Dollars and Sense: Equal Relative Value Units (RVU) in Radiology

In all medical specialties, whether they be in private practice, small hospital, large medical center or entire enterprise, success boils down to two things: dollars…and sense. If clinicians do what makes sense for their patients, and if they do it sensibly, a profit is turned at the end of the billing period. Excellence in patient care is certainly of paramount importance, but turning a profit is also essential. In the fast-growing arena of medical imaging, RVUs mean everything, especially where both profitability and holding the line on cost are concerned.

RVU is the shortened version of “Relative Value Units,” and these are what physician charges for Medicare, Medicaid and most insurance payers are based upon. Basically, they evaluate doctor productivity.

In earlier times, physicians charged their patients whatever was customary, and there was broad disparity from doctor to doctor. That has changed. Today, a system based upon the Resource-Based Relative Value Scale (RBRVS) that was developed three decades ago at Harvard and tweaked to create the framework for Medicare is in widespread use and has been since 1992. The scale ultimately created standardization within the Medicare payment system and across the board.

How it works

The Harvard project assigned a value to the many services provided in medicine in order to measure the work required and the cost of those services, based largely upon information that was available at the time.

The hope was to apply a relative value to services, essentially establishing quantitative measures to the work that doctors perform and the time they spend doing it.

What is RVU based on?

The present-day Medicare fee schedule emerged from the various RVU values established for covered services and involved a number of considerations. These include:

  • Physician “labor” costs
  • Clinician practice expenses
  • Malpractice insurance costs
  • Cost-of-living differences from region to region

How is productivity determined?

The end result was the RVUs that are used today to measure clinician productivity across the landscape known as medicine. Today, productivity is based upon such indicators as:

  • The number of procedures performed
  • Billing amounts
  • Payments received

CPT examples

In medical imaging, RVUs are also in play, including the various RVUs involved in daily practice. Here are some recent CPT codes with assigned RVUs derived from a radiology RVU list:

  • Chest x-ray (2 view): physician work unit, 0.22 RVUs; practice expense unit, 0.08; malpractice unit, 0.01; total RVU assignment, 0.31.
  • CT abdomen/pelvis with contrast: physician work unit, 1.82 RVUs; practice expense unit, 0.68; malpractice unit, 0.10; total RVU assignment, 2.60.

Indeed, the art of assigning RVUs is a complicated but necessary process, especially as medicine—and radiology—becomes more and more complicated. If productivity and fairness, while at the same time holding down costs, are the end goals, then RVU radiology will have to do until something more efficacious is developed.

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