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2021 RVU valuation changes - employer decreasing $ / RVU

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  • 2021 RVU valuation changes - employer decreasing $ / RVU

    As you probably already know Medicare adjusted the RVU valuation for quite a few codes this past year. At the start of the year, I asked my employer if they are going to put us all on the new scale and they said they do not plan to do so because they would be losing quite a bit of money by doing that. As a PCP, it was going to be about a 15% raise if they implemented the new valuation. I think it really hurt the specialist income though

    I caught wind earlier this week that those of us who just renewed their contract with a raise are going to have their RVU valuation adjusted (decreased) to line up with the new 2021 RVU valuation. I am sure they'll confidently assure us that there will be no difference in pay ultimately. It seems to me this is a loop hole to get around the intended pay increases Medicare made for this year.

    Not really clear on the reasoning either -- said medicare wants PCP to keep most patients and not refer out to specialists. They said many groups are reverting back to the 2020 scale. "This would put your pay above fair market value" --- not the case based on two year old MGMA numbers I have access to

    Basically this is a take it or find a new job. It is frustrating that you get a contract and 3 months later you get a completely different one. You can be dang sure that if this was the other way around you would get laughed out of the room!

    Has this happened to any of you? I got about a 15% pay raise on the new contract and this would be another 15% on top of that. I'm fine with the 15% but this just seems wrong, and somewhat dirty to me?
    Last edited by tndoc; 05-19-2021, 10:54 AM.

  • #2
    I see no where in my contract where employer can change the terms at will. It depends on what your contract says.


    • #3
      What does your contract say regarding how your pay is determined?


      • #4
        It’s good to have FU money in this situation. You should have options besides quitting, but unfortunately administrators have been acting like they have all of the cards for the past 20 years.


        • #5
          Ride it out. CMS increase in wRVUs is meant to be budget neutral. Theres no way it will, thus CMS conversion factor will be decreased too. This is to say that a 15+ % increase in wRVUs will not equal 15% revenue for the hospital.

          Here is what should happen and hopefully will happen: Hospitals need to look at how much % increased revenue will be done in 2020 RVU model vs now 2021 model. This percentage should be included in the conversion factor. The more doctors that share this info the better, then we have more bargaining power.

          While I don't like it I see why hospitals are pausing the wRVU increase until they can see what revenue turns out to be...


          • #6
            I am guessing that the change in conversion factor was to incentivize cognitive specialties over procedure based. The total payout is not any different from a budget perspective because it is budget neutral. Many hospital employed are paid on some sort of wRVU based system. I think hospitals will be forced to follow. As an Internist my income is would be close to 30% higher this year , if I didn't personally decide to slow down. I am still up significantly with much less work (wRVUs) So why would I want to work for a system that would not pass along the increase to me personally. If I worked for a system , who wanted to decrease the conversion factor of pay by old rates , I would vote by moving.


            • #7
              In addition, my contract does state how much $per wrvu I get but doesn’t not say how many wrvus each cpt code gives me so when I heard cms was increasing wrvus I was optimistic that my health system would pass on the increased wrvus. I was wrong, I learned last month that I was getting 2020 wrvus and the reason they gave was because they didn’t know if commercial insurances ware going to give increases.


              • #8
                Hospital systems are in a bit of pickle with this as if they went exactly by the board non-procedure based physicians would get a raise, while procedure based physicians will get a pay cut with no change in their work.

                As you can imagine, hospitals do not want to make the procedure based physicians angry as the procedures are very important for the hospitals.

                PCPs deserve to get paid more as it is just as dangerous to monitor an elderly patient on 10-20 meds as any procedure.


                • #9
                  That sound like a bunch of BS. Almost everyone follows CMS , with some sort of ratio. A WRVU is a WRVU, it does not matter what insurance company, program or self pay thats why it is called a work RVU.

                  As a side point, your most important financial asset as a physician is your ability to generate income from your specialty. Your contract should specifically state how this is done and what the compensation is. These terms should be presented clearly in your contact with full understanding of the process. Failure to do this as a physician is a sign of weakness and poor understanding of the reimbursement system. These issues should be part of the training process. If not , it should be the first process you tackle as an individual after training. Keeping you in the dark with some sort of hocus pocus formula is a way of manipulating your salary for their benefit.

                  Not to be harsh, but basically you are giving up a 30% raise because of the terms of your contract were best written for the terms of your employer instead of you as an individual.


                  • #10
                    Yea the conversion factor did drop with this from like $38 to $32 bucks so I think they are trying to offset that. The budget neutral concept I think is supposed to be with respect to Medicare's budget remaining neutral? Not the hospital or physician group?

                    Our contracts state the year of Medicare's RVU valuation, and then our $ / RVU scale. 2020 average office visit (99214) was 1.5 and the 2021 scale increased to like 1.8ish - doesn't sound like much but over thousands of patient encounters, that adds up a lot. I really want to ask how much their (the CFO) salary is going to decrease with this and what other specialties are going to see their salary drop. I suspect the answer is none.

                    Not sure how true it is, but I have read it costs $20k+ to onboard a new physician- if a few of us left, with lost productivity, lost patients, and costs to hire a new physician I think that would turn this around. I would love for us to have a better way to socialize/band together or even unionize against the admin BS. I feel like with how much busywork we have and now with covid, I rarely get to have a conversation with anyone but the other physician who is in my office.

                    Contract has the usual vague statement that we agree to implement whatever change they propose. I would think this is a bit beyond whatever "standard" that statement implies in the legal realm. Given the huge contract change, I would imagine the whole thing becomes voided and the restrictive covenant along with it. I will go work literally across the street with a competitor if needed I was curious if this was something others are seeing or not - looks like dontgetthejab is seeing this happen to them also


                    • #11
                      I don't disagree with above sentiments. Though no hospital currently knows what their increase in revenue will be. As time goes on people will share this info and see what other hospitals are doing. Most/all hospitals are either keeping Wrvus at 2020 or only doing a portion of an increase.

                      I agree that being firm with your contract is appropriate but, currently which hospitals are doing full 2021 Wrvus and no change in conversion factor???
                      My guess is those hospitals will struggle telling their docs when they have to decrease conversion factor next year to account for losses.

                      Thus ride it out and continue to share info and at some point when we know the market of what hospitals are capable of we can push...


                      • #12
                        “just as dangerous to monitor an elderly patient on 10-20 meds as any procedure.”



                        • #13
                          Our hospital transitioned to the 2021 wRVUs for clinic visits and providers have received higher production numbers accordingly. wRVUs for our providers are all up quite a bit. No change to the $ per wRVU. Our administration's take is that reimbursements are up as well so it is a win-win.


                          • #14
                            wRVU went up for a given procedure, but conversion factors are typically derived from retrospective surveys, and obviously that's not yet available. The risk is 2021 RVU x 2020 conversion factors which is both not market and not the intention of the paperwork reduction act.

                            I'm ok with giving my employer 2021 to figure this out, but they've been fair to us for a long time. For example they protected production based docs during Covid.

                            By 2021 I expect the higher wRVUs and a lower conversion factor for a net modest increase in income.