[tdetlie_105]

Quote from contrast reaction

I’ve been in an HMO system forever and switched to a private practice group where the focus is much more on wRVU.  Can someone explain the concept of a wRVU to me?  I understand that certain studies have certain wRVU.  Is there a standard $ per wRVU or does that vary by group?  How is that determined and generally does that stay the same year to year or has it gone up/down?  What determines that change?

Also, what is a reasonable expectation for wRVU / year?  

Thanks!

 
This has been discussed on many threads…essentially the wRVU is the majority of your professional fee (what you are paid for interpretation)…off the top of my head, mean/median (unsure of which) for PP is around 10-12K wRVU/year I believe. 17-18K wRVU is getting closer to 90/95th%…Its my understanding that for PP, $50-%70/wRVU is the range…Overall our compensation per study trends down.  Unsure if this is a decrease in wRVU or its a matter of coding/bundling etc.  This is determined by CMS (medicare) and commercial insurers usually base their reimbursement on these rates.
 
CT head w/o is around 0.8 wRVU. CT a/p with is around 1.7/1.8…Look up the CPT code for a particularly exam and you can calculate wRVU with below site:
 
[link=https://www.aapc.com/tools/rvu-calculator.aspx]https://www.aapc.com/tools/rvu-calculator.aspx[/link]

[ruszja]

This is something I posted a few years ago. Just to spell out the basics of how ‘global RVU’, ‘professional RVU’ and ‘work RVU’ relate to each other.
 
 
 
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The reimbursement for a radiology service, consists of two parts, the ‘technical component’ which gets billed with a modifier ‘-TC’ and the ‘professional fee’ which gets billed with a modifier ‘-26’. Together, they add up to the ‘global fee’ for the service.
So if you are in a outpatient imaging center and you bill everything together, you dont add a modifier and you get everything in one payment. If you are in a hospital, the hospital bills under their separate billings scheme (HOPPS, I have no idea how that works) and you bill your professional service with a modifier -26.
 
You can search the fees on the CMS website:
 
[link=https://www.cms.gov/medicare/physician-fee-schedule/search]https://www.cms.gov/medic…an-fee-schedule/search[/link]
 
Lets say we look at CPT 74178-26, the professional fee for a CT Abdomen pelvis with.
If you select ‘Relative Value Units’ and ‘-26’, it tells you that the
wRVU is 2.01
PE-RVU is 0.72
Malpractice RVU is 0.09
Total professional component: 2.82 RVU
 
These are basically ‘abstract’ representations how much reading a CT A/P is ‘worth’ relative to other medical services. To get from that to the actual reimbursement, each of these components gets multiplied by a geographical factor (GPCI)
Lets say you put in for ‘Manhattan’, you get the following GPCIS:
 
GPCI work 1.056
GPCI practice expense 1.203
GPCI medmal 2.01
 
Each of the components gets multiplied with the respective factor
 
work 2.01 x 1.056 = 2.122256
PE 0.72 x 1.203 = 0.86616
medmal 0.09 x 2.01 =  0.1809
total: 3.169316
 
Now this gets multiplied by the ‘conversion factor’ of $34.6062  and you arrive at a total reimbursement of $109.68 (a few cents off from the CMS site, probably a stacked rounding error).
 
If you do the same calculation for Ants Elbow, WI, your dealing with the wisconsin medicare contractor.
 
You will notice that the wRVU, PE-RVU and MP-RVU are the same. Also, the conversion factor of $34.6062 is the same. What is different are the GPCIs for the three components. Apparently it is ‘harder’ to do the work in Manhattan than in Ants Elbow. So the GPCIs are
 
GPCI work 1.00
GPCI practice expense 0.942
GPCI medmal 0.296
 
You do the same math:
 
work 2.01 x 1.00 = 2.01
PE 0.72 x 0.942 = 0.67824
medmal 0.09 x 0.296=  0.02664
total: 2.71488
 
Again, conversion factor is $34.6062 and you now get $93.95 for the same service
 
The interesting thing here is that the ‘PE’ in Manhattan is only about 28% more than in Ants Elbow. Medmal expense in Manhattan is what, 680% more ? (2.01 vs. 0.296, its late, cant do big math).
One is a medmal reform state, the other a medmal hellhole. Maybe something to look into when people want to cut the cost of healthcare.

[Chris1]

Thank you so much. Very helpful as I look at jobs.

[ruszja]

The reason wRVU is used to compare comps is because it is independent from geographic and modality specific weighting  factors and are a representation of the amount of work being done.  We know that the system has its wrinkles with some things being overweight and underweight, but for practice wide numbers, that’s not a problem.
 
The general medicare conversion factor $34.6062 is for the full up professional RVU. Depending on modality and location, the ‘work’ portion represents about 65% of the total RVU. So if you calculate wRVU relative to gross income, you arrive at that $53/wRVU number. Some practices that have good payor contract and payor mix will make more than that on average, some practices with a high medicaid, managed care and ‘self pay/no pay’ percentage will collect less. 
Again, this is ‘gross’, the practice still has to pay to bill and collect that money, pay medmal insurance and staff salaries for the admin employees who keep the practice running. If that’s 20%, you get into that $42/hr range for take home that you will find for many jobs. You will find health system jobs in difficult to recruit locales that pay more than that and of course many corporate jobs that pay less (because the bond holders and MBAs in suits gotta eat too).
 
That’s sort of the 10,000ft view.

[alex.nieto_484]

It’s how admin can measure the quality of their radiology department

[tdetlie_105]

Great info fw!