Job offer based on RVU's

Jules A, MSN · Oct 7, 2015

I think some of it will depend on how quick and efficient you are. I liked it because when I'm being killed I like to know I'm making more money. When I worked for strictly wRUVs my rate was $24 per. My lowest quarter ended up being $80 an hour which at that time I felt was good money.

Nacki, MSN, NP · Oct 7, 2015

Hey Jules!

I love reading your posts and value your insight. Do you have any literature on RVU's or did your school teach you about this model? And was your job based strictly on RVU's after years of experience or when you were fairly new?

This would be a new field for me obviously, but I'm pretty quick on my feet. I did Cardio as a RN and although I know it doesn't quite compare I'm familiar with common diagnoses and medications for the specialty. I would have a few weeks of training from the doctors and on the EMR for all facilities.

Jules A, MSN · Oct 7, 2015

My school didn't tell us squat about any sort of negotiating or salary expectations and in fact they didn't even discuss the difference between employee and 1099 status. Some people I graduated with took 1099 jobs without understanding the implications. I guess I was fortunate that I tend to be business oriented and had great mentors so I knew much of this from before I got my NP.

The hospital offered it to me after six months because I asked for more money and that was the model the physicians were reimbursed. They told me what my wRVU would be, gave me an estimate based on my previous quarter and told me the number of wRUVs each of the different billing codes was worth so I could figure out a rough estimate of what my hourly wage would be.

PG2018 · Oct 7, 2015

I think it's a bad idea really.

Time, skill, effort, and stress are considered in the RVU.

How do you know you'll make 550 or more? Who are you working for, and do you know how many patients they carry?

It sounds like you've got a subspec. position and need to ask for more money. I think you first need guaranteed income, via salary, with productivity factored in beyond that. I like in the south, and when there's ice on the ground few people go to work. Those that do, get there late. Any driving movest at like 15mph. That being said, in a circumstance of your own you could be in a position to not see, or see very few, patients for several days. Then what? You'd be taking a big hit.

At roughly 550 RVUs / 22 work days per month you're looking at $400 each work day. On days where it takes longer to drive from one site to the other you'll see less patients. Are they paying mileage and travel time? They need to be. I infer that you're in a really big city.

I don't want to crush your aspirations, but it looks like a physician group is trying to crush your soul. If you were confined to a sky scraper of elderly heart patients I'd say go for it, but you're traveling and trying to be productive on top of that. I don't see this as efficient, and I think you'd end up stressing over making sure you get where you're going and that you're seeing enough patients. I'd run, but that's just me. I like security.

jer_sd · Oct 8, 2015

With this patient population you will primarily be seeing medicare patients.

Look up the medicare reimbursement for RVUs in your area. Keep in mind you get 85% of the physicians fee schedule.

Look up the E+M codes for nursing facilities and other cpt codes you will be billing for. Look at over all reimbursement and how much you will get.

Personally I am a fan of "eat what you kill" for NPs. It is fair and rewards effort. However make sure your share is fair.

Jeremy

https://www.cms.gov/apps/physician-fee-schedule/overview.aspx

99308 is a follow up worth 1.16 RVU in my area physician reimbursement is 71.86 so collection from medicare is about 48.86 for a np assuming no secondary payer and pt does not pay obligation. So if you get 16.02 that would be 1/3 of collections. Keep in mind your reimbursement may be higher or lower so check the payment in your area.

Nacki, MSN, NP · Oct 8, 2015

With this patient population you will primarily be seeing medicare patients.
Look up the medicare reimbursement for RVUs in your area. Keep in mind you get 85% of the physicians fee schedule.
Look up the E+M codes for nursing facilities and other cpt codes you will be billing for. Look at over all reimbursement and how much you will get.
Personally I am a fan of "eat what you kill" for NPs. It is fair and rewards effort. However make sure your share is fair.
Jeremy

I have no problem of hard work, but like PsychGuy mentioned earlier I also like stability. I would be going to 2-3 facilities per day. No telling where they would be, the practice manager said it would be no further than 30 miles from my home.

This is a new venture for the company although they already do PM&R in other facilities. I'm already leaning towards saying "NO" to this offer.

A few other things that threw me off during the interview:

- No vacation! They justified it by saying paying PTO would leave providers making less than they would if they just took off for a week???

- No clear holiday schedule (don't know if you work or if you're off, just see your patients)

- What if the LTAC census drops?

- No clear answer to whether or not call is required

There are way too many variables that make this a viable offer for me. Thanks for your input..I was really just interested if any other providers worked strictly off of RVU's.

PG2018 · Oct 8, 2015

There are entirely RVU practices, but they pay more than the token youve been offered and have a stream of patients. Any time you go to the patient you're losing money because of lost time.

Jules A, MSN · Oct 8, 2015

There are entirely RVU practices, but they pay more than the token youve been offered and have a stream of patients. Any time you go to the patient you're losing money because of lost time.

And with regard to call you can count on it. Anytime we have a "patient load" we will have to take calls about status changes, labs, meds etc.

Nacki, MSN, NP · Oct 8, 2015

Thank you for the looks links Jeremy. That's an eye opener. Not only will I be working more, it seems as if I'll be making less and I'll have to work my butt off for money but no real quality of life if I'm always at work or on call.