Keelan: The patient is no longer the focal point

By Don Keelan

Not too many years ago, when you went to see your medical provider, you were the focal point. In the ensuing years, that has changed. Today, you are still greeted by a medical provider, who holds an IPad, and it is that device that is the focus of attention.

Your provider is concentrating on a list of acronyms: RVUs, CPT, GPC, CF and EMR. The most important to the provider is the RVU (Relative Value Unit), and for good reason: it will form the basis for what you are being charged.

Not to get bogged down in the terminology, RVU is a coding system that enables the provider’s employer to bill third parties for the services provided to you, as well as the basis of the provider’s compensation.

If you are seeing a family practice provider for a “simple exam,” there is an RVU numerical factor assigned. And for illustration purposes, I have assigned a factor value of 1.0. If you were seeing a cardiologist for coronary angiography, he or she would assign an RVU of 4.54 to your visit.

The RVU also has a monetary value assigned by CMS, the Centers for Medicare and Medicaid Services, in Maryland. Depending on where a provider is located (this is the GPC, Geographic Practice Code), the RVU dollar (in the case of the family practice provider, say $47) multiplier can be much different.

The CMC, in valuing all 7,800 codes (by last count), takes into consideration the provider’s practice experience, professional liability and practice expense. It costs a provider much more to practice in New York City than in Rutland, Vermont.

Now comes the time-consuming and data-entry role of the provider. If the patient requires labs, injections or scans, the RVU of 1.0 noted above can be raised to, say, 1.5 times the $47. In other words, the provider doesn’t get compensated $47 for seeing Mr. Smith, and instead receives $70.50 (1.5 times $47). This is what the provider earns, not what is billed to third parties, which is much more.

And herein lies the problem for both patient and provider. If a provider feels more time needs to be spent talking to the patient (or patient’s family), as well as not seeing the need for additional tests, labs, or scans, the provider’s compensation will be negatively impacted.

Under the RVU system of coding, and its adoption by employers as a formula for compensating their providers, the more patients are seen and other services prescribed, the more one is compensated. As a patient, you must have wondered why a visit is 20 minutes and out the door.

To earn $270,000 for 48 weeks, a family practice provider would need to generate 5,760 RVUs annually, which translates to approximately 24 patients and 20-minute visits per day.

Of course, all of this comes under the auspices of having health care institutions convert to Electronic Medical Records (EMR), a policy that was mandated by the federal government. EMR was sold to the public as being the panacea for having a patient’s medical records available anywhere and at any time. While in many cases that might be valid, let’s not be snookered. RVU is a billing coding system that has grown into a nightmare for providers.

Epic, a major supplier of the software for EMR and a privately owned multi-billion dollar company located in Verona, Wisconson, has done a thorough job in convincing the government and major health care institutions of the benefits of their EMR coding systems. Billions of dollars have been paid to convert to Epic — Duke University Health Systems ($700 million), University of Vermont Medical Center ($150 million), and Dartmouth-Hitchcock ($80 million), as well as many of America’s top health care centers.

I am not smart enough to understand why the EMR software is so costly. Nor can I answer the larger question — where is all of this taking us?

Don Keelan writes a bi-weekly column and lives in Arlington, Vermont.

Image courtesy of Wikimedia Commons/Walleigh

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