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AAFP Calls For Revisions to RVU Formula

Cheryl Clark, for HealthLeaders Media, July 25, 2011

Should payers add a "C" – to reflect 'cognitive value' – to the physician relative value unit (RVU) formula and thereby increase primary care physician pay? Would that help improve the supply of family physicians, pediatricians and internists?

The American Academy of Family Physicians thinks so, and has created a special task force to increase efforts to add cognitive value to the relative value unit physician fee formula, which now consists only of work, practice expenses and malpractice costs.

Yes, it's another task force. But this time, things are getting serious. The issue has been brewing for decades but recently reached a bubbling point – spawning the task force – because of two key factors, explains Lori Heim, MD, AAFP's immediate past president and task force chairwoman.

First, there's a gap – as there should be – between what primary care providers get paid by the RVU versus what specialists or proceduralists get paid, she says. But it is far too wide considering the amount of work a primary care provider has to do to take care of a typical patient, she says.

The mean compensation of a primary care provider is less than 55% that of other medical specialties, according to a report last December from the Council of Graduate Medical Education (COGME), these elements threaten the supply of primary care providers. It should be more like 70%, the report says.

Second, "the complexity of patients seen in primary care offices has changed over time so that today it is far more complicated, with far more co-morbidities," Heim said in a telephone interview. "People don't just come in with a sore throat. Today, it's 'I have depression, diabetes, a past heart attack and by the way, I also have a sore throat.' "

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2 comments on "AAFP Calls For Revisions to RVU Formula"


Marilyn Masick (7/25/2011 at 10:50 AM)
The RVU's were developed, and include the work expense component. This, combined with the Medicare points system and the CPT levels of E and M, codes result in the cognitive function being included. This is already a part of the current E and M documentation system. Adequate and appropriate training on E and M would be good for someone who doesn't understand how that works.

Jacob Kuriyan (7/25/2011 at 9:41 AM)
Improving reimbursements to all doctors who provide time consuming "cognitive" services in a "[INVALID]ive manner" is desirable. I go beyond family practitioners and include neurologists, for example, in this preferred group. Simply paying more for a particular procedure code ( as we do currently) will not work as it will also reward specialists who use such codes, whether they provide time consuming cognitive services or not. There is a serious omission in the article. The origin of this disparity can be laid at the feet of primary care physicians and their professional groups. When the California Medical Association invited physicians to participate in designing RVS codes (precursor to CPT codes in use today) only specialists showed any interest in working on it. With few if any PCPs involved it is no surprise that "procedure" based practices were amply rewarded. Once adopted by insurers, California suregeons saw their incomce sky-rocket compared to their PCP colleagues. There is a lesson to be learned here. Organizations like AAFP must play an active and positive role in health reform related activities (ACOs, PCMHs etc.) and not sit on the side-lines complaining about "Obamacare". They should focus on PCP issues and figure out a way to help them thrive under health reform initiataives.