Relative Value Units and Physician Performance: Is Time to Evolve?
Relative value units (RVUs) were devised to provide a common scale to judge the relative resources used to provide a service. The relative value of each service is reassessed periodically by the Relative Value Scale Update Committee and others to decide whether changes need to be made.
In a recent ‘Viewpoint’ paper (Nurok and Gewertz; JAMA, 2019) the authors make a powerful case that the use of RVUs as the only measure of physician performance is not only misplaced but leads to inferior patient care. The connection to financial compensation such as bonuses is especially fraught. The report that some organizations are moving away from RVU-based, fee-for-service reimbursement methods that alternative payment models that focus on quality rather than incentivize high volume care. They provide evidence that these non-RVU models can even reduce healthcare costs.
Aside from financial incentives, the authors also point out the moral reasons exist for moving away from RVU-based compensation models. A physician’s first duty should always be to the patient and not the payors. Furthermore, RVUs emphasize procedures while diminishing the role of public health and important physician-patient interactions, such as counseling.
In summary, RVUs should be just one part not the only party of individual clinician performance. One group created the all-in model consisting of
Job 1: Every physician should deliver high-quality health care services to their patients
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