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Economic Realities of Cardiology - 2015

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Eric Grubman

on 19 February 2015

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Transcript of Economic Realities of Cardiology - 2015

How to Succeed in Cardiology
Economic Realities of Cardiology - 2015
Eric Grubman, M.D., FACC, FHRS
How do I earn money?
How does my employer earn money?
What changes are afoot?
How do I succeed?
Professional RVUs
Physician Work (52%)
Practice Expense (44%)
Malpractice Expense (4%)
Geographically weighted
Medicare conversion factor
Facility vs. Non-facility
Technical RVUs
2009 Non-Facility Payment Amount = [(Work RVU * Work GPCI) + (Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * [Conversion Factor adjusted for budget neutrality]
Your Government at Work
Mrs. Smith sees you for her coronary disease (remote stent) and blood pressure check.
15 minutes in the office, no medication changes
Level 3 office visit
CPT code 99213
RVU = 1.0
RVU Calculation Example
99213 = 1.67 RVU’s includes work (0.97) and practice, malpractice, geographic adjustment
Conversion factor = amount of money you get per RVU:$ 34.0376( geographically adjusted, not specialty specific)
The maximum allowable charge that medicare will approve for the visit is 1.67 x 34.0376 = 56.84
Medicare pays you 80% = 45.47
Try to collect $11.37 from the patient or co insurance
RVU Calculation Example - 2
20970 Bone/skin graft, iliac crest A 44.26
33503 Coronary artery graft A 22.29
99291 Critical care, first hour A 4.5
99213 Office/outpatient visit, est A 0.97
Examples of Work RVU’s
What If there are Multiple Codes?
EP Study with arrhythmia induction - 100%
EPS with LA recording - 50%
EPS after IV drug infusion -50%
Advanced (3D) mapping -50%
RFA of SVT - 50%
Trans-septal catheterization - 50%
How does the Boss make Money?
Employee vs. "Private"
Technical component
Possible professional component
"Pay for performance"
Private Practice
Professional RVU Component - all yours
Technical RVU component - all theirs
Relative Value Unit (RVU)
Based on CPT codes
Attempts to equalize all work
Yields professional component and technical component
Professional component - M.D.
Technical component - Owner
What Changes are Afoot?
Differential Reimbursement
Practice expense RVU
Cut to private practice
HOPPS payment
NET: More money for hospitals/less for Private practice
Pay for performance, ACOs
Changes in Employment
Hospitalist Compensation Survey 2009 Data
Incentives to Produce: Expect Them
How to Succeed
Evaluate landscape
Opportunities inside practice
Opportunities outside practice
Identify competition
Identify growth areas
Provide excellent service
Your Government at Work
Employed Physician
Professional RVU component
- all theirs
Technical RVU component
- all theirs
Other revenue streams
Pay for performance
Research grants
HOPPS payment
Evaluate Landscape
Referral sources
Inside practice
Outside practice
"The patients is the power"
Identify Competition
Referral patterns are difficult to change
Identify Growth Areas
New procedures
Create a niche
Underserved areas
Create a niche
Provide Excellent Service
Do a good job
Don't overpromise
Eliminate phone calls
Sample Codes
EPS w/ induction - 7.31 wRVU
EPS p IV drug infusion - 2.85 wRVU
3D mapping - 6.99 wRVU
RFA of SVT - 15 wRVU
RFA of VT - 20 wRVU
RFA of AFib 20.02 wRVU
Changes in Compensation
For the Observant
For the Observant
Cardiology Fellowship
29th Grade
DDD Pacer implant - 8.77 wRVU
VVI ICD implant - 15.17 wRVU
LV lead implant - 8.33 wRVU

Office pacer check - 0.77wRVU
Carelink - 1.29 wRVU
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