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Medical Group Management Association

RVUs: Applications for Medical Practice Success, 3rd edition

Book -

RVUs

Risk & Compliance

SKU: 8539

Overview

ISBN#: 978-1-56829-396-7

The third edition of this perennial bestseller from MGMA is filled with examples, calculations and spreadsheets, and is the single-best source for information on applying RVUs in medical practices.

Relative value units (RVUs), based on Medicare’s Resource-Based Relative Value Scale (RBRVS), have proven to be the most popular tool for measuring key elements of medical practices’ fundamental activities, such as physician productivity and procedure costs.

Using RVUs as a basis for measuring what your practice produces and how much it costs affords greater confidence when making decisions regarding physician compensation, new service lines, payer contract negotiation and more.

What's New in the 3rd Edition

  • Using updated models to determine physician compensation
  • Compliance risk analysis using RBRVS
  • RBRVS-based cost accounting from a lean perspective
  • Advanced statistical analysis

Find in-depth knowledge on RVU applications, including:

  • Tracking physician productivity
  • Determining practice visit trends
  • Conducting cost analyses and allocation
  • Developing fee schedule
  • Negotiating managed care contracts
Frank Cohen

Frank Cohen , MBB, MPA

Director, Analytics and Business Intelligence, Doctors Management LLC

Mr. Cohen is a computational mathematician with a focus on applied statistics, data mining, predictive analytics, and machine learning. The author of several books, including, “Lean Six Sigma for the Medical Practice” and “RVUs: Practical Applications for Medical Practices,”  Mr. Cohen has participated in and published numerous articles and studies and trained thousands of physicians, administrators, CPAs, and other healthcare professionals in all areas of healthcare analytics. His experience includes eight years as a Physician Assistant in both the Navy and as a civilian, clinic administrator and hospital CEO. His clients include hospitals, large and small medical practices, medical and professional associations, legal and accounting professionals, government agencies, and other healthcare professionals.

Chapter 1 - Understanding Information Technology

  • What is Information Technology?
  • How is Information Technology Used in the Medical Practice?
  • Where Did Information Technology Start?

Chapter 2 - The Essentials of the Resource-Based Relative Value Scale

  • What is a Relative Value Scale?
  • What is the Resource-Based Relative Value Scale?
  • History of the Resource-Based Relative Value Scale
  • Use of the Resource-Based Relative Value Scale
  • Understanding the Resource-Based  Relative Value Scale Model
    • Relative Value Components
    • Geographic Adjustment Factor Components
  • Calculating the Adjusted Relative Value Unit
  • Calculating the Medicare Fee Schedule Amount
  • Facility vs. Non-Facility Procedures
  • Sample Geographic Adjustment Factors and Relative Value Unit Values
  • Sample Non-Facility Relative Value Unit Calculation
  • Sample Facility Relative Value Unit Calculation
  • Building the Resource-Based Relative Value Scale Table
    • Adjust Totals for Geographic Adjustment Factor Values
    • Calculate the Medicare Fee Schedule Amount
    • Modifier-Factored Relative Value Units
  • Cohen Acuity Factor
    • Development Assumptions
    • Calculating the Acuity Ratio
    • Evaluation and Management vs. Non-Evaluation and Managemen
    • Work vs. Total Relative Value Units

Chapter 3 - Understanding Conversion Factors

  • What is the Conversion Factor?
  • How is the Conversion Factor Used?
  • Calculating the Conversion Factor
  • Weighted vs. Linear Average
    • Calculating the Average Conversion Factor
    • Calculating the Weighted Average Conversion Factor

Chapter 4 - Procedural Cost Accounting

  • Data Requirements for Cost Accounting
  • A Word about Practice Expenses
  • Word about Expense Categories
  • Application of Expense Categories
  • Cost Accounting Results
  • Building the Spreadsheet
    • Total Adjusted Relative Value Unit
    • Totaling Fees and Relative Value Units
    • Calculating Expense Percent
    • Calculating the Relative Value Unit Cost Factors
    • Calculating the Cost per Occurrence
    • A Word about Collections
    • Calculating Profit and Loss Amounts
    • Calculating Break-Even Fees
    • Calculating Resource Allocation

