Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and specialty.

For instance, in an RVU-based salary structure, if a 15-minute office visit is assigned an RVU value of 0.7, and a doctor is paid $35 per RVU, that visit will add $24 to a physician’s yearly salary.

Just for comparison’s sake, a colonoscopy, which may take twice the time, is valued at close to 6 RVUs, which is 8-times the value given to a 15-minute primary care office visit.

But I digress.

The reason I bring this up is that Boston Globe columnist Sam Allis talks about the issue, and interviews a few select Harvard physicians about its flaws. Physician-author Jerome Groopman, of How Doctors Think fame, rightly notes that the system does not value some of the truly important things that doctors do: “There are no RVUs for spending an hour with a grieving family, or a colleague who wants you to lend him your brain on a case. There are no RVUs for sitting with a confused third-year medical student. There are no RVUs for the humanistic core of medicine that drew me into this profession in the first place.”

I would also add that although there are RVUs for talking over the phone with a patient, or communicating via e-mail, they are rarely paid for by Medicare or insurers, and hence, worthless.

Perhaps instead of searching for ways to re-invent systems to pay doctors, modifying the RVU system to value, and having the insurers to recognize, this type of work will go a long way to incentivize doctors to provide the type of care that’s truly important to patients.

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