Relative value units (RVUs) are a measure of value used in the United States
Medicare reimbursement formula for
physician
A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
services.
RVUs are a part of the
resource-based relative value scale Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).
RBRVS assi ...
(RBRVS).
Background
Before RVUs were used, Medicare paid for physician services using "
usual, customary and reasonable" rate-setting which led to payment variability.
The
Omnibus Budget Reconciliation Act of 1989
Omnibus may refer to:
Film and television
* Omnibus (film), ''Omnibus'' (film), a 1992 French short comedy film
* Omnibus (broadcast), a compilation of Radio or TV episodes
* Omnibus (British TV programme), ''Omnibus'' (British TV programme), an ...
enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed.
The services are classified under a nomenclature based on the
Current Procedural Terminology
The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...
(CPT) to which the
American Medical Association
The American Medical Association (AMA) is an American professional association and lobbying group of physicians and medical students. This medical association was founded in 1847 and is headquartered in Chicago, Illinois. Membership was 271,660 ...
holds intellectual property rights.
Each service in the fee schedule is scored under the
resource-based relative value scale Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).
RBRVS assi ...
(RBRVS) to determine a payment.
Use
For each service, a payment formula contains three RVUs, one for ''physician work'', one for ''practice expense'', and one for ''malpractice expense''. On average, the proportion of costs for Medicare are 52%, 44% and 4%, respectively.
The three RVUs for a given service are each multiplied by a unique geographic practice cost index, referred to as the GPCI adjustment. The GPCI adjustment has been implemented to account for differences in wages and overhead costs across regions of the country.
The sum of the three geographically weighted RVU values is then multiplied by the Medicare conversion factor to obtain a final price.
Historically, a private group of 29 (mostly
specialist
A specialist is someone who is an expert in, or devoted to, some specific branch of study or research.
Specialist may also refer to:
Occupations
* Specialist (rank), military rank
** Specialist (Singapore)
* Specialist officer, military rank in ...
) physicians—the
American Medical Association
The American Medical Association (AMA) is an American professional association and lobbying group of physicians and medical students. This medical association was founded in 1847 and is headquartered in Chicago, Illinois. Membership was 271,660 ...
's
Specialty Society Relative Value Scale Update Committee
The Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee (RUC, pronounced "ruck") is a volunteer group of 31 physicians who have made highly influential recommendations on how to value a physician's work when ...
(RUC)—have largely determined Medicare's RVU physician work values.
See also
*
Healthcare Common Procedure Coding System The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).
History
The acronym '' ...
References
External links
The BasicsFederal RegisterMedscape.com*
*
*{{cite news , title=The hidden public-private cartel that sets health care prices , author=Darshak Sanghavi , newspaper=
Slate
Slate is a fine-grained, foliated, homogeneous, metamorphic rock derived from an original shale-type sedimentary rock composed of clay or volcanic ash through low-grade, regional metamorphism. It is the finest-grained foliated metamorphic ro ...
, date=Sep 2, 2009, url=http://www.slate.com/articles/news_and_politics/prescriptions/2009/09/the_fix_is_in.html , accessdate=January 7, 2012
Work RVU Calculator
Medicare and Medicaid (United States)