RVUs and Provider Burnout: Is There a Connection?
Key takeaways:
Relative value units (RVUs) assign a reimbursement value to each procedure a healthcare provider (HCP) performs. This affects a healthcare organization’s revenue.
Many healthcare organizations measure HCP productivity through RVUs. They use RVUs to determine compensation packages for HCPs.
RVU-based compensation values quantity over quality and creates environments where HCPs can’t complete their administrative work without taking it home. This contributes to HCP burnout.
Relative value units (RVUs) are used to calculate reimbursement provided to healthcare providers (HCPs) for the medical services they render. RVUs have also become a way to capture the productivity of HCPs. Ideally, the work involved in caring for the patients can be captured and reimbursed rather than just the number of patients seen each day. However, the reality seems otherwise.
The RVU system is not without critics. Even though it allows for a standardized reimbursement system, it fails to reflect administrative tasks, complex patient care, and quality of care. Some factors of burnout in HCPs include larger required workloads to meet RVU targets and a culture hyperfocused on RVU-based productivity.
RVUs basics
In the U.S., the RVU is the most widely used measure of clinical productivity. The exact formula for calculating RVUs is complex, but each Current Procedural Terminology (CPT) code essentially corresponds to an RVU that determines total payment. Many healthcare organizations set targets for their clinicians based on RVU measures. HCP compensation is based on their ability to meet these targets. Unfortunately, the potential for a quantity-over-quality scenario is all too common.
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While practices base HCP compensation on RVU productivity models, many HCPs don’t understand the models and have difficulty meeting targets. Additionally, the RVU model seems to give an advantage to specialists. Procedures and surgeries have a higher RVU than office visits. Office visits for complex patients that require counseling and disease management do not generate the same RVUs as procedures that could be performed in the same amount of time.
Primary care providers can recover some of this work if they participate in a program for chronic care management. The downside, however, is the documentation required to support the services. More documentation requires the HCP to find the time to document in addition to seeing the required numbers of patients each day.
The impact on burnout
Over 50% of today’s HCPs report burnout. Burnout’s harmful effects are well documented and include:
Negatively impacted personal relationships
Higher risk of substance abuse
Higher professional turnover
Lowered productivity
Reduced quality and safety of patient care
Relying on RVU generation as a measure of productivity contributes to stress and burnout for HCPs who are seeing more patients with higher demands for electronic health record (EHR) documentation and administrative tasks. HCPs often end up spending an additional 2 hours charting for every hour of direct patient care. This extra time usually occurs at home after regular clinic hours and cuts into an HCP’s personal time.
Today’s HCPs suffer a serious lack of work-life balance. HCPs rely on face-to-face visits to earn revenue. But a full schedule means even more time completing EHR tasks after clinic hours that are often uncompensated.
HCPs may find themselves professionally isolated and lonely, too. Time that can be spent networking with other colleagues is now spent staring at the computer screen, grabbing a quick lunch at your desk while charting, and keeping up with productivity demands.
In reality, RVUs capture only one aspect of clinical care: the volume of patients seen. And all the other necessary HCP activities that do not generate revenue are uncompensated. Uncompensated care reflects a wide range of activities, such as:
Charting after the clinic visit
Phone calls to patients to coordinate care
On-call hours
Teaching and precepting students, residents, and fellows
Peer-to-peer calls
Medication changes and charting between office visits
Reviewing lab and test results
Reviewing records
Hospital committee meetings and other mandatory meetings
Prior authorizations
Continuing medical education activities
Unfunded research and assisting trainees with mandatory research
HCPs experience moral injury when there is a direct conflict between their desire to meet patient needs and provide optimal care versus business-oriented and profit-driven healthcare environments. These types of conflict can lead to:
Physical and emotional exhaustion
Restricting practice to focus only on direct patient care
Leaving academic settings of practice
Early retirement or leaving the practice of medicine
Considering other practice environments, such as a cash-only practice
Working within a broken system
Unfortunately, RVUs compensation systems are not the best method. But they are the system most HCPs are required to work under. Future improvements to compensation models would recognize clinical work and quality, education, and research. Methods to capture value-based measures — such as patient outcomes and rehospitalization rates — would make sure that increased productivity is not at the expense of quality.
HCPs functioning in an RVU-based system must look for ways to ease their current burdens, which is not an easy task. Consider ways to reduce administrative duties with assistive personnel like medical assistants and scribes. Workflow redesign that includes the use of these personnel can help take the pressure off HCPs when they delegate tasks that don’t require an HCP’s skill set.
The bottom line
RVU compensation systems contribute to HCP burnout rates when they value quantity over quality. Pressures to meet numbers, along with a lack of support for completing complex documentation requirements, leave HCPs with a profound lack of work-life balance. Future compensation models must include ways to account for the non-revenue generating activities required to provide quality patient care.
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