Every year, I review the latest RVU release to understand how the changes will affect my clients and other independent pediatric practices - you can see my pediatric comparison here. 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 shift more money into primary care meant that E&Ms were significantly improved and that money came out of specialty codes. All those primary care 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 2026 better than 2024? The answer isn't simple (though anything from 2021-2026is great, really), and this year is no different. But don't panic, it's not 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, 2026 is STILL a better year for pediatric RVUs than any time before 2021. Let's look at this year's GPCI analysis.

I know this is a lot of preface, but it's important. 

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 of the annual fight over the "Work GPCI Floor of 1.0."  Basically, the Feds ensure that the minimum Work-RVU adjustment, by location, is always neutral.  In 2024, for example, 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.  I'm just going to assume it will be corrected for now.

In 2025, however, every state received at least a 1.3% reduction because of the GPCI results.  You can see them here.   Better news this year.

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.

First, let's look at the locations with the biggest swings:

Here's the entire table for the nerds among us!

I welcome input.