More Work RVU Increases in 2023, What!?
According to the new work RVU values released in the 2023 Medicare Physician Fee Schedule (MPFS) final rule on November 1, 2022, we are facing another round of disruptive changes during 2023.
The outpatient evaluation and management (E&M) procedure code changes introduced during 2021 were first discussed and disclosed by the American Medical Association’s CPT Editorial Panel during their February 2019 meeting (2/2019 Meeting Minutes). The CPT Editorial Panel then referred the codes down to the RVS Update Committee (RUC) for reassessment. The February 2019 meeting represented the first of three cycles of Editorial Panel/RUC reviews in advance of the 2021 Medicare Physician Fee Schedule.
COVID-19 effectively monopolized the CPT Editorial Panel’s time during 2020, but by February 2021 they finally circled back around to the inpatient E&M and observation service procedures (2/2021 Meeting Minutes). The RUC finalized the inpatient E&M work RVU changes during its January 2022 meeting (1/2022 Meeting Minutes). Work RVUs for physician E&M services in nursing homes and home visit settings were also revised. These changes will have meaningful effects on productivity and compensation measures for hospitalists, internists, geriatricians, and psychiatrists, among others.
Work RVUs for inpatient E&M services have not materially changed since before 2008, though hospital adoption of Electronic Health Record (EHR) system has grown by over 10 times during the same period (96% in 2019 vs 9% in 2008).
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Hospitalist Work RVU Increases in 2023
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2023 Work RVU Increases Impact Real Groups
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The new inpatient E&M work RVU values published in the 2023 MPFS Final Rule include both substantive increases and decreases in work RVU values from code-to-code. The top three codes most commonly billed by hospitalists (99232, 99233, 99239) will realize +14%, +20% , and +13% increases in work RVUs, respectively. However, any attempt to forecast the impact of all the changes must also take into account the deletion and merging of observation E&M codes (99217-99220 and 99224-99226) into general inpatient E&M codes (99221-99223,99231-99239), increased work RVUs for nursing home visits, and the deletion and replacement of over 20 other E&M codes. This is not a simple exercise.
Most hospitalists, internists, psychiatrists, geriatricians, hematologists, and trauma physicians can expect substantially different changes in work RVUs from physician-to-physician. Large employers of these hospital-based specialists should start crunching their billing data to see the impact these changes will have on physician production, compensation, and practice reimbursement.
