How to Keep Your Income Up as RVUs Transition Away

Deborah Walker Keegan, PhD


January 03, 2013

In This Article

What Value-Based Reimbursement Means to You

We are in the midst of an extensive experiment in the United States to test out new reimbursement models for physician and hospital services. Although the end-state model is uncertain, 4 models are emerging as promising replacements to the current volume-based approach:

• Bundled payment;

• Pay-for-performance;

• Shared savings; and

• Fixed fee.

Bundled Payment Models

Bundled payment models focus on care coordination, essentially requiring Part A (hospital) and Part B (physician) providers to work together and align care, sharing a single fixed-fee payment for a bundle of services provided. Physicians who remain focused on RVUs will perpetuate a volume-driven focus that runs counter to the fundamental tenets of the bundled-payment demonstration projects currently under way.

Pay-for-Performance Models

Pay-for-performance models involve enhanced fee-for-service reimbursement provided that specific quality, cost, and technology metrics are met. Because RVUs measure volume, not performance, reliance on RVUs can actually negate the tenets of pay-for-performance, which is to demonstrate value, defined as high quality at low cost. The right care at the right time with the right outcomes may be volume-driven, but a fundamental shift to value-based measures will probably be needed to ensure a laser-like focus on outcomes.

Shared-Savings Models

A shared-savings model is intended as an intermediate vehicle to foster collaboration and integration of disparate entities, such as hospital and physician groups joining to form Accountable Care Organizations. It is an intermediate model because a diminishing point of return will eventually be met, with little or no additional savings to be wrung out of the delivery system over time. Care collaboration, resource-sharing, shared decision-making with patients, and other value-driven delivery strategies require a focus beyond service volume. A continued reliance on RVUs is nonsensical if the intent is to identify care that may not be needed for a patient or to emphasize preventive care in these models.

Fixed-Fee Models

Fixed-fee reimbursement, such as a global rate for the care of an individual patient or patient population, also will not be well served by the RVU system. Patient population health relies on prevention and wellness, doing more with less, and providing seamless care coordination and collaboration, not churning services or continuing in an individually focused world with each specialty or physician-maximizing reimbursement streams.