Medscape recently revealed data collected from a physician survey on the medical billing and reimbursement system of RVUs. The respondents included physicians from various medical specialties, including radiology, but did not include practice owners or partners. RVUs, or Relative Value Units, are a measure of the time, complexity, and cost involved in providing medical services and the standard form of physician compensation in hospitals and larger health networks.
The results of the survey are interesting, to say the least, with 43% of doctors claiming dissatisfaction with RVUs shaping their salary, and 16% being very dissatisfied. Which raises a good question…
Do RVUs incentivize physicians to prioritize the quantity of patients seen over the quality of patient care?
Worth sharing: We like this video produced by Medscape, in which Alok Patel, MD. breaks down how RVUs are calculated and weighs the pros and cons of the system. He explains “An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physician.”
Watch the video here:
RVUS and Performance Bonuses
The Medscape Survey revealed that 59% of doctors claim their performance bonuses are affected by the number of RVUs they generate.
This suggests that a physician’s ‘productivity’ is rewarded when a higher financial return for the institution is achieved, potentially leading to a conflict of interest that could compromise patients’ best interests.
Do RVUs accurately reflect productivity?
In radiology, work RVUs are measured by the volume of cases read. When administration pressures radiologists to increase their RVU count, doctors may become more competitive, often selecting less complex cases or high-value modalities. This can lead to complex cases being left on the worklist (a result of “cherrypicking” the easier or better-paying cases to read first) and potentially longer wait times for some patients.
Because of examples like this, 7 in 10 doctors believe the RVUs aren’t an accurate measure of productivity.
RVUs may measure cases seen, but they may not be an indicator of doctor providing the most timely diagnosis or treatment for their patients.
Physicians feel pressure to up patient count and use high-RVU billing codes
When a hospital administrator or practice owner brings up financial concerns, physicians feel pressured to generate RVUs. 43% of physicians have felt pressured from their workplace to generate revenue by squeezing in more patients, therefore upping their RVU count. But with this system, wait times increase and patients inevitably feel rushed. More than 50% of doctors also report at least occasionally feeling pressure to up-code a service in order to increase RVU counts.
Is there a better way?
What would a reimbursement system that prioritizes patient care over financial gain look like? Close to 3/4ths of the survey participants believe including qualitative aspects of treatment would create a more fair calculation for reimbursement.
One physician suggests a hybrid model combining RVUs with quality data and adjustments for population. Another offered that the formula for compensation should include the complexity of medical conditions, time spent with patients, telephone and portal messages, paperwork, and medication management. While another suggested a simple but effective solution: an agreed-upon salary with paid time off and productivity bonuses.
!["At the end of the day, a better approach would be having physicians actually involved in the conversation as opposed to [the reimbursement system] being determined by some venture capital or hospital administration group." Alok Patel, MD](https://excaliburmed.com/wp-content/uploads/2024/08/pull_quote.png)
“At the end of the day, a better approach would be having physicians actually involved in the conversation as opposed to [the reimbursement system] being determined by some venture capital or hospital administration group.” Alok Patel, MD, encourages physicians to advocate for what is just in the profession, not allowing private equity to up financial gain at the cost of patient care.
We asked, Rads Answered:
We asked radiologists on Reddit; What are your experiences with RVUs – are you satisfied with this method of reimbursement? Here are some of the response:
Excalibur Healthcare’s Approach
Excalibur Healthcare does not use work RVUs as a unit of measurement. We offer simple to calculate, pay-per-read work. We are 100% radiologist-owned with a commitment to high-quality patient care.
Join our team and focus on what matters most.
If you are considering teleradiology as a career option, reach out to discuss your needs and learn more about our career opportunities and compensation model.
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