Although the use of value-based payment models is growing,¹ the most common payment method in physicians' employment contracts is still a base salary plus a production bonus based largely on relative value units (RVUs).² RVUs reflect a physician's volume of work and level of effort in treating patients. The more RVUs a physician generates, the more income the practice (and the physician) should receive.

Knowing the RVUs assigned to different types of services allows physicians to understand how their productivity is measured. And knowing their RVUs per visit and per year allows physicians to understand how they compare to their peers. They can then assess whether they need to see more patients, work more efficiently, or change key processes such as billing and coding to better reflect the amount of work they are doing.

The four questions outlined in this article can help physicians get started in understanding and improving their RVUs.

1. WHAT ARE RVUS?

RVUs are part of the Resource-Based Relative Value Scale (RBRVS), which Medicare and other payers have used for decades to determine payment for physician services. RVUs are just one of three components that factor into the payment calculation.³ The other two components are geographic practice cost indices (GPCIs), which adjust RVUs to reflect regional differences in the cost of physician services, and a conversion factor (CF), which is the dollar amount by which total, geographically adjusted RVUs are multiplied to arrive at the payment amount for a given service. (See “How payment for a service is calculated.”)

Total RVUs are the sum of three types:

• Work RVUs, which reflect the physician's work, including mental effort, decision making, technical skills, physical effort, stress related to patient risk, and amount of time spent,

• Practice expense RVUs, which reflect the clinical and nonclinical labor costs and practice expenses,

• Malpractice RVUs, which reflect the liability insurance costs.

The remainder of this article will focus on work RVUs because they are a key measure of physician productivity. Work RVUs for common services in primary care are listed at the end of this article. For example, a 99214 established patient evaluation and management (E/M) office visit has 1.92 work RVUs, a “Welcome to Medicare” visit has 2.6 work RVUs, and a 99223 initial hospital visit (admission) has 3.5 work RVUs.