Projecting Physician Work RVU Productivity Without Survey Data

Darcy Devine
2 hours ago
2 min read

Physician employers often rely on published surveys to estimate the number of work relative value units (“wRVUs”) they can expect from their doctors. While survey data is helpful, it can be expensive and difficult to obtain. Instead of relying on survey data, employers can use a bottom-up approach to determine the level of wRVUs they should expect from their providers.

For some specialties, projecting physician wRVUs from the bottom up can be a relatively simple exercise. For example, primary care physicians working in an outpatient clinical setting who primarily perform evaluation and management (“E&M”) services will generate wRVUs within a predictable range. The following summarizes the questions, data, and calculations used to develop that range.

Employers can start by determining how many wRVU-generating hours their physicians will work each year.

In the example presented below, we estimated 184 clinic days. This assumes the physician will work a 5-day-per-week schedule and take standard amounts of vacation and sick leave. It also considers work time dedicated to continuing medical education (“CME”) and other non-wRVU-generating activities. The math is straightforward: 52 weeks per year x 5 days per week = 260 work days; subtract 30 days off, then subtract any administrative or non-clinic days (we estimated 46 days), and the result is 184 clinic days. Assuming a standard eight (8) hour day, the 184 clinic days will yield 1,472 clinical hours when wRVUs will be generated.

Next, determine how many patients can be seen per hour.

This is a bit trickier to estimate because some physicians work more slowly, while others work faster. Data for primary care physicians generally show that throughput is about 3 patients per hour, totaling 24 patients per clinic day. For our projections, we considered a lower bound of 20 patients per day (2.5 patients per hour) to 28 patients per day (3.5 patients per hour).

Finally, estimate how many wRVUs will be generated per hour.

Based on CMS utilization data for Medicare, the average wRVU per new and established patient visit for a family medicine physician is 1.75 wRVUs. If the clinic sees mostly Medicare patients, this may be a reasonable place to stop. However, a clinic will generally see a broader mix of patients. Data show that Medicare visits account for 25%-40% of physician visits in the U.S. So, for the example below, we estimated a lower bound of 1.3 wRVUs per patient, reflecting a steady stream of low-acuity, established patients. The upper bound we established is the 1.75 wRVU per patient average from the CMS data for Medicare visits.

Projecting the wRVU Range

Using the inputs described, we projected the wRVU range for employed clinic-based physicians, identifying lower, moderate, moderate-high, and high levels of wRVUs. We note that the projected wRVUs closely align with published wRVUs at the 25^th, median, 75^th, and 90^th percentiles as reported in the major physician compensation and productivity surveys for family medicine, internal medicine, and pediatrics.