Impact of 2023 RVU Values on Pediatricians

Every year, I analyze the impact of the RVU changes on pediatricians. Why? Because what the Feds do each year has a profound, downstream effect on pediatricians.  Going through this process is also how I figured out what was happening with immunization administration codes in 2018,  and helps me counsel many practices working on fee schedule offers from the payers.

The results going back the last few years have been a mixed bag  for pediatricians, but we have some good news for 2023.  Before we begin, though, it's important to recognize what a watershed moment 2021 was for pediatricians and primary care in general.  The Feds moved so much value into primary care RVUs (namely through massive improvements to E&M valuation that you really can't talk about RVUs broadly without knowing whether you're referring to pre- or post-2021.. 

However, pediatricians have largely been isolated from these improvements - why?  Because pediatricians don't take Medicare and commercial payors know that a move to 2021 RVU values for pediatricians represents a serious payment improvement.  But they can't avoid it forever.

Maybe the interesting news in 2023 will make a difference.  Let's look.

First, a review of my methodology:

• I start by grabbing the full CPT utilization of our customers to determine which RVU-valid codes (i.e., codes with RVU values) have real impact on pediatric revenue. I want to know how these changes will affect a typical pediatrician.  In 2021 (because I can't use 2022, yet), that amounts to just under 250 CPT codes that make up 99%+ of pediatric revenue and about 100 that represent most of the RVUs. Our sample crossed the billion dollar threshold a few years back, so it's a decent data set.
  
  
• Using mildly proprietary math, I distribute those codes based on what I'd consider to be the most typical FTE arrangement. In other words, imagine a pediatrician with about 4000 visits a year - how many 99213s would that be, how many screenings, etc.? Every practice and every pediatrician is different, of course, but it is helpful to have a baseline from which to predict.  N.B.: the sick:well ratio for 2021 was more historically typical than 2020 for COVID-obvious reasons, so I think we're back on track.
  
  
• I then plugged in the 2023 RVU data, using a neutral GPCI and 100% of Medicare rates, and compared it to both the 2020 and 2022 data. Which codes change the most - and which codes, by virtue of their pediatric volume - have the biggest impact? Where do we land?  Why compare to two previous years, skipping one in the middle?  Because 2020 represents the pre-E&M shift made by the Feds and we also want to compare to last year.

The results for 2023?

• Headline: I estimate that 2023 will increase pediatric RVUs by about 2.8% over 2022 and 16.6% over 2020.   Payments, on the other hand,  tell a different story.  2023 payments may be 7% higher than 2020, but they are actually lower than 2022 by about 2%. 
  To summarize: 2023 is still markedly better than 2020 or any year before it, but not as good, overall, as 2022.  
  
  
• Wait, how can the RVUs in 2023 be higher than 2022 but the expected payments lower?  Because the annual Medicare Conversion Factor - the amount Medicare pays per-RVU - has dropped considerably, from $34.61 (2022) to $33.06 (2023).  This is required to keep the Medicare budget neutral, not some conspiracy to reduce payments.  The Feds shifted billions to primary care, but to do that they have take a little off the top everywhere else.
  
  
• Note: Don't forget to adjust by your GPCI!  I haven't done the 2023 numbers yet, so stay tuned.
  
  
• To put this in perspective, the implication is that an FTE pediatrician would see an increase of about $38,000 in revenue in 2023 using 2021's volume and 2023's RVU values.  Note, that's not how this works, but it's an encouraging result!
  
  

• The AAP's strong work to restore immunization administration values, especially in this pandemic era, has really paid off.  The 90460's RVUs are 168% of the 2020 values and the revenue is 153% of 2020.  Similar, though more mild, improvements have been made for the 90471, 90472.  However, the 90461 has been cut considerably (almost 25%), offsetting the 90460 improvement.  Don't panic, as the result is still quite net positive.  A practice with a typical 90460/90461/90471/90472 distribution would still see an overall revenue improvement of about 25%, which is fantastic.

• There are other small changes in other pediatric corners - vision screening, hospital visits - but the imms admins are the real story.

The bottom line?  Practices working on their insurance contracts should heartily avoid RBRVS-based contracts based in years 2018-2020.  Anything from 2021 on looks good. 2023 looks the best so far.  Given the slightly lower benefit from 2023 vs. 2022, you just might have more luck convincing Aetna or UHC or one of the other similar-to-organized-crime organizations to jump to the 2023 RVU schedule.

Let's see what the changes look like.  Below is a list of the top ~99 RVU-valid codes for pediatricians and what their changes look like for both RVUs and $$, comparing 2023 to both 2022 and 2020.   So, below...the 2023 RVUs for 10060 are 9% higher than 2020 and the revenue is even.  For 2022 -> 2023, the difference is 102% and 97%, respectively.