>> It could be that the whole RVU thing is a sham to make it look analytical and thoughtful.
It is a "thoughtful" process IMO; however, it is sort of archaic at this point. They review all the codes in use every few years (3 or 5, I think) and they do allow practitioners to have input as to codes that need to be reviewed. But I wonder who comments?
The process is zero-sum; every time a new code is added, some units have to be pulled from other codes to make up for it. One would think that by now, there could have been some statistical refinement in the methodology to get more accurate data.
I don't see it as a great tool for determining reimbursement as much as a less-than-arbitrary method of allocating the available Medicare dollars. But, a lot of private insurers have adopted it as a basis for reimbursement, as well.
The RVUs are broken down by "Work" (which incorporates skill and time but not other costs), "Practice Expense", and "Malpractice", then there is an adjustment factor for the locality (state or city). The practice expense component is actually two sets of RVUs, one reflecting procedures performed in the office and others in a "facility" -- I don't really know how they get these.
I understand Skinowski's complaints; however, if you aren't going to allow markets to decide total reimbursements from half of the health care economy, I don't see how a market-based solution works at all. So, it is probably not a bad alternative, all things considered. The problem is that they fiddle with the RVUs to allocate more money to one specialty or another (since the conversion factor from RVUs to dollars -- currently about $35/RVU -- is fixed across all specialties).
It continues to be the best tool we have for evaluation of insurance payment contracts and determining an estimate of the cost of the procedures physicians perform. Since physicians don't generally track time per-procedure, it allows the development of something approaching a standard cost system for doctors offices and that is a very valuable tool, IMO, even if there are some codes which have been manipulated. |
