Impact of 2024 RVUs on Pediatricians

Just last week, the Feds finally posted the 2024 RVUs in the official spot I like to retrieve them from - I don't know why they were so late, we even had to write to them to see what the delay was.  No response, yet, but POOF! they appeared.

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 a little good news for 2024.  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 2024 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.  I used 2023 CPT volumes because we're so late in the season I figured it wouldn't change the relative volumes too much. (because I can't use 2022, yet).  Our clients recorded just under 500 RVU-valid CPT codes, but we need only 60 CPT codes to address 99% of pediatric revenue. Our sample crossed the billion dollar threshold a few years back, so it's a decent data set.  Remember, this doesn't include ~30% of the work that doesn't have RVU values (immunizations, labs, after-hours codes, etc.).
  
  
• 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.  
  
  
• I then plugged in the 2024 RVU data, using a neutral GPCI and 100% of Medicare rates, and compared it to 2024 data. Which codes change the most - and which codes, by virtue of their pediatric volume - have the biggest impact? Where do we land?  

The results for 2023?

• Headline: I estimate that 2024 will increase pediatric RVUs by about 1.4% over 2023 (which is probably about 18% over 2020!).   Payments, on the other hand,  tell a different story.  2024 payments would be 2.1% lower than 2023, marking the second straight annual decrease. 
  To summarize: when it comes to your contracts, 2024 is still markedly better than 2020 or any year before it, but not as good, overall, as 2021-2023 for dollars.  
  
  
• Wait, how can the RVUs in 2024 be higher than 2023 but the expected payments lower?  Because the annual Medicare Conversion Factor - the amount Medicare pays per-RVU - has dropped from $33.89 to $32.74.  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.  The medical universe has already complained about the ~3.4% drop, but the real impact needs to be calculated by estimating a weighted model of pediatric CPT codes to the results.  Sure, the CF dropped, but what about the RVU increases to the 90460 and 99213?
  
  
• Note: Don't forget to adjust by your GPCI!  I haven't done the 2024 numbers yet, so stay tuned.
  
  

• What I wrote last year remains true: the AAP's strong work to restore immunization administration values, especially in this pandemic era, has really paid off.  2023's 90460's RVUs are 168% of the 2020 values and the revenue is 153% of 2020 and the RVUs are even higher in 2024.  Similar, though more mild, improvements have been made for the 90471, 90472.  However, the 90461 has been cut considerably (more than 25% at this point, I believe), 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.

• Other codes have met with serious RVU improvements, especially in the screening space.  96110 up 9.5%, 99173 up 11.1%, 96160 up 12.5%, 92551 up 5.6%, 99177 up 7.1%, 94760 up 14.3%, 92552 up 7.5%, 99174 up 5.6%, etc.  These codes have two major elements in common - first, I believe they are all dots on the Bright Futures Periodicity Table, which means generally required payment.  Second, they're generally low dollar procedures (sad trombone).

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.   IMO, it doesn't matter which year you get after 2020. 

Let's see what the changes look like.  Below is a list of the top ~60 RVU-valid codes for pediatricians and what their changes look like for both RVUs and $$, comparing 2024 to both 2023 and 2020.