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AAFP Calls For Revisions to RVU Formula

Cheryl Clark, for HealthLeaders Media, July 25, 2011

Forget just for a moment, the other controversial issues swirling around physician pay such as the GPCI (geographic practice cost index) and the SGR (sustainable growth rate). This is about recognizing that primary care doctors – geriatricians, internists and pediatricians in addition to family docs, have to really think about their patients in a different, more expansive way, now more than ever before.

In fact, Heim says, that level of skill required, and the difficulty involved may much more closely reflect the value now placed on a cardiologist's placement of a stent in a coronary artery or a gastroenterologist's removal of a polyp during a colonoscopy.

"We as the academy are saying there's a problem with the methodology by which we looked at payment for fee for service primary care," she said. Heim emphasized that this is not about saying, "Pay us more," although that is clearly one end result. "We're saying the way we've looked at fee for service, the formula is flawed because it does not recognize the work effort and complexity that goes into it."

AAFP says that if the nation does not want to further erode its supply of its front line physician workforce, it needs to find a way to compensate for this part of their extra workload.

"When the formula for the RVU was set up, the folks who did that did a fairly good job of being able to capture procedures, for example, how much work went into it, how much malpractice risk was there. The current system is pretty good about what that might be worth," she said.

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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.