Using relative value units to measure faculty clinical productivity

Abstract

The objective of this project was to compare faculty productivity in teaching and nonteaching clinical settings. We hypothesized that teaching activity would have no impact on productivity. A mixed model, repeated measures analysis of variance was used to analyze average relative value units (RVUs) billed and to test for differences between clinics. Data were drawn from 4,956 clinical encounters made within a student, resident, and faculty clinic. Average RVUs per visit were similar in the three settings. Resident supervision increased faculty productivity, while student supervision had no impact on billed RVUs. Thus, RVUs can be used as a measure of faculty clinical productivity in different settings in an academic medical center. Precepting students does not appear to affect clinical productivity.KEY WORDS: faculty productivity; relative value units; resident training; student education. J GEN INTERN MED 1997;12:715-717.cademic health science centers are coming under intense financial pressures; thus, efforts are under way at many institutions to optimize faculty clinical productivity. 1 Faculty clinical productivity has been measured in various ways: for example, number of patient visits, procedures performed, visits billed, and dollars collected. [2][3][4][5][6] These measures are inadequate if adjustments are not made for differences in practice characteristics such as the complexity of patients' diseases, variations in the length of time spent with patients, and differences in types of reimbursement for patients seen in various settings. Relative value units (RVUs) offer one way to measure productivity directly. The Health Care Financing Agency uses RVUs as the measure of physician productivity to calculate reimbursement for Medicare patients. According to this system, professional services (except for hospital based-services such as clinical pathology, radiology, and anesthesiology) are given a unique weight in RVUs based on the amount of time spent with patients and problem severity using Current Procedural Terminology (CPT4) codes. 7 Total RVUs reflect the practice costs and professional work associated with delivering a clinical service.At the same time as faculty are expected to optimize clinical productivity, many also have the added responsibility of supervising students and residents. The purpose of this study was to determine whether faculty clinical productivity, as measured by RVUs, is affected by teaching in outpatient clinics.Three clinics were compared: a medical student clinic characterized by episodes with case patients in which two students were supervised by one attending physician, a resident continuity care clinic in which four internal medicine residents at various levels of experience saw the panels of patients assigned to them and were supervised by one attending physician, and a faculty primary care clinic in which clinical services were provided by faculty who did not supervise students or residents. Our hypothesis was that teaching in outpatient clinics-either students or resident...

No relationship between measures of clinical efficiency and teaching effectiveness for emergency medicine faculty

“…It was conducted at one institution and therefore only reflects the performance of one group of faculty. However, many of our findings are similar to finding from other studies at other institutions 1 3 6…”

“…Several recent studies have questioned this perception 1 3. This paper sought to evaluate the relationship between clinical productivity and teaching effectiveness for faculty at a busy teaching hospital.…”

What If Pediatric Residents Could Bill for Their Outpatient Services?

“…Albritton et al 18 found that internal medicine attendings earned more RVUs when they supervised residents in a continuity clinic setting than they did in a private practice setting or while supervising medical students using preliminary RVU values. The Urban Institute 19 estimated graduate medical education costs to be 2055 RVUs per resident per year in their analysis of inpatient hospital expenditures.…”

Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial

“…Work RVU is a consistent measurement of productivity that has been used in previous studies; it is independent of differences in payer mix, geographic adjustment, or specialty. [46][47][48][49][50][51] We excluded malpractice and practice expense RVUs because they vary by location, and thus estimates generated using these figures would not be generalizable. We collected data on all professional services claims reimbursed to the practice for patients in the study during the study period.…”