Short version: My experience with RVUs in MCOH was unpleasant.

I signed on with a hospital with a productivity based incentive among others. They shut down the external client operations which made it somewhat hard to be "productive" when a large piece of our business went away, I was fortunate to not be in the laid off portion of staff. Over the next few years the dept pivoted to quality improvements to be productive with our new free time instead by preventing internal staff injuries and optimizing care which further decreased visits, while losing compensation for low productivity at times as incentives changed. We yielded possibly better safety but definitely lower average claims costs. It was still a bit of a fight to show that looking at $1,000,000 in decreased claims costs in my last year there might make more sense than continuing on with more abstract productivity measures that don't value prevention. The argument that RVUs correspond to money was not accepted in reverse order (AGMA has tables published on the value of RVU so you can math it out). Our Epic build also somehow didn't capture WC RVUs accurately (I had 3.7 RVUs for one entire fiscal quarter which despite the obvious absurdity wasn't even double checked) and the employee health EMR didn't report it well either as best we could tell. The silly thing is I could have had patients come back at more frequent intervals costing the system money but optimizing by RVUs for compensation, if the RVU counting had worked correctly. I personally will endeavor not to practice a prevention based speciality in a production based model based on that experience.

I would think one would really need to carefully look at what their specific clinic does and if RVUs accurately capture the totality of value output better than other measures.

Thanks,

Rob

Rob Filler, MD, MBA, MPH

OccMedSource

robert.filler@gmail.com

On Tue, Jan 28, 2025 at 1:11 PM Haq, Farah via MCOH-EH <mcoh-eh@mylist.net> wrote:

Good Afternoon,

Does anyone have experience with any RVU or incentive-based models for medical center employee health and/or for occupational medicine (not limited to medical centers)?

We are looking into possible salary plus RVU or productivity/incentive-based pay for our providers but are not familiar with models that may work for employee health.

Thank you,

Farah

Farah Haq MD, MPH

Division Head, Occupational, Environmental and Clinical Preventive Medicine

Clinical Assistant Professor

Dept. of Family, Population and Preventive Medicine

Stony Brook Medicine

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