Professional Documents
Culture Documents
This practice, out of economic necessity, is a busy one. This does not eliminate the administrative duties not
re ected in work RVU. Whenever possible, the administrative duties are limited to “off-hours” when the department
caseload is lightest. The scheduling program does codify these time commitments and, hopefully, they were
accurately factored in the time simulations.
There is another factor that is di cult to quantify when comparing productivity statistics for this practice versus
others. The major coverage location is still lm-based in many areas, but is moving forward with the installation of
a full PACS. It is likely that the work RVU per FTE could be higher in a fully digital environment. There is little or no
information published on this issue because it is di cult to quantify, plus there is a behavioral component. If a
digital environment does make a radiologist more productive, then practices will either restructure themselves to
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 1/7
2/18/2019 Radiologist Productivity Benchmarks: Slacker or Slave? - Axis Imaging News
handle caseload with fewer members, thus enhancing income, or choose to take more time off because
productivity per hour/day/week is higher.
PAYOR MIX
The group portrayed in this case study services a health care delivery system with a payor mix that likely impacts
its ability to generate a competitive salary/bene t package. Table 1 puts this in context.
Column D is a relative measure of income per payor group, using Medicare as a baseline. Many commercial and
managed care payors establish fees that are multiples of the Medicare rates since HCFA (now CMS) established
its relative value system in the late 80s. The multiplication of the two payor mixes by these income factors
establishes a weighted difference in overall income, all other factors being constant (more on this point later). This
implies that the average practice in the sample practice’s region could produce almost 20% more income from its
cases.
If two practices covered different hospital/health care delivery systems with approximately equal caseload
demands, and one generated 20% more income from its caseload, the number of radiologists in that group might
be greater, choosing to reduce coverage hours per member rather than receive higher income.
Recommendation: When national organizations seek out work RVU statistics from their membership, they should
ask for a payor breakdown as a data subset, to establish a correlation between payor mix and productivity.
COVERAGE SCHEDULES
There were seven full-time and one part-time members in 2004, the
compilation year for the examination statistics. Three of the full-time Table 3.(Click the image for a larger version.)
members handled the interventional caseload and are assigned more backup call. As a practical matter, they were
potentially on backup call one third of the time to handle any off-hour interventional demands that, fortunately, are
infrequent. The trade-off was fewer weekend call days. The “CALL-NOON” and “CALL-10AM” designations imply
that the individual assigned that responsibility arrived at either noon or 10 AM, remaining in the department until 10
PM. Any diagnostic cases after 10 PM were handled as a wet reading by a nighthawk service, with the formal
dictation performed by one of the eight radiologists the following day. The four columns at far right start the
simulation of coverage hours by assignment of assumed physical time in the departments. The backup call time is
a non-scienti c attempt to simulate annual hours actually in the department while on backup call. Table 3 portrays
the on-site hours.
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 2/7
2/18/2019 Radiologist Productivity Benchmarks: Slacker or Slave? - Axis Imaging News
The physical hours on-site are an important component of the differences in productivity between groups. It is not
likely that any surveys have asked respondents to provide both work RVUs and coverage hours. If, as suggested,
material differences in the income systems affect decisions about coverage hours, we would likely see the more
lucrative practices showing fewer hours per full-time-equivalent (FTE).
PRODUCTIVITY SUMMARY
Columns E and F represent caseload handled by the practice, not billed through the receivable system. It consists
primarily of plain lms with no CPT code detail and was arbitrarily distributed equally among the full-time
diagnostic members, using the average RVU/procedure for plain lms. Columns G and H are the combined totals,
and column I represents the average work RVU per coverage hour.
The full-time member statistics are segmented at bottom as to totals, mean, and standard deviation. The standard
deviation, as a percent of the mean, suggests the value of using the work RVU as a productivity measure.
Procedure volume has a predictably large variance because of case mix differences, yet the work RVU and
resulting RVU/hour are tightly bunched.
This practice has a complex case mix that demands, because of the
volume in relation to group size, that each full-time member handle all
modalities. Concessions are made to the three members who handle
the interventional workload, yet they all do cover other areas to some
degree. This explains why the total work RVUs per member are tightly Table 5.(Click the image for a larger version.)
bunched.
There is a theory that specialists who concentrate on only a few modalities can produce a great number of work
RVUs because of disproportionate weighting of the values. Compiling the work RVU distribution this way might
help answer questions about wider disparity among members of other practices that are larger and more
subspecialized. The nal model of this article also is a useful tool to test if some examination groupings are
over/under weighted.
