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  • #31
    Originally posted by shady View Post

    Our hospital is doing something similar. They sent me a contract that says I agree to 2020 RVU rates but they didn’t state my particular conversion factor. I said if they put my number (my original contract has me above the 50th percentile conversion factor) in the addendum I’ll sign but thus far they have refused and haven’t responded to my follow up questions so not sure how I’m getting paid this year? 😐

    In my opinion, you are likely best with your 2020 values. A FMV generally works in favor of the hospital and I doubt it would result in a raise for you if the hospital is using their own data for the FMV.
    Given the changes, an FMV (which it never is, paid consultant for hospital ofc) wont even be remotely accurate for a couple of years after this takes effects.

    Its pretty easy to see what the wRVU changes do, if you're a proceduralist with minimal clinic, it may hurt you and improve you if you're clinic based. However, because in reality thats not where hospitals make money...they want to keep 2020 levels so specialists are retained and make good money for the hospital and continue to pay less for office based folks where not as much is generated.

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    • #32
      Originally posted by Saeed Payvar View Post
      I am an interventional cardiologist and employed by HCA. They are suggesting that due to CMS 2021 changes, there is likelihood that I may end up getting underpaid or overpaid, and in order to het me _whole_ (?), they are asking me to choose between two options: 1. to amend my contract to use 2020 RVU tables in 2021, or, 2. go through an independent "fair market valuation" (FMV). I do not know how to choose between these two options, or, if I have any other options. I appreciate any hints on how to address this.
      "Independent" as chosen by the hospital. Please. Stick with the known. 2020 values.

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      • #33
        I'm just glad I don't have to click through a 10 system ROS to make it count as a 99204!

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        • #34
          Originally posted by DocintheBox View Post
          I'm just glad I don't have to click through a 10 system ROS to make it count as a 99204!
          That's the single best thing that occurred here. Though I think a downside of this new system that I haven't seen mentioned is incentivizing a more lackadaisical approach to the H&P, which is where most diagnoses are made. The new E&M certainly allows for better throughput, but we still need to be doctors here. Diagnostic failures are the leading cause of malpractice, particularly in primary care. Keep your wits about you, folks.

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          • #35
            Originally posted by ENT Doc View Post

            That's the single best thing that occurred here. Though I think a downside of this new system that I haven't seen mentioned is incentivizing a more lackadaisical approach to the H&P, which is where most diagnoses are made. The new E&M certainly allows for better throughput, but we still need to be doctors here. Diagnostic failures are the leading cause of malpractice, particularly in primary care. Keep your wits about you, folks.
            Not sure the E/M had any usefulness here, in fact I'd say that making sure to think of, ask, and type out relevant factors instead of just being doctors is worse and leads to issues.

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            • #36
              Originally posted by Zaphod View Post

              Not sure the E/M had any usefulness here, in fact I'd say that making sure to think of, ask, and type out relevant factors instead of just being doctors is worse and leads to issues.
              do you mean 'ir'relevant ROS questions?

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              • #37
                I think the positive side , if that you dont have to justify your note by clicking boxes , HPI , ROS and PE. You just need to do an appropriate history and PE , and document you findings in a rationale approach by level of complexity. The level of complexity is .... because of this....

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                • #38
                  Originally posted by Zaphod View Post

                  Not sure the E/M had any usefulness here, in fact I'd say that making sure to think of, ask, and type out relevant factors instead of just being doctors is worse and leads to issues.
                  agree. Do as detailed an h and p as you want to “be a doctor”... doesn’t mean you have to type out your whole conversation

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                  • #39
                    Originally posted by Zaphod View Post

                    Not sure the E/M had any usefulness here, in fact I'd say that making sure to think of, ask, and type out relevant factors instead of just being doctors is worse and leads to issues.
                    I get that, but diminishing the importance of the history and physical can have unintended consequences just the same as mandating stupid crap be documented.

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                    • #40
                      Originally posted by Zaphod View Post

                      Given the changes, an FMV (which it never is, paid consultant for hospital ofc) wont even be remotely accurate for a couple of years after this takes effects.

