What do you need to know for a wRVU based job?

[damaca]

Interviewing for wRVU based jobs. I am wondering what factors are mandatory to know. For example, $/wRVU conversion factor, how the conversion factor is determined, total wRVU to break even with guarantee, at which point productivity bonus kicks in, what is the current wRVU productivity of the group. Any other suggestions? Is the average wRVU/encounter important?

 

Is anyone aware of how the wRVU value of each type of service is determined? Is it the same for any job anywhere, or can the value of a particular service vary?

[Fugue]

You've got most of it. All that really matters is the conversion factor. The wRVU/encounter is usually inherent to the field and type of visits you're doing. The amount of wRVUs per visit or service do not vary, those are set nationally by CMS. Look up the physician fee schedule.

Average collections/encounter matter in a % system, because now the amount coming into the practice actually matters.

[Tim]

One common issue that has been mentioned in the past is the priorities used in the scheduling. Depends on the practice and how new patients are split and how workloads are assigned. The “tales” of senior physicians cherry picking and leaving the scraps for the new employee are many. In that case, average is Senior high wrvu’s and you get the short end. Things like ma and no support as well can impact your production.
Some places really want you to get your production up to speed, others are perfectly satisfied leaving you necessary but lower productivity work.

[MaxPower]

The things that you aren’t asking, but that I would argue are more important in a pay for wRVU model are what control do you have over staffing? If you have an MA that shows up late, or is constantly on the phone for personal stuff and doesn’t get patients back, or if the OR turnovers are terrible you won’t be efficient no matter how high your conversion factor is.

What control do you have over what types of patients get scheduled into your clinic (if you’re a surgeon or a proceduralist you want lots of operative patients who have been worked up already by PCPs or PAs/NPs)? How onerous is the EMR (the more onerous the fewer patients you can see)?

You might not be able to get answers to all of these questions directly, but you could ask for average wRVUs for the partners or clinic. Before I graduated from residency I sat down with the residency program’s practice manager and he gave us the current MGMA data and wRVU conversion numbers as well as the wRVUs for the physicians in our program so I had a pretty good idea about how busy they had to be to reach those kinds of numbers.

If you’re going into an employee hospital setting, you should be shooting for a conversion number quite a bit higher than that for Medicare since the hospital is only paying you for your work, and just collecting all of the revenue for things you generate like radiology studies or labs, therapy, facility fees, inpatient hospital stays, etc. They’ll tell you they have no idea what those numbers are, but in reality they just don’t want to give them to you to see how underpaid you are.

[q-school]

wRVU is set nationally by committee.  this is inherently political and great debates occur all the time.

for your purposes, you should focus on conversion factor.  if at large institution, you may not be able to negotiate that either.

welcome to real world. 

 

 

[SValleyMD]

You obviously need to know your $ per rvu then it’s all about what your expected production is going to be, what the boss man wants it to be and what you want it to be..

You need to be on the same page as all three

1. Regardless of whether u want to crank rvus you still want to be efficient.. how many rooms do I have, how quickly can MA room, how much support with nursing for paperwork, how are new patients divided up, how many new pts are out there, etc

2.. sometimes boss man actually doesn’t want u to be busy (I know sounds stupid but it’s true).. They hate outliers. They don’t want others saying you’re too busy or busier than them. They often don’t want u hitting high income numbers.
They don’t like the 90% rvu guys hitting 90% production


3. How busy do u want to be.. can u hit your income targets based on your conversion factor and expected work. Can u psychologically take time off when you’re eat what u kill and “losing” $ wity each day off. Do u have the potential practice growth to hit the numbers u want..

[SLC OB]

MaxPower wrote:

you could ask for average wRVUs for the partners or clinic.

Click to expand...

Besides what you asked in the original post, ask this. It will tell you how efficient the partners are, the work flows in the clinic, office staff, etc. Ask for the range (slow doc to fast doc) and how they schedule the patients.

Compare to national benchmarks.

Good luck!

 

[damaca]

Thanks! I am in Hematology/Oncology, so essentially only generating wRVU based on office visits and inpatient consults/follow ups. No chemotherapy compensation is directly tied.

I have been careful to examine the source they use to determine their conversion factor, but also have purchased MGMA data to use to negotiate.

I also have been provided the actual wRVU ranges of the current docs in the group

As far as the practice management issues, MA/RN/NP support, I can see how important that would be. Thanks for all your input!

[SLC OB]

As for hem/onc... lots of people negotiate higher then median due to the chemo revenue... as they need you to order the chemo. Just think about that. Good luck.