Help with RVU on new Samsung TV Discussion in 'DIRECTV HD DVR/Receiver Discussion' started. There is no way to use the TV's built in WiFi connection, the software in the TV prevent that. If you want you could get a C41W wireless client and a WVB to get DIRECTV to that TV. RVU TV's still require that a coax cable run be to it and then a. Rocky Vista University (RVU-COM) Discussion Thread 2016-2017. It's ExamSoft. Further unfortunately, basically all med schools use that software. Overall, I'd say ~50% of the class is Mac, and 50% PC. Of the PC users, the majority have the Surface Pro, or the newer Surface Book.
The Structure of Physician Compensation The structure of compensation for hospital/health-system employed physicians is a constant struggle for administrators with the rise of and subsequent employment of these physicians. Based on estimates from Jackson Healthcare 1, approximately 35 percent of all physicians are employed by a hospital/health-system.
As a result, the issue of how to structure and benchmark physician compensation has emerged as a leading topic among both valuators and hospital/health-system administrators. In this article, the author discusses the pros and cons of the work RVU compensation model, the most popular model. The structure of compensation for hospital/health-system employed physicians is a constant struggle for administrators with the rise of physician practice acquisitions and subsequent employment of these physicians. Based on estimates from Jackson Healthcare 1, approximately 35 percent of all physicians are employed by a hospital/health-system.
As a result, the issue of how to structure and benchmark physician compensation has emerged as a leading topic among both valuators and hospital/health-system administrators. Traditionally, employed physicians have been compensated for clinical services utilizing a variety of methods including, but not limited to: base guarantees, compensation per work relative value unit (work RVU), base salary plus productivity bonuses, percentage of practice pre-compensation earnings, percentage of professional collections, and more recently, pay for performance and other value-based compensation. However, by far the most common method of structuring clinical compensation arrangements for employed physicians is productivity-based compensation. According to the 2014 Medical Group Management Association (MGMA) Physician Compensation and Production Survey: 2014 Report Based on 2013 Data 2, approximately 39 percent of physicians are paid utilizing 100 percent productivity-based methods. Work RVU Compensation Models The basic premise of work RVU compensation models is to align the physician’s compensation to the productivity of the physician (as measured by work RVU).
This is typically completed by utilizing independent physician compensation surveys and analyzing the expected productivity of the physician. The three most commonly utilized physician compensation surveys to accomplish this task are as follows:. American Medical Group Association (AMGA) Medical Group Compensation and Financial Survey. MGMA Physician Compensation and Production Survey.
Sullivan Cotter and Associates, Inc. (Sullivan Cotter) Physician Compensation and Productivity Survey Each survey details various production and compensation metrics and is commonly used by administrators to help evaluate the competitiveness of compensation levels for physicians. In addition, the three most common methods of clinical compensation arrangements utilizing work RVU are:.
Compensation per work RVU: Also known as an “eat what you kill” model. Physicians are paid a set dollar conversion rate for each work RVU generated. Pros:. Easiest model to administer. Incentivizes physicians to produce more if wanting more compensation Cons:. Large downside risk for low producing physicians.
May be difficult to determine the “appropriate” compensation per work RVU rate. The highest producers are often underpaid and the lowest producers are often overpaid in a group model. Graduated scale: Under this model, physicians are paid dollar conversion rates per work RVU based on a graduated scale.
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Pros:. Effectively incentivizes the physician to produce more to achieve the higher compensation per work RVU rates Cons:. Large downside risk for low producing physicians in a group model. Difficult to administer.
Potential of “overpaying” the physician if higher than expected productivity levels are achieved or if each individual compensation per work RVU rate is not within fair market value (FMV). Base guarantee plus productivity bonus: Under this model, physicians are paid a base guarantee and will receive incentive/productivity compensation for every work RVU generated above a pre-determined threshold. Pros:. Limit’s the physician’s downside risk by establishing a guaranteed minimum salary. Incentivizes the physician to produce more if wanting a production bonus Cons:. Risk for employer if physician does not produce at a level commensurate with the base salary. If base guarantee is set too high, the physician may not be motivated to increase current production levels Benefits of Work RVU Based Models Work RVU=based compensation models offer several benefits to both the employer and employee and are relatively easy to implement making them a favorite among both parties.
