Which RVU Year Should I Use?

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Over on SOAPM yesterday, someone asked a question I've been handed many times. "My payer has just switched from 200X RVUs to 201X, is that good or bad?" Or, "What year should I have the insurance company use for RVUs in my contract?"

Generally speaking, pediatricians fair better with each new year. The differences are substantial over time, frankly. I've documented this change at length because I'm a nerd.  The bottom line is that the Feds have made conscious effort to slowly shift money to primary care.  Immunization admins, well visits, and even acute visits, have seen significantly increased RVU values over the last decade.

There are some clear exceptions, though.  The big issue that often gets missed is the GPCI - that is, what is your local Medicare adjustment rate.  Some parts of the country, like Boston, have been killed by it.  Others (particularly Alaska) have seen massive improvement.  My 2014 analysis of this issue is here.

It's also important to remember what I call the "non-RVU-valid codes," especially vaccines.  With vaccines making up ~25% of the overall revenue in pediatric practices nationally, that's a huge chunk of income that could be losing you money.

Finally, we need to remember that each practice's coding distribution is different.  Your Sick:Well visit ratio, the age distribution of the kids you see, how well you code - all of those things affect your revenue.  But if you read my blog, you know that.

Putting those issues aside, how would we compare 2011 to 2014 for pediatricians?  Here's how I did it.

  1. I downloaded the free RVU calculators I shared here on my blog (2011 and 2014, respectively).  Yes, I could do this by using the PCC software with a couple keystrokes, but I wanted this to be for everyone.
  2. Using a table I compiled of the top pediatric codes for 2013, I entered the CPT codes into each spreadsheet.  I then added the relative volume of each procedure (i.e., 90460s make up 13% of all pediatric codes).
  3. I took the prices calculated in each spreadsheet and multiplied them by the relative volume of each procedure.  You should use your real volume.
  4. I then compared the 2014 RVU dollars to the 2011 RVU dollars.

What did I learn?  I found an 8.9% increase in the dollars generated by a typical pediatric practice using 2014 RVUs over 2011.  Just as I predicted.  That number may not work for you - you might do a lot of 96110s (developmental screening), which have gone down a little.  Or a lot of 92551s or 92587s (hearing tests), which have gone down a lot.  But well visits have increased by more than 20%.  Imms admins have increased another 6%.  And your bread and butter - 99213s - have gone up almost 5%.

Someone check my math!

CPT Code 2014 Value 2011 Value Change
90460 $25.08 $23.10 +9%
99213 $73.08 $68.97 +6%
90461 $12.54 $11.55 +9%
99214 $107.83 $102.27 +5%
99392 $106.75 $88.000 +21%
96110 $8.24 $8.15 +1%
99391 $99.95 $79.17 +26%
99173 $2.87 $2.72 +5%
99393 $106.39 $87.66 +21%
90471 $25.08 $23.10 +9%
99394 $116.42 $95.81 +22%
92551 $11.82 $11.55 +2%
90472 $12.54 $11.55 +9%
94760 $3.22 $2.72 +19%
99212 $43.70 $41.45 +5%
92587 $22.21 $37.03 -40%
92552 $30.81 $25.48 +21%

So, when in doubt - use a newer RVU year pediatricians.  But check the math, first.  It's easy.  Someone tell me if I got it wrong.