The term “Relative Value Units”, or RVUs, forms the basis for payment of physician fees by Medicare and other payers, and can be used to measure physician productivity for a variety of purposes. Healthcare Administrative Partners (HAP) can help you navigate today's RVU challenges in radiology and maximize your revenue.

What Are RVUs and Why Do They Matter in Radiology?

RVUs were established to quantify the relative work and cost of physician services across all fields of medicine. Resource costs include the direct cost of the equipment and support staff required for a particular procedure and the overhead allocated to the procedure.

In traditional models, radiology procedures are assigned a certain number of RVUs based on how much work, skill and time they take for the radiologist, plus equipment costs and practice operations. In value-based care, the focus of RVUs shifts to measuring and rewarding the quality and efficiency of healthcare, not just the number of services provided.

Insurance companies, including Medicare, use RVUs to set payment rates. Especially in contract negotiations, understanding radiology RVUs can help practices know what to expect for reimbursement, ensuring services are fair and reflect the complexity of work involved.

How Radiology Practices Measure Physician Productivity With RVUs

Physician practices have measured productivity using a variety of indicators, such as:

• The number of procedures performed: Using “unit volume” as a measure fails to take into account the complexity, time or cost of the various procedures.
• The amount of charges billed: Using “charges billed” as a measure accounts for some of these factors, but fee schedules tend to be arbitrary and often influenced by market conditions.
• The sum of payments received: Using “payments received” as a measure has all of the limitations of charges billed, plus the added variability of processing difficulties on the part of either the practice or the payer. 

The RVU scale is not perfect.  Still, it is at least an independent standard that can reasonably be used for productivity measurement. However, practices should be cautious when using RVUs to compare the work of the group’s members among themselves. For example, within the RVU scale, some interventional procedures are undervalued compared with other radiology services, whereas MRI services tend to be heavily valued. 

Factors other than the scale’s internal imperfections can also come into play. For example, physicians working on a weekend will generate fewer RVUs than during a regular workday, so those shifts will introduce an unintended difference in RVUs produced unless the group assigns its weekends and holidays equally. Another example is that when a common worklist is used from which the group of radiologists can pick which studies to read, a radiologist could skew their performance score by choosing the higher-weighted studies. In theory, the RVU scale should automatically take care of this “cherry picking,” but in reality, the difference in effort among high- or low-valued studies isn’t as significant as the valuation difference.

How RVU Changes Affect Your Practice's Revenue

Practices — such as hospital-based facilities, imaging centers or academic practices — are all very different. Each of the relevant factors of the practice will contribute to differing results in the level of RVUs generated, making it very important to identify a benchmark that matches your particular situation.

Some practices advocate calculating RVU productivity for each “seat” or assignment in the practice. This way, the various physicians working that assignment can be compared with each other. Other statistics can be developed that will indicate changes in the practice when they are tracked over a period of time. These include RVUs per day worked (or this could be limited to full weekdays, thereby eliminating the weekend/holiday issue described above) or RVUs per procedure billed. Monitoring these statistics can help to identify shifts in the practice’s activities.

Strategies for Navigating RVU and Reimbursement Shifts

There are ways to balance out some differences and shifts if a practice is seriously interested in using RVUs as a performance measurement:

• A shift differential could be introduced to even out the lower production generated during less busy times, such as weekends or holidays.
• Comparison of RVU production can be limited to each subspecialty, rather than comparing subspecialties against each other.
• Administrative duties or educational activities that take time away from RVU-generating activities should be assigned a compensating value.
• Benchmarking an individual’s production against their own historical data is a reasonable way to monitor current work levels without introducing competition among group members.
• Comparisons among group members have to be adjusted to full-time equivalents (FTE) when there are disparities in the work schedule.

Why Trust Healthcare Administrative Partners?

HAP is your partner for expert revenue cycle management (RCM). From medical billing and coding services to navigating the complexities of RVU in radiology, we can help you find the solutions you need for your practice.

Specifically, we offer:

• Extensive experience: Since 1995, HAP has served physician practices in various settings and medical specialties, including radiology. For over two decades, we have continued to grow from our headquarters in Philadelphia and reach practices and medical centers nationwide.
• Certified specialists: HAP is a primarily women-led business that takes pride in each of our experienced team members and their diversity. Our team is highly trained and certified to tailor our services to your practice.
• Established core values: We embrace five values at HAP — integrity, accountability, customer first, diversity and expertise. We use these values to guide our services and help you navigate today's challenges.

Ready to Optimize Your Radiology Revenue?

Understanding the RVU structure and using it wisely can offer useful insights into the workings of the practice. Regardless of the statistics your practice decides to monitor, be sure to define the methodology accurately and then track them over a significant period in order to iron out short-term variability. Subscribe to this blog for more articles like these or contact Healthcare Administrative Partners for more information.

Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.

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