Chapter 5 - Global Pricing and Cost Analysis

  • Application to the Physician Market
  • Ambulatory Diagnosis–Related Groups
  • Building the Global Model
    • Choose the Method for Category Classification
    • Determine a Severity Level
    • Select the Codes to be Include
    • Assign Individual Frequency
    • Calculate Total and Average Costs
  • Case Study: Humerus Fracture
    • Log the Procedures
    • Determine Average Frequencies
    • Assign Procedural Costs
    • Calculate Total Cost
  • Practical Uses for Global Pricing
    • Bidding on Managed Care Contracts
    • Negotiating with Carriers
    • Clinical Outcomes
    • Clinical Re-engineering

Chapter 6 - Measuring Physician Productivity

  • What is Productivity?
    • Old School
    • New School
  • Measuring Production
  • Measuring Expenses
  • Measuring Productivity
  • Physician Production Models
  • Calculating Collection Percent by Provider
  • Identifying Resource Consumption
    • Distribute Data by Control Totals
    • Build Revenue-to-Utilization Ratios
  • Physician Compensation Considerations
    • Calculate Distribution Amounts
    • Using Profit/Loss to Calculate Productivity
  • Calculate Profit Distribution
  • Practice Example
    • Revenue vs. Utilization
    • Productivity vs. Profit
  • Productivity Using Work Relative Value Units
    • Work Relative Value Unit Productivity Model
    • Revenue/Expense vs. Work Ratio
    • Work Effort vs. Profit/Loss Distribution
  • Using Work Relative Value Units to Assign Full-Time Equivalent Values
    • Defining a Full-Time Equivalent
    • Using Full-Time Equivalent Ratios for Compensation Calculations
  • Acuity Factoring
    • Benchmarking with Acuity Factors
  • Compensation Case Study
    • Sample Salary Distribution
  • Advanced Compensation Issues
  • Case Study Using Complex Cost Models
    • Redistributing Malpractice as a Direct Cost
    • Staff Resources as a Direct Expense
    • Distributions Based on Excess Capacity
    • Recalculating Profit/Loss by Provider

Chapter 7 - Fee Schedule/Reimbursement Analysis

  • Existing Fee Scheduling Methods
    • Medicare Fee Schedule Amount Usual, Customary, and Reasonable Values
    • Relative Value Studies
    • Surveys and Published Lists Flat Increases
    • Asking Other Physicians
  • What is a Fee Schedule?
  • Fee Schedule Philosophy
  • Methodological Considerations
  • Benchmarking Fees
    • Competitive Factor
    • Establishing the Charge Thresholds
  • Data Elements
    • Building the Spreadsheet
    • Adjusting the Fees
    • Determine the Fee Adjustment Amount
    • Establish Resource-Based Relative
  • Value Scale–Based Adjustment Amount
    • Calculate the Net Financial Impact
  • Cost Accounting
  • Time-based Calculations
  • Global Conversion Factors
  • Charge Data Comparisons

Chapter 8 - Applications to Managed Care

  • Managed Care and the Medical Practice
  • Utilization Calculations
    • Data Requirements
    • Calculate Utilization per Thousand
    • Assign Cost
  • Measuring Visit Capacity
  • Projecting Contract Volume
  • Projecting Contract Cost
  • Calculating Per Member Per Month Costs
  • Applications to Capitation
    • Socio-economics of Utilization
    • Evaluating the Rate
    • Calculating Visit and Cost Potential
    • Using Standard Deviation Models

Chapter 9 - Compliance Risk Assessment

  • The Audit Event
  • The Audit Process
  • Procedure Code Utilization
    • Data Requirements
    • Conducting the Analysis

Glossary

Index

About the Author

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