                      Its pretty easy to see what the wRVU changes do, if you're a proceduralist with minimal clinic, it may hurt you and improve you if you're clinic based. However, because in reality thats not where hospitals make money...they want to keep 2020 levels so specialists are retained and make good money for the hospital and continue to pay less for office based folks where not as much is generated.

                      We just got told that we are sticking with 2020 due to the uncertainty... but I believe you nailed it on the head!

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                      • #41
                        Originally posted by shady View Post

                        Our hospital is doing something similar. They sent me a contract that says I agree to 2020 RVU rates but they didn’t state my particular conversion factor. I said if they put my number (my original contract has me above the 50th percentile conversion factor) in the addendum I’ll sign but thus far they have refused and haven’t responded to my follow up questions so not sure how I’m getting paid this year? 😐

                        In my opinion, you are likely best with your 2020 values. A FMV generally works in favor of the hospital and I doubt it would result in a raise for you if the hospital is using their own data for the FMV.
                        Thank you. I contacted a consultant asking him about the best way to make an educated decision about this; and he requested numerical details of the 2020 tables and 2021 tables, my 2017-18-19-20 wRVUs and compensation, as well as what happened during the COVID pandemic. I forwarded these requests and I am waiting for a response. We'll see.

                        Comment


                        • #42
                          Originally posted by Zaphod View Post

                          Given the changes, an FMV (which it never is, paid consultant for hospital ofc) wont even be remotely accurate for a couple of years after this takes effects.

                          Its pretty easy to see what the wRVU changes do, if you're a proceduralist with minimal clinic, it may hurt you and improve you if you're clinic based. However, because in reality thats not where hospitals make money...they want to keep 2020 levels so specialists are retained and make good money for the hospital and continue to pay less for office based folks where not as much is generated.
                          Thank you. I wonder about the decision to keep 2020 tables. The CMS changed the wRVU and CF in 2021, and they had an intent, which was to give financial advantage to office visits. Did they give the payees a choice to ignore it if they wanted? Personally, I am 50% time office practitioner and 50% time proceduralist. I spend a lot of my procedure time on patients with critical limb ischemia. These procedures are tedious and labor of love, and not that high on RVUs. I do these because it is my passion and to serve patients because few others do them in the area. With that, I would say that most of my wRVU comes from office visits. Therefore, and based on the data that came out of reports by the Society of Cardiovascular Interventions looking at the mix of wRVU generated by Interventional Cardiologist, the hope is that the CMS 2021 changes would not be a pay reduction for most people like me.

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                          • #43
                            Originally posted by ENT Doc View Post
                            I would suggest looking at the E&M guidelines, which have changed significantly. The AMA didn’t just revalue wRVUs and the CF. Based on the new guidelines I don’t see how every primary care follow up isn’t a level 4 now - you are typically dealing with 2 chronic problems, and you are managing prescription meds. Done. Level 4. As asinine as it seems, a child with chronic eustachian tube dysfunction coming in with a draining ear tube is also a level 4 - chronic disease with exacerbation + prescription management. Also, a guy with a gigantic tumor sticking out of his throat for whom you order a scan on could easily just be a level 3. Looks like they put a lot of deep thought into this over two years.
                            I couldn't agree more.

                            Almost every visit will be a level 4.

                            When I did read on it more, it was quite a bit more difficult to get a level 5. Previously, I could manage say 5-6 problems with mostly rx maintenance, some orders, and counseling, click enough boxes for HPI/ROS/PE - and level 5. With the changes, level 5 has to be quite severe and it no longer takes into account the volume of work and problems. I supposed time could still be billed.

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                            • #44
                              It is somewhat hard to adapt to. As stated, a level 4 is so easy that I’m hesitant to bill it in fear of being audited for a disproportionate number of level 4s.

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                              • #45
                                I think the most important issue is formulating a plan which has real thought and a description of why you are doing it rather than just clicking on the order ct button.

                                A history with some one has chest pain which I think is cardiac is a whole lot more informative than hitting the CP template with 3 pages of useless ROS , that really wasn't asked anyway.

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