Physician Compensation Requires Knowledge of Relative Value Units (RVU) and An Appropriate Conversio
In Oncology, the infusion codes include a physician work RVU that is part of the office based infusion codes. The hospitals’ payments are not based on RVU, but hospitals can use the office based RVU numbers to calculate their physician employment compensation amount.
The conversion factor and RVUs must be accurate and not overstated, as this could signal a Stark violation. This means any conversion factor above $80 would be considered excess compensation and would fail the test of fair compensation. One major concern is efficient physicians who work long hours and use extenders that create RVUs in the 90 percentile or higher. This suggests that RVU numbers from national publications are not accurate as they include university setting physicians, part-time physicians or physicians who only work a 32-hour work week. This can affect the average national numbers that result in efficient physicians’ numbers being outside the bell curve. This then suggests that providers who are efficient (and their numbers put them in the 55% or higher bell curve) need to be proactive in explaining their proactive patterns.
There must be clear written policy that attempts to identify what types of patients require a separate evaluation, since patients who present for infusion therapy with no complaints or symptoms should not require a billable evaluation RVU by the provider. The provider should still see these patients and track the non-billable visits as separate RVU to offer proof the provider is not gaming the system to be overpaid. Instead, the providers are still evaluating the patients and not sending them to the nurse who is not qualified to evaluate the patient to approve the patient for treatment. See my blog for articles about Modifier 25 and why E/M codes Are Failing Us for further details.
It is important to identify the physician practice standards that include patient satisfaction and information this outlier is following (national clinical standards such as NCCN).
The end point is that physicians who are paid using an RVU formula and use national data to validate their practice RVUs and their numbers, fall outside the bell curves ad should take precaution to validate their numbers to reflect work and supervision of patient care. Otherwise, they risk being charged with a Stark referral kickback and excessive compensation by Federal and State authorities.