Friendly competition has developed among the five radiologists of Capital Imaging Associates, Albany, New York, to the benefit of referrers (and, potentially, to patient care). Six months ago, the group implemented an RVU-based system for productivity tracking, which has allowed the physicians to gain awareness of their individual caseloads and how they stack up against those of their colleagues. The ultimate goal is to improve efficiency and maintain the group’s current position as the radiology practice with the fastest turnaround time in its county.
Michael Gabor, MD, MBA, managing partner of the group and chair of the medical imaging department at Albany Memorial Hospital, explains, “At the margin, I’ve been pushing myself. Instead of any animosity, it’s been more that if I have someone breathing on my heels, I’m going to push myself more. It’s a friendly competition, and I think that’s a healthy thing.”
In the late 1980s, the ACR®, together with the DHHS, created the ACR RVS. The mission was to use a value scale to show the relative amount of work input for the various types of imaging exams, and to scale reimbursement appropriately under the Medicare program. Values were assigned to the professional and technical components of exams. In 1992, HCFA implemented the more comprehensive RBRVS, an adaptation of the earlier ACR RVS. According to the RBMA, the RBRVS differed in one major respect: For each code, the RVUs assigned to the professional component were subdivided into expenses for work, practice overhead, and malpractice risk.
Gabor has been interested in RVUs for about a decade, ever since reading about the management tool in medical journals. From 2002 to 2006, he intermittently received a monthly RVU report, which he says “was essentially useless because it was just a small snapshot in time.” Due to skepticism from the group, as well as an antiquated RIS, however, fully implementing the system was never more than a pipe dream for him.
That all changed two years ago, when the group hired Medical Imaging Specialists (MIS), a consulting company based in Hammond, Louisiana. By this time, Gabor had become managing partner. When he began talking with MIS about RVUs, he discovered that the company would be able to help mine the relevant data. Gabor started discussing RVUs during meetings, and eventually, the radiologists became more comfortable with the concept. With the company’s help, the practice’s billing partners were able to cull the necessary data from its RIS, and the data can now be manipulated in a way that allows RVU calculation.
Since earlier this year, the group has been able to look at monthly RVU reports broken down by individual radiologist; in addition, it can see the group‘s total RVUs compared with national-average benchmarks by site and by modality.
The productivity-tracking tool was initially greeted with skepticism by some of Gabor’s colleagues, but he attributes this to a fear of the unknown. “You can’t manage what you can’t measure,” Gabor says. “Every person thought he or she was doing more work than everybody else, so people were sometimes disgruntled.” Gabor says that some of the group’s radiologists were not happy with their existing compensation scheme, which divided the pie equally among the partners. “On the surface, that sounds very fair, but in practice, it incentivizes mediocrity, in my opinion,” Gabor says. “There is no incentive to go the extra mile or push the gas pedal to the floor. If you lag, there is no penalty. If you surpass others, there is no reward.”
Gabor admits there might have also been a subconscious fear among the radiologists that salaries would decrease for certain people with lower RVU totals, or that RVU tracking could fuel in-house fighting. Keeping in mind the group’s concerns, Gabor argued his case, pointing out that the system would be used for informational purposes at first, not to shake up salaries.
In time, the group started to warm up to the idea, and the radiologists have become increasingly comfortable with the concept. “Thanks to the help of our consultants, RVU analyses as part of the monthly practice meetings have been very clinical, matter-of-fact presentations,” Gabor says. “There have been some good discussions, and nobody has been singled out; I think some behaviors have changed just because we’ve been showing the numbers.”
Although Gabor praises the use of RVUs, he does concede the