Physicians often prefer this method as the physician’s compensation will be independent of the patient’s ability to pay or hospital/health-system’s ability to collect, thus allowing the physician to practice medicine without having to worry about billing and collecting. In addition, the physician’s compensation is not subjective to variations in healthcare reimbursement as the work RVU credit is always given regardless of the collections actually received from the patient. Hospitals/health-system administrations often prefer this method as it incentivizes physicians to produce more, potentially leading to more revenue for the employer. The model is also relatively simple to administer and effectively rewards the highest producing physicians with the highest compensation.
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In addition, it allows the hospital/health-system to compensate the physicians for treating unassigned and self-pay patients which allows the hospital to serve the local community. Nuances and Misapplication As previously discussed, work RVU-based compensation models are the most common arrangement.
However, this does not mean it is the easiest solution to implement correctly and that there are no nuances when setting physician compensation arrangements. Although work RVU-based models effectively account for the productivity of the physician, the models do not account for:. Level of reimbursement in the local market place. Physician’s payor mix and negotiated commercial contracts. Return to the owner of the practice.
Actual professional collections. Cost incurred by the physician and cost efficiencies In addition, MGMA has noted for several years the difficulty in knowing how to adequately reward the highest producing physicians without overpaying and creating possible healthcare issues. The difficulty arises due to the unique relationship between compensation and production; more specifically, the inverse relationship between compensation and compensation per work RVU rates. As shown in the chart below for general surgeons, compensation per work RVU decreases, but compensation increases from the first quartile to the fourth quartile. 2014 MGMA Physician Compensation and Production Survey: 2014 Report Based on 2013 Data The declining pattern in the compensation per work RVU by quartile of production data denotes that compensation per work RVU rates do not necessarily correspond to total compensation.
In theory, one would intuitively think that the compensation per work RVU rates would eventually increase with increased production as the fixed costs of the physician would eventually be covered, thus creating an increasing profit margin per work RVU. However, the survey data does not reflect this pattern.
As a result, the survey data is commonly misapplied resulting in compensation arrangements that may not be fair market value (FMV). For example, a general surgeon producing at the 90 th percentile of work RVU (11,036) should not necessarily make the 90 th percentile compensation per work RVU rate. As the chart below indicates, paying a general surgeon who is producing at the 90 th percentile the 90 th percentile compensation per work RVU rate ($91.02), would result in compensation 39.2 percent higher than the 90 th percentile compensation from the MGMA survey data. In addition, the chart below illustrates the effective compensation per work RVU rates decreases as the physician becomes more productive. What this means is that physicians producing above the median work RVU should not necessarily make above the median compensation per work RVU rate. This is a very frustrating concept to grasp as most people would assume a highly producing physician should make more per work RVU than a lower producing physician. But what causes this disparity?
In order to fully understand this concept, one must first understand how the data is derived in the MGMA survey. The compensation per work RVU rates are derived by dividing the total compensation for the physician by the physician’s total work RVU. This means that the physician whose total compensation is reported at the 90 th percentile does not necessarily mean he/she is earning a 90 th percentile compensation per WRVU rate. In addition, the MGMA survey does not actually detail “reported” compensation per work RVU rates from physicians who are compensated under such an arrangement. As a result, the survey data is potentially skewed by physicians who are paid base salaries that do not necessarily correlate with their actual production. For example, a newly hired physician normally has a “ramp-up” period for a few years.
During this time, it is not uncommon for the physician to receive a base salary and once the physician has built up his/her practice the physician will be switched to a productivity=based model. Another plausible explanation is that even at the 90 th percentile of work RVU, the physician is still not producing enough revenue to account for the large fixed cost necessary to run a physician practice. It is important to note, this concept is still being researched and a single answer has not yet been developed.
Key Takeaways Physicians employed by hospitals/health-systems are subject to various regulations including that compensation paid to physicians be within fair market value (FMV). As a result, hospital/health-system administrators should ensure physician compensation arrangements are within FMV by seeking an independent valuation firm to provide an opinion of value.
Fellow Members, Wondered if you could enlighten me as to why CMS has decided that Code 45388:Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is worth $3,000.00 + and any other code within the same range family is only valued around $400.00 - $600.00? I have been contacted by my C-team when they noticed the GI cost was extremely high. Contacted the local MAC First Coast Service Options, they did research and had to rely on the files they received from CMS for the fees, not knowing why it was so out of alignment, or if they knew of the increase. I was referred to the Final Rule for November 2015 which had the Fee schedule changes, nothing relating to the substantial increase in code 45388.
