The Relative Value Unit: History, Current Use, and Controversies
Introduction
Understanding physician reimbursement is crucial to the sustained health of any medical practice. Physician reimbursement from The Centers for Medicare and Medicaid Services (CMS) is a 3-step process, which begins with the appropriate coding of the service provided by using a current procedural terminology (CPT®) code.1 Second, the appropriate diagnosis is coded using an International Classification of Diseases (ICD) code.1 Finally, a determination of payment is made based on the CMS resource-based relative value scale (RBRVS).1 The CMS process is important to understand, as other payers typically use the CMS model as a guideline for reimbursement. In radiology, monitoring relative value units (RVUs) also allows practice managers to identify physician payment, productivity, budgeting needs, and cost benchmarking, and also has implications for future hiring needs.
Over the years, there has been an increased focus on incentive-related payment models. During all medical residencies, formal education regarding billing and coding is suggested to be included as a part of the core competency of professionalism by the Accreditation Council on Graduate Medical Education.2 However, multiple studies have shown that trainees are unsatisfied with the quantity and quality of education they are receiving in these areas.2 The purpose of this review is to educate radiologists and radiology practices on how they are compensated under the current RBRVS. The authors review the history and components of the RVU, demonstrate how RVUs are calculated, and provide examples of current RVUs for a variety of imaging examinations and interventional radiology procedures. In addition, they define the role of groups that advocate for radiology reimbursement, and highlight current issues and controversies with this payment model.
Section snippets
History of the RVU
RVUs are a measure of value used in the CMS reimbursement formula for physician services. RVUs are a part of the RBRVS, which was designed to value physician services and to serve as a guide for reimbursement. Before the creation of RVUs, CMS paid for physician services using a “usual, customary, and reasonable” rate, which led to a wide range of payments.1 A large study was authorized by the Congress and conducted by researchers at Harvard University and the American Medical Association (AMA).
Issues and Controversies
There are a multitude of controversial issues regarding radiology reimbursement. Most of these center around RVUs and current procedural terminology (CPT®) coding. Radiologists must be aware of these controversies, as recent changes have led to substantial decreases in reimbursement for diagnostic imaging examinations.
Conclusion
Radiologists must understand the history and current use of RVUs and (CPT®) codes for reimbursement. This knowledge allows radiologists to remain current on controversial issues regarding reimbursement and future payment strategies, so as to understand our role in this new paradigm. Radiologist involvement in regional-, national-, and government-level discussions about future reimbursement models is crucial to ensure that our specialty remains at the forefront of medical advancements and
References (33)
- et al.
The threat to radiologists from the multiple-procedure payment reduction
J Am Coll Radiol
(2013) CMS cuts expand to breast imaging
J Am Coll Radiol
(2014)Obamacare and fee-for-service
J Am Coll Radiol
(2014)Healthcare reform and its impact on radiology practice
J Am Coll Radiol
(2014)- et al.
Physician coding and reimbursement
Ochsner J
(2007) - et al.
RVU ready? Preparing emergency medicine resident physicians in documentation for an incentive-based work environment
Acad Emerg Med
(2009) - et al.
Resource-based relative values: An overview
J Am Med Assoc
(1988) - Uwe Reinhardt (December 10, 2010). The little-known decision-makers for Medicare physician fees”. The New York Times....
- Roy A. Why the American Medical Association had 72 million reasons to shrink doctors’ pay. Forbes.com. Available at:...
- Patel S, Sura A, Ho A. Attendings’ and residents’ knowledge of RVUs. Poster presented at ACR Annual Meeting and Chapter...
Impact of resource-based practice expenses on the medicare physician volume
Health Care Financ Rev
Cited by (62)
Are Foot & Ankle Surgeons Being Adequately Compensated for Ankle Fractures? – An Analysis of Relative Value Units
2023, Journal of Foot and Ankle SurgeryOverview of Cardiothoracic Surgeon Compensation: Practice Setting, Productivity, and Payment Structures
2022, Annals of Thoracic SurgeryA Metrics-Based Research Salary Award System and Its 9-Year Impact on Publication Productivity
2022, Academic RadiologyCitation Excerpt :Landmark clinical and academic performance metrics are increasingly used in radiology (1,2) with anecdotal success, but there is a paucity of literature – particularly over a long tenure, to benchmark the impact of these innovations. To date, there has been considerable focus on clinical productivity, through systems based on the relative value unit (RVU) metric (2,3). However, there have been relatively few RVU systems for evaluating academic activity published in radiology (2), and other specialties (4–9).
Leveraging the electronic health record to evaluate the validity of the current RVU system for radiologists
2021, Clinical ImagingCitation Excerpt :The RVUs are based on Current Procedural Terminology (CPT) codes because each physician's service/procedure has its own CPT code.4,5 The CPT code determines the RVU and therefore the fee payment associated with the service/procedure.4 The payment formula for any service/procedure has 3 RVUs: 1 for physician work, 1 for practice expense (PE) and 1 for professional liability insurance costs (PLI).4,6
Quantifying the Surgeon's Increased Burden of Postoperative Work for Modern Arthroplasty Surgery
2021, Journal of Arthroplasty