Audio Coursesby JellypodLesson 04 of 17
Overview
Vicky Muller: Alright, welcome back to Starting Strong! Today, we’re diving into something every new hospitalist needs to understand—RVUs. That’s Relative Value Units, and honestly, if you’re just starting out, this is one of those things you wish someone had explained to you in residency. I know I did. RVUs are basically the backbone of how we get paid and how our work is measured, right?
Beth Blimmer: Yeah, and I’ll admit, when I first heard about RVUs, I thought it was just another admin thing I could ignore. But it’s actually huge! RVUs are how your work gets translated into compensation. Every CPT code you bill—like, every admission, every consult—has an RVU attached to it. And it’s not just a random number. There are three parts: the work RVU, which is your time and effort; the practice expense RVU, which is like, the cost of running the hospital; and the malpractice RVU, which covers the risk and liability side.
Mark Krause: Yeah, and the work RVU is the one everyone talks about, because that’s what most of your pay is based on. Like, if you’re doing a high-complexity admission—CPT 99223, for example—has a higher value of RVUs, but most of that is the work part. I always think of it as, the more complex the patient, the higher the RVU. But, uh, Vicky, you said learning about RVUs early helped you out?
Vicky Muller: Oh, absolutely. When I was looking at my first contract, I didn’t even know what an RVU was. But once I figured out that my bonus and even my base salary were tied to these numbers, I started tracking them every month. It made a huge difference. I could actually see if my documentation matched the work I was doing. During my first annual review with the boss, we looked over my numbers and thought things were going well. You may not feel it matters day-to-day but it does impact you and your working group. But is it’s not just about getting paid—it’s about making sure your work is valued fairly.
Beth Blimmer: And it’s so easy to miss that, especially when you’re new. Like, you think, “I’m just here to take care of patients,” but if you don’t understand RVUs, you might be leaving money on the table—or not getting credit for all the work you’re actually doing. Even things like taking extra time and getting home late. If you're going to miss dinner with the family, it's important you are billing appropriately for that time. It will be something that you have to address at some point.
Mark Krause: So, let’s talk about how these RVUs actually get set. It’s not your hospital just making up numbers. There’s this committee—the AMA RUC, which stands for Relative Value Scale Update Committee. They review and propose values for every CPT code, and then CMS, the Centers for Medicare & Medicaid Services, either adopts or tweaks them. Private insurers usually follow CMS, but sometimes they negotiate their own rates. It’s, uh, a little more complicated than I thought when I first started.
Vicky Muller: Yeah, and the other piece is the conversion factor. That’s the dollar amount you get per RVU, and it changes every year. For 2024, let's say it's about $32.75 per RVU. So, if you rack up, say, 5,000 RVUs, you just multiply that by the conversion factor to get your compensation from RVUs. But here’s the catch: that conversion factor can go up or down depending on federal budgets and policy changes. So your paycheck can change even if your RVUs stay the same.
Beth Blimmer: And that’s why it’s so important to ask questions when you’re looking at contracts. Like, what’s the base salary versus the incentive? And what’s the RVU target you’re expected to hit? I mean, you want to know if those targets are even realistic, right? I always asked what percentage of the group was meeting their targets to help ensure it was a reasonable goal.
Mark Krause: Exactly. And don’t be afraid to advocate for yourself and educate yourself. Talk to your peers or look up benchmarks for your specialty and region. It’s not just about the number—it’s about making sure you’re valued for the work you’re actually doing.
Vicky Muller: Alright, so let’s get practical. Once you’re in your job, you’ve gotta keep an eye on your RVUs. For day-to-day rounding, make sure you have a system to keep track of what you have submitted otherwise you could be missing out on real money. Also, ask about RVU reports. Set up a regular time to review your RVU reports, and don’t be shy about asking your billing team questions if something looks off. Lastly, find out if their is someone that does documentation or billing review. Usually they are more than happy to review a selection of notes and agree or disagree with your billing and why. They were very helpful for me and happy to review as they would rather catch problems on the front end rather than after submitting to insurance.
Beth Blimmer: Totally! And it’s not just about clinical work. Some places give RVU credit for non-clinical stuff—like teaching, quality improvement, or leadership roles. But you have to know your institution’s policies and, honestly, sometimes you have to negotiate for it. If you’re spending hours on committee work or mentoring, make sure you’re getting recognized for that. Otherwise, it’s just invisible labor. But, that may not be a realistic negotiation when you first start out.
Mark Krause: Exactly. I remember talking to colleagues at other hospitals and learning abut their compensation. There's were all different so take it with a grain of salt. One colleague had a very high base salary which looked great on paper but his RVU targets were very high and they barely met goal. So. no bonuses.
