Geriatrician Work RVU Increases in 2023
Geriatrician physicians can look forward to work RVU increases beginning on January 1, 2023. New changes affecting inpatient and observation services will impact Geriatricians’ productivity measurement, employee compensation plans, and reimbursement during 2023.
The American Medical Association (AMA) proposed updating its CPT procedures codes for inpatient Evaluation and Management (E&M) and observation services during its February 2021 CPT Editorial Panel Meeting (2/2021 Meeting Minutes). The AMA’s RVS Update Committee (RUC) finalized the work RVU revisions to inpatient and observation E&M changes during its January 2022 meeting (1/2022 Meeting Minutes). The AMA sent its recommended changes to Medicare during the spring of 2022, and Medicare published the changes in its 2023 Medicare Physician Fee Schedule (MPFS) final rule on November 1, 2022.
Geriatrician Work RVUs
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2023 Work RVU Increases Impact Real Groups
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The new inpatient E&M changes published in the 2023 MPFS final rule include both increases and decreases in work RVU values. Three codes often billed by Geriatricians (99309, 99308, 99232) will realize +24%, +12% , and +14% increases in work RVUs, respectively. However, any attempt to forecast the impact of all the changes must also consider the variability of E&M complexity among different geriatricians.
Geriatrician Compensation
When the 2023 work RVU changes are aggregated and deleted observation codes are crosswalked to replacements, geriatricians are projected to experience 6% overall increases in work RVUs as a specialty, with large variation from physician-to-physician. When combined with the outpatient E&M work RVU increases from the 2021 MPFS, half of geriatricians are projected to experience 19% to 29% increases in work RVUs, or more, from 2020 to 2023.
Geriatricians compensated on work RVU productivity plans will realize increases in compensation as a result. Geriatricians will hit their productivity bonus thresholds much earlier during 2023, and individuals who have not met their productivity bonus thresholds in the past will meet and exceed them.
Estimated Work RVU Change Variability Among Geriatricians (n=2,757)
Geriatrician Reimbursement
Medicare is a budget-neutral program, and it cannot allow overall program spending to increase without congressional approval. Therefore, Medicare has enacted budget-neutrality adjustments to reimbursement rates to keep overall program reimbursement flat. The 2023 final rule included a 4.5% decrease in the physician conversion factor (payment rate).
Congress will likely implement a budget fix late during 2022 or early 2023 to minimize the conversion factor decrease. Congress has a long consistent history of overriding Medicare’s budget neutrality adjustments for physician reimbursement decreases dating back over 20 years.
Commercial insurance carriers are not likely to adopt the 2023 Medicare physician reimbursement changes any time soon. Most commercial insurance carriers are still piggybacking on Medicare’s rates from the 2020 MPFS or prior years.
Geriatrician Employers
Employers of geriatricians will have a very short window of time to deal with these changes between the time Medicare issues its final rule in November and when the changes become effective on January 1, 2023.
Geriatrician employers that cannot afford to pay compensation increases with face of flat or declining reimbursement may have to implement adjustments to bonus productivity thresholds and/or productivity compensation rates ($ per work RVUs) to maintain budget neutrality. These calculations must rely on actual billing data, past and future work RVU values, and the crosswalking of deleted observation codes to their replacement codes.
