8% | -1.4% | -1.4% | -0.3% | |
| NEW MEXICO | 95.9% | 94.7% | 97.2% | 95.7% | 96.1% | -2.6% | -1.4% | -1.4% | |
| MANHATTAN | 113.6% | 113.6% | 115.2% | 114.9% | 115.1% | -1.4% | -1.4% | -1.3% | |
| NYC SUBURBS/LONG ISLAND | 116.2% | 116.2% | 117.8% | 117.7% | 117.9% | -1.4% | -1.4% | -1.5% | |
| POUGHKPSIE/N NYC SUBURBS | 108.4% | 108.4% | 109.9% | 108.5% | 107.1% | -1.4% | -1.4% | 1.2% | |
| QUEENS | 114.4% | 114.4% | 116.0% | 117.1% | 118.3% | -1.4% | -1.4% | -3.2% | |
| REST OF NEW YORK | 96.5% | 96.1% | 97.8% | 96.7% | 96.4% | -1.8% | -1.4% | -0.3% | |
| NORTH CAROLINA | 95.1% | 94.4% | 96.4% | 95.5% | 95.6% | -2.2% | -1.4% | -1.3% | |
| NORTH DAKOTA | 98.4% | 97.5% | 99.8% | 98.2% | 98.1% | -2.3% | -1.3% | -0.7% | |
| OHIO | 95.6% | 94.8% | 96.9% | 95.8% | 95.9% | -2.2% | -1.4% | -1.2% | |
| OKLAHOMA | 93.8% | 92.2% | 95.1% | 93.6% | 93.8% | -3.0% | -1.4% | -1.7% | |
| PORTLAND | 104.8% | 104.8% | 106.2% | 103.7% | 102.5% | -1.3% | -1.3% | 2.3% | |
| REST OF OREGON | 98.1% | 97.1% | 99.5% | 96.9% | 96.6% | -2.4% | -1.3% | 0.5% | |
| METROPOLITAN PHILADELPHIA | 104.4% | 104.4% | 105.8% | 105.1% | 106.0% | -1.4% | -1.4% | -1.6% | |
| REST OF PENNSYLVANIA | 96.0% | 95.5% | 97.4% | 96.3% | 96.7% | -1.9% | -1.4% | -1.2% | |
| PUERTO RICO | 100.3% | 100.2% | 101.7% | 100.0% | 100.4% | -1.4% | -1.4% | -0.2% | |
| RHODE ISLAND | 102.6% | 102.6% | 104.0% | 103.0% | 103.5% | -1.4% | -1.4% | -0.9% | |
| SOUTH CAROLINA | 95.0% | 93.7% | 96.3% | 94.6% | 94.0% | -2.7% | -1.4% | -0.3% | |
| SOUTH DAKOTA | 98.0% | 96.8% | 99.3% | 97.8% | 97.7% | -2.5% | -1.3% | -1.0% | |
| TENNESSEE | 93.2% | 91.6% | 94.5% | 93.0% | 93.1% | -3.1% | -1.3% | -1.6% | |
| AUSTIN | 102.1% | 102.0% | 103.5% | 101.7% | 100.7% | -1.4% | -1.4% | 1.2% | |
| BEAUMONT | 94.9% | 94.2% | 96.2% | 95.3% | 95.6% | -2.1% | -1.4% | -1.5% | |
| BRAZORIA | 100.3% | 100.3% | 101.6% | 100.6% | 100.6% | -1.4% | -1.4% | -0.3% | |
| DALLAS | 100.5% | 100.5% | 101.8% | 100.7% | 100.6% | -1.4% | -1.4% | -0.1% | |
| FORT WORTH | 100.1% | 100.1% | 101.5% | 99.4% | 98.8% | -1.4% | -1.4% | 1.3% | |
| GALVESTON | 100.2% | 100.2% | 101.5% | 100.7% | 101.1% | -1.4% | -1.4% | -0.9% | |
| HOUSTON | 102.1% | 102.1% | 103.6% | 102.4% | 101.9% | -1.4% | -1.4% | 0.2% | |
| REST OF TEXAS | 97.0% | 96.3% | 98.3% | 96.7% | 96.2% | -2.0% | -1.4% | 0.1% | |
| UTAH | 96.4% | 94.6% | 97.7% | 95.8% | 96.1% | -3.1% | -1.4% | -1.5% | |
| VERMONT | 98.1% | 96.8% | 99.4% | 98.3% | 98.9% | -2.6% | -1.3% | -2.1% | |
| VIRGINIA | 98.5% | 98.5% | 99.8% | 98.9% | 99.2% | -1.4% | -1.4% | -0.7% | |
| VIRGIN ISLANDS | 100.3% | 100.2% | 101.7% | 100.0% | 100.4% | -1.4% | -1.4% | -0.2% | |
| SEATTLE (KING CNTY) | 112.7% | 112.7% | 114.2% | 111.6% | 109.5% | -1.3% | -1.3% | 3.0% | |
| REST OF WASHINGTON | 101.7% | 101.7% | 103.1% | 100.7% | 100.0% | -1.3% | -1.3% | 1.7% | |
| WEST VIRGINIA | 94.1% | 92.3% | 95.4% | 93.9% | 93.7% | -3.3% | -1.4% | -1.5% | |
| WISCONSIN | 95.6% | 94.9% | 96.9% | 95.1% | 95.0% | -2.0% | -1.3% | -0.1% | |
| WYOMING | 99.1% | 98.0% | 100.5% | 99.3% | 99.5% | -2.5% | -1.3% | -1.6% |
I welcome input.
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