Beth Blimmer: Yeah, I know someone who had a good balance between base salary and bonus productivity but there was a clause in their contract that they would not personally take home the bonuses for a few years. So basically all of the money they were making was going to the bosses and not back to them. That was tough.
Beth Blimmer: Great conversation. So ideally asking about base vs bonus potential, how many group members meet their targets, and how soon can you see the bonuses come back to you is a great place to start looking at contracts.
Beth Blimmer: Yes, and I think it is important to be careful about negotiations if your collage and you are in different situations. If you are at a teaching hospital and your colleague is in a private hospital, or another in a rural setting, all of you may have different RVU breakdowns and all of them may work wonderfully!
Beth Blimmer: So, RVUs aren’t just about your paycheck—they can actually help you grow your career. If you want to boost your compensation, look for ways to increase your RVU productivity. That might mean developing new skills, like doing more procedures, or even specializing in a certain area. The more you can do, the more RVUs you can generate, and that can open doors for advancement.
Mark Krause: And don’t forget to stay plugged in with your administration and your peer network. RVU policies and benchmarks change all the time, and you want to be the first to know if something shifts. I mean, I’ve seen people get caught off guard when the conversion factor drops or when the hospital changes how they credit certain activities. If you’re in the loop, you can adapt—and maybe even get ahead.
Vicky Muller: Yeah, and one thing I always recommend is tracking your RVU trends over time. Like, actually look at your numbers month to month, year to year. Are you seeing patterns? Are there times when your RVUs dip or spike? That data is gold when you’re setting goals or going into a performance review. You can show your value with real numbers, not just anecdotes.
Beth Blimmer: And it helps you set realistic goals, too. Like, if you know what’s possible for your role and your institution, you can push for more—but you’re not setting yourself up for disappointment. Plus, it just feels good to see your progress, you know?
Mark Krause: Alright, let’s get into some real-world scenarios. Say you’re interviewing for a hospitalist job and they say, “We offer a competitive salary with RVU bonuses.” What do you ask? Well, you want to know the base salary versus the bonus structure, the dollar amount per wRVU, the expected RVU target, and how often you’ll get RVU reports. If they can’t answer those, that’s a red flag.
Vicky Muller: And if you hear, “Most of our doctors easily exceed 6,000 RVUs a year and make six figures in bonus,” dig deeper. To me, that sounds like they see a LOT of patients and while high RVUs and high bonuses sound great when you start out, it may not work over time if needing to see a large volume of patients and pull long hours each shift. Ask about support systems—do you have scribes, case managers, or advanced practice providers? Are there RVUs for procedures? Are there caps on admissions or night coverage that could limit your RVUs? And are RVUs tracked individually or pooled across teams? High bonus potential doesn’t mean much if you can’t actually hit those numbers.
Beth Blimmer: And watch out for penalties. If a job says you need to hit 4,500 RVUs a year to keep your full salary, ask what happens if you don’t meet that in your first year. Also, you may think your bonuses are tied to just your billing and productivity but that's not always the case. Sometimes groups share so what happens if you are pulling your weight but not the other folks, do you still get your share? Can they share data on how often people actually miss the target? You don’t want to walk into a situation where you’re set up to fail.
Beth Blimmer: Oh, and I have to share this—when I got my first monthly RVU report, I realized I’d been missing out on a bunch of RVUs just because my documentation wasn’t detailed enough. Once I fixed that, I actually got a bonus I didn’t even know was possible. So, documentation really is dollars. What you don’t record, you don’t get credit for.
Mark Krause: That’s such a good point. And honestly, don’t be afraid to ask all the “dumb” questions when you’re job hunting. It’s your career, your paycheck, and your sanity on the line. It is okay when you start to clarify how hey onboard new docs? Do non-clinical duties count toward your RVUs? You may be able to ask your program about a billing audit where they can review your notes and see if it matches the billing your submitted. If not, find ways to improve so you can make sure what you are billing, and thus the RVUs you generate are appropriate and accurate.
Vicky Muller: Alright, I think that’s a good place to wrap up. RVUs are the currency of our work—so learn how they’re earned, how they’re valued, and how to make them work for you. Thanks for joining us on Starting Strong. Beth, Mark, always a pleasure.
Beth Blimmer: Thanks, Vicky! This was super helpful—I feel like I learn something new every time. Mark, see you next time?
Mark Krause: You bet! Thanks everyone for listening, and don’t forget to check your RVU reports. Catch you all in the next episode!