The section above on payor mix discussed the theory that practices with more lucrative income systems would
likely favor quality of life over enhanced income. Table 5 also hints at another reason why the work RVUs for this
practice might be higher than average, again in uenced by income-related issues. This group has a
disproportionate amount of surgical cases for its size. The payor fees for surgical codes are less favorable than for
diagnostic ones. This implies that other groups with a procedure volume of 127,000 might have not only a better
payor mix but also fewer surgical codes.
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 3/7
2/18/2019 Radiologist Productivity Benchmarks: Slacker or Slave? - Axis Imaging News
Column C is the 2004 examination volume for the grouping and modality con gurations, and column D is work
RVU resulting from the examinations. Column E shows average work RVU/procedure for the grouping/modality
con guration. Column F is the normalization of the column E values, using the Chest/Plain Film as “1.00”; all other
groupings are restructured in relation to this benchmark.
Column G is the simulation of average procedure times for each grouping based on the assumption made about
the average reading time for Chest cases. Column H is the multiplication of the time per procedure by the annual
volume. The total is then divided by 60 to estimate annual hours handling caseload. Now we need to critique this
model:
1. The 1,241 hour simulation was based on an assumption that caseload time has to be less than coverage
time. It is not reasonable to expect any physician to handle clinical workload 100% of the hours worked.
No data exists that suggests maximum workloads before stress interferes with clinical e ciency. An
arbitrary assumption was made that 6 reading hours out of 8 coverage hours is a maximum limit.
2. FTD#4 simulated average of 6.04 work RVU per coverage hour would translate to a different gure per
reading hour. If 6 hours per day is a limit (75%), then the work RVU per reading hour is 6.04/.75 = 8.05.
The chest lm(s) average RVU is .21, implying: 8.05/.21 = 38+ Chest examinations per hour. That
translates to 1.58 minutes per examination (top of column G).
3. The surgical codes likely have a work RVU that does not t well with the diagnostic examinations; this is
just a theory based on the history of how the original RVU values were assigned. Each specialty had direct
input about its own coding mix, and the performance of cases involving the surgical codes in the 1980s
was impacted by turf battles. Also, interventional cases involve multiple surgical codes, implying that
simulation of the time for an interventional case requires addition of two or more surgical and S&I codes.
4. The challenge to the reader is to determine if the column G averages per procedure are realistic. Changing
the baseline time to a higher number will result in simulated hours at or greater than the coverage hours.
This model could just as easily be expanded to include each CPT code in this radiologist’s 2004 universe
where we used the single view Chest as the baseline.
5. If the work RVU includes both a time and “clinical signi cance” component, would there be a value in
splitting them up? Is it reasonable to assume that large groups that might subspecialize should use the
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 4/7
2/18/2019 Radiologist Productivity Benchmarks: Slacker or Slave? - Axis Imaging News
work RVU to distribute part of their income pool because some specialists might be handling more
“clinically signi cant” cases?
CONCLUSIONS
This article suggests that the work RVU per member for this
practice is higher than average out of economic necessity. If
the reader is a member of a practice with a more favorable
payor mix, and the proportion of surgical codes is lower, then
the theory put forth by this article is that the reader’s annual
work RVU will be lower.
It would not be di cult for the American College of Radiology, if their members wanted it, to produce a work RVU
based strictly on time commitments per CPT code. It would be more straightforward than the subjective “clinical
signi cance” component.
The practice pro led democratically distributes the caseload out of logistical necessity. It is too small to
subspecialize. This eliminates any inappropriate weighting of CPT code groups where an hour spent on a single
modality or organ system arti cially generates more work RVU than is appropriate. The only way to test if the
assigned work RVU is wrong is to speculate on how many cases can be done in an hour for a procedure grouping
and then decide if the resulting total work RVU difference is justi ed because one type of caseload is more
clinically important than the other.
James A. Kieffer, MBA, is president, Proforma Financial Group Inc, Nashua, NH; www.Proformafg.com .
Related Articles
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 5/7
2/18/2019 Radiologist Productivity Benchmarks: Slacker or Slave? - Axis Imaging News
Resource Library
Case Study: Kennedy Health Enhances Imaging Interoperability across their Enterprise
Poll
Are you aware that AXIS was formerly Imaging Economics?
Yes
No
Vote
VIEW RESULTS
Orthodontic Products
Plastic Surgery Practice
Physical Therapy Products
Rehab Management
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 6/7
2/18/2019 Radiologist Productivity Benchmarks: Slacker or Slave? - Axis Imaging News
Sleep Review
HELPFUL LINKS
Contact Us
Advertise
Reprints
Subscriptions
Site Feedback
http://www.axisimagingnews.com/2006/05/radiologist-productivity-benchmarks-slacker-or-slave/ 7/7