Pseudo RVU

[waky02]

One of the many challenges of in hospital medicine and surgery is that our production is lost due to the credit getting susummed by the attending/surgeon.

I was brainstorming with the lead PA at my hospital and came up with the idea of assigning a pseudo RVU value to work accomplished with values assigned to assorted tasks.

The hope being to attach a RVU figure to a FTE value 

A short list of possible number generating values 

1.  Charting time culled from EMR
2. First assist as a ratio from surgeons RVU
3. Post op/global visits as a ratio of surgeons RVU

Has anyone attempted such a system?

[delco714]

One of the many challenges of in hospital medicine and surgery is that our production is lost due to the credit getting susummed by the attending/surgeon.
I was brainstorming with the lead PA at my hospital and came up with the idea of assigning a pseudo RVU value to work accomplished with values assigned to assorted tasks.
The hope being to attach a RVU figure to a FTE value 
A short list of possible number generating values 

1.  Charting time culled from EMR
2. First assist as a ratio from surgeons RVU
3. Post op/global visits as a ratio of surgeons RVU

Has anyone attempted such a system?

No such luck, but all of us in similar situations and functions have the same struggle of RVU based bonuses or pay bc like you said, MD takes the cake. I would love to come up with a solution. UHC hasn't been helpful

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[AbeTheBabe]

They'd probably just say "that's why you get paid a base salary" and they would sort of be right. Probably easier to try to increase the percentage of the current bonus payout or your current base salary rather than try to rework the whole bonus system altogether.

[mgriffiths]

I had an ortho position offered to me coming out of school that would have paid a bonus as a percentage of the entire surgical team's collections (ortho surgeon + PA).  This is the only fair system I can think of to ensure the PA is getting a bonus based on work completed.  This also included EVERYTHING!  Surgeon on call...goes into collection bonus for everyone.  Arthroscopy where first assist can't be billed...goes into collection bonus whether PA assists or not.  The main reason for this is because if the PA isn't in surgery then he/she is in clinic seeing patients producing RVUs.  Plus, it keeps the PA from getting screwed with 100% post-op patients within the global period.  In this system...bring on the post-op patients.  I'm getting a cut of the physician's RVUs seeing other patients in clinic.  Unfortunately the surgeon was a dirt bag so I passed on the job...and glad I did, he went through 4-5 PAs in like 18 months if I recall before I stopped getting updates (had an acquaintance who worked with another surgeon in the practice...but he retired).

 

But, the bonus on the entire surgical team's collections seems most fair to me.

 

I have been offered an ortho position with my current employer (would be transitioning from FM to ortho) and I frustratingly can't justify it.  I currently work 4 days of clinic...I would have to work 5 in ortho.  Not against that, but needs to be an equivalent pay raise.  My base salary would increase from $110k to $115k and the bonus structure would change...but I would only produce RVUs toward the bonus while in clinic.  Plus, one of the ortho surgeons currently sees all of "her" patients...even going in after her PA finishes with a patient to "confirm the diagnosis and say hello."  She uses that to bill under herself, essentially stealing the PAs RVUs.  Therefore, he isn't on track to bonus this year and administration is asking why...wonder why he is putting out resumes?  Being in FM my employer is good, but just seems like they are clueless when it comes to ortho.

[delco714]

I had an ortho position offered to me coming out of school that would have paid a bonus as a percentage of the entire surgical team's collections (ortho surgeon + PA).  This is the only fair system I can think of to ensure the PA is getting a bonus based on work completed.  This also included EVERYTHING!  Surgeon on call...goes into collection bonus for everyone.  Arthroscopy where first assist can't be billed...goes into collection bonus whether PA assists or not.  The main reason for this is because if the PA isn't in surgery then he/she is in clinic seeing patients producing RVUs.  Plus, it keeps the PA from getting screwed with 100% post-op patients within the global period.  In this system...bring on the post-op patients.  I'm getting a cut of the physician's RVUs seeing other patients in clinic.  Unfortunately the surgeon was a dirt bag so I passed on the job...and glad I did, he went through 4-5 PAs in like 18 months if I recall before I stopped getting updates (had an acquaintance who worked with another surgeon in the practice...but he retired).
 
But, the bonus on the entire surgical team's collections seems most fair to me.
 
I have been offered an ortho position with my current employer (would be transitioning from FM to ortho) and I frustratingly can't justify it.  I currently work 4 days of clinic...I would have to work 5 in ortho.  Not against that, but needs to be an equivalent pay raise.  My base salary would increase from $110k to $115k and the bonus structure would change...but I would only produce RVUs toward the bonus while in clinic.  Plus, one of the ortho surgeons currently sees all of "her" patients...even going in after her PA finishes with a patient to "confirm the diagnosis and say hello."  She uses that to bill under herself, essentially stealing the PAs RVUs.  Therefore, he isn't on track to bonus this year and administration is asking why...wonder why he is putting out resumes?  Being in FM my employer is good, but just seems like they are clueless when it comes to ortho.

Could work for some, but awkward when you work with 11 MDs and 2 other PAs.
I have 3 of 4 weeks a month in clinic, each week seeing about 130-150 patients. Week 4 is inpatient consults around the city, and some OR days peppered in. Those are lucrative bc I do my own buccal grafts and op report, and then assist on the case after, so he bills higher for his case, and we get the assist fee. I'm the only one not getting extra now hahaha

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[mgriffiths]

2 minutes ago, delco714 said:

Could work for some, but awkward when you work with 11 MDs and 2 other PAs.
I have 3 of 4 weeks a month in clinic, each week seeing about 130-150 patients. Week 4 is inpatient consults around the city, and some OR days peppered in. Those are lucrative bc I do my own buccal grafts and op report, and then assist on the case after, so he bills higher for his case, and we get the assist fee. I'm the only one not getting extra now hahaha

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Yeah, if you are not a specific surgical team then certainly would make it way too convoluted to work, unless you based it on total practice collections, but with 11 MDs and only 3 PAs wouldn't seem to make sense.

[delco714]

Yeah, if you are not a specific surgical team then certainly would make it way too convoluted to work, unless you based it on total practice collections, but with 11 MDs and only 3 PAs wouldn't seem to make sense.

My rvu were 5300 last year. That's fairly impressive. Imagine that on a rvu bonus schematic.. working on a revision of that

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[mgriffiths]

2 minutes ago, delco714 said:

My rvu were 5300 last year. That's fairly impressive. Imagine that on a rvu bonus schematic.. working on a revision of that

Good grief...on my FM bonus structure that would be around a $45k bonus!  Definitely need to revise your pay structure.  If I recall you are in urology (which also makes sense with buccal grafts)...yes?

[delco714]

Good grief...on my FM bonus structure that would be around a $45k bonus!  Definitely need to revise your pay structure.  If I recall you are in urology (which also makes sense with buccal grafts)...yes?

Yes I am indeedy.. they are making a Killing. I make more rvu then one of the MDs did in his last rural job.

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[jbm14]

Ive tried to do this same thing at my hospital with no luck. They’ve set up a wRVU bonus in my current contract. Last year I pulled 4300 RVUs. This year they’re saying that I’ll get 25% of the surgeon’s RVUs on any billable cases. And 85% of the RVUs I make from clinic. Anyone else experiencing these kind of RVU deductions from their practices? 

[ventana]

think like a doc

 

if it is not billable and payable to you, then don't do it..... make your attending do their own scut work (sorry I am in clinic that day type excuses)

 

watch and pay attention to insurances, what reimbursements are, cut out those things that done generate RVU's.