Over the last few weeks I have talked to several primary care physicans throughout the country about increased burdens associated with the field, and the one thing that comes up in every single conversation is the need for RVU payment reform. Currently, physicans are paid or reimbursed for their services based on a Relative Value Unit (RVU) system, which assigns a service code and a unit value for hundreds of medical services that physicans perform. Unfortunately, this system has been designed to undervalue or completely ignore an entire range of primary care services and care coordiation,
"Because patients tended to have insurance for many procedural services provided by surgeons and other specialists at that time, fees for these services were already much higher per time spent then fees for primary care visits, which were rarely covered by insurance. As a result a wide discrepancy between primary care payments and specialty payments was wired into the system from the beginning. For example, a brief follow-up visit in a primary care doctor’s office might have an RVU of 1, while a comprehensive hospital visit might have an RVU of 7. Payments would be based on these RVUs multiplied by a conversion factor (determined by the insurance company).
So let’s say you broke your arm and your insurance company gives that injury a conversion factor of five. You go to your GP’s office for the follow-up visit. Your GP would receive $5 (1RVU X $5) but if instead you decided to go back to the hospital for the same follow-up treatment the attending physician would receive $35 (7 RVU X $5)."
Interested in an indepth look and history of RVU's? Click here.
There is little hope at increasing primary care access if we are unable to attract quality physicans to the field. Reforming RVU payments to adequately reimburse primary care physicans for the care they provide is essential to decreasing the compensation gap and increasing the number of primary care phyiscans nationally.