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This doesn't seem correct? We are considering the data input of the RVU is incorrect, however when looking at other MACs they have the same RVU with fees similar to local MAC. I find it highly irregular that CMS would increase the fee for the same procedure performed in 2014 45383 from $400.00 +/- to well over $3,000.00 +/- in 2016?? Any assistance with the reasoning behind this would be very helpful and put my administrators including CMO, and CEO at ease. If the increase was justified, they would like to know reasoning behind it, if it is an error, we could then proceed to make corrections.
Thank you in advance for your assistance. Costa RHIT, CPC, CDIP Holly Hill, FL. Maybe it is because the instrument - laser is so expensive to purchase. I have often come across incorrect coding when I have read the op report closely. Sometimes physicians get confused with ablation and removal.
It is generally accepted that if the CPT code 45388: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is being utilized, the polyp(s), tumor(s), or other lesion(s) are ablated with laser. Nothing is left over to be removed. If a physician states in the op note that he ablated polyps, tumors or other lesions and removed them via snare, that is technically not 45388, but 45385.
Laser equipment is extremely expensive. That is only my opinion why CMS has such a high fee for this code. Fellow Members, Wondered if you could enlighten me as to why CMS has decided that Code 45388:Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is worth $3,000.00 + and any other code within the same range family is only valued around $400.00 - $600.00? I have been contacted by my C-team when they noticed the GI cost was extremely high.
Contacted the local MAC First Coast Service Options, they did research and had to rely on the files they received from CMS for the fees, not knowing why it was so out of alignment, or if they knew of the increase. I was referred to the Final Rule for November 2015 which had the Fee schedule changes, nothing relating to the substantial increase in code 45388. This doesn't seem correct? We are considering the data input of the RVU is incorrect, however when looking at other MACs they have the same RVU with fees similar to local MAC. I find it highly irregular that CMS would increase the fee for the same procedure performed in 2014 45383 from $400.00 +/- to well over $3,000.00 +/- in 2016??
Any assistance with the reasoning behind this would be very helpful and put my administrators including CMO, and CEO at ease. If the increase was justified, they would like to know reasoning behind it, if it is an error, we could then proceed to make corrections. Thank you in advance for your assistance.
Costa RHIT, CPC, CDIP Holly Hill, FL. I can't access the in depth RVU breakdown from 2014 (i use find a code and there is a ton of cost basis info behind the RVU calculation) but for instance with today's codes: 45388 requires use of 'radiofrequency generator, endoscopy' w/ average purchase price of $108,000 w/ 5 years of equipment life which is additional to say what is needed equipment wise w/ the snare. There is an additional direct supplies expense for 'catheter, RF ablation, endoscopic' which on average costs $1,700 on top of supplies for snare removal. I attached PE RVU breakdown of 45385 (snare technique) vs 45388 (RFA technique). Maybe it is because the instrument - laser is so expensive to purchase.
I have often come across incorrect coding when I have read the op report closely. Sometimes physicians get confused with ablation and removal. It is generally accepted that if the CPT code 45388: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed); is being utilized, the polyp(s), tumor(s), or other lesion(s) are ablated with laser. Nothing is left over to be removed. If a physician states in the op note that he ablated polyps, tumors or other lesions and removed them via snare, that is technically not 45388, but 45385. Laser equipment is extremely expensive.
That is only my opinion why CMS has such a high fee for this code.Thank you for this information, now the fee associated with this code starts to make sense. Will convey to administration so we can make adjustments. I can't access the in depth RVU breakdown from 2014 (i use find a code and there is a ton of cost basis info behind the RVU calculation) but for instance with today's codes: 45388 requires use of 'radiofrequency generator, endoscopy' w/ average purchase price of $108,000 w/ 5 years of equipment life which is additional to say what is needed equipment wise w/ the snare. There is an additional direct supplies expense for 'catheter, RF ablation, endoscopic' which on average costs $1,700 on top of supplies for snare removal.
I attached PE RVU breakdown of 45385 (snare technique) vs 45388 (RFA technique) Coding King, Thank you for all the information including the file with RVU breakdown, this was very helpful as sometimes visuals are the best form of communication. This really shows why the fee is so high. Close Message In addition to full participation on AAPC forums, as a member you will be able to:. Access to the largest healthcare job database in the world. Join over 150,000 members of the healthcare network in the world. Be a part of an industry leading organization that drives the business side of healthcare.
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