RVU value

[Dr P]

Hello I was hoping to get opinions on a couple scenarios.

My practice is about 75% insurance and 25% cosmetic based.  I'm in the process of renegotiating my contract and am looking at moving to a base + bonus structure vs eat what you kill.  Since my billers don't have a great track record with collections, I'm leaning towards an RVU model.

Does anyone have experience assigning RVUs to cosmetic procedures?  Alternatively, is a combination of wRVUs for insurance payments and collections for cosmetic procedures too complicated?

Another question is regarding assigning a value to the wRVU. My admin has decided on a largely out of network model to benefit another specialty within our practice, but this limits my wRVUs because of the difficulty in establishing relationships with referring doc. Given this difficulty in reaching a high wRVU level, and a payer mix that results in high reimbursement to the practice, does it make sense to ask for a higher $/wRVU.

Any advice would be appreciated.

[Matas]

I assume the cosmetic procedures have no assigned wRVU value?

[Zaphod]

I have heard of getting a straight dollar compensation and also getting a wRVU based upon number of hours for the cosmetic cases. For the wRVU I believe they just agreed upon some number of standard hours for every case and went on the normal base rate or some such agreement.

My question for that was that wRVU value was really low compared to what you get for these procedures and they dont take much time....to which I learned they were always paid for the full amount of time which was quoted at somewhat absurd lengths like 2 hours for a breast aug, etc...

Take my comments with a salt mine since I have never dealt with any of these wRVU/insurance type of payments so dont really know how that works, but in discussion with my colleagues who work at hospitals and such this is what they say.

Cosmetic procedures are extremely inefficient at hospitals and they dont make that much money for the hospital compared to what they can charge insurances for facility fees for similar length cases, and keep the costs at a good market rate so these are always tough. If your practice has a surgery center but again arent used to dealing in cash pay, again you end up losing just due to inexperience of the team you work for.

The other issue is if the center does a bunch of stuff like ortho, etc...their overhead is going to be insanely high while cosmetic procedures typically have very low overhead above typical staffing needs that will be baseline everywhere. Multispecialty ASCs are more costly due to these reasons of having all kinds of equipment and needs for all different types. Its kind of crazy really, the only thing you need at a pure cosmetic one is really basic surgical case stuffs (packs, etc...), lipo machine, consignment implants, suture, and a few meds. Its very sleek. In a multispecialty one you'll have all this fancy equipment for each different specialties cases, etc....and devices can get real spendy. This will really bring down the low overhead doc and you'll be basically subsidizing their higher COGS.