The staffing calculator give practice administrators the ability to easily model the financial impact of hiring an Advanced Practice Provider. Administrators can select where they are geographically located, the specialty they are looking to hire and the years experience of that hire. Once selected the model uses benchmarked data to determine revenue and expenses. The model will not only show the production of the Advance Practice Provider but it also models increased productivity for the Physician. Practice Administrators will have the ability to add their own assumptions to the benchmarked section of this model, such as physician productivity increases, benefit percentages and expense assumptions.

The calculator recognizes that benchmarks change over time and each practice may have its own market factors where using benchmarks to model the impact of hiring an Advance Practice Provider may need more customization. We’ve provided you with a section that you can input your own practices information to better aid with your analysis and decision making.

What does w/RVU stand for?
“w” stands for “work. “RVU” stands for “Relative Value Unit”

What is a w/RVU?
RVU is a Relative Value Unit. It is comprised of the 3 parts, the worked portion, practice expense portion and the malpractice portion. CMS (Centers ford Medicare & Medicard Services) has formulas that they use to calculate the dollar of an wRVU which are updated each year

What is CMS?
The Centers for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services. CMS oversees many federal healthcare programs, including those that involve health information technology such as the meaningful use incentive program for electronic health records (EHR).

When a patient comes to the office, what is the process of walking in to generating a wRVU?

  • Patient enters the office and sees a clinical provider (PA, APRN or MD)
  • Clinical provider documents what they did and what needs to be done
  • Based on the documentation, the provider or medical coder will code the visit and generate a bill using CPT codes.
  • These CPT codes have wRVUs and payments associated with them based on the insurance provider being billed

Can you give an example of a CPT code and how it is applied?
Once the visit or procedure is coded, each code has a wRVU. So if John is sick, and sees a clinical provider. Let’s say they give John some decongestant and tell him to go sleep and hydrate. The provider would then enter a CPT code of 99213 (which is simply defined as an office visit).

What is the CPT code worth and how much money would the provider make?
The 99213 code may have a wRVU value of .97. And dependent on the insurance company, this code can be worth anywhere from $67 to $89 dollars.

When would the provider/practice get paid and how much would they earn?
The provider/practice would submit the CPT code/bill to the insurance company. If the wRVU is .97 with a dollar amount of $85 per wRVU, the insurance company would then pay $82.45($85*.97) to the practice, or $70.08 to the practice if it was a PA or NP that submitted the CPT code/bill (as APP’s only receive 85% of what the MD receives.

If the provider/practice saw 20 office visits a day, 5 days a week, 52 weeks a year, what do they earn?
.97 wRVU, times 20 a day (19.4) times 5 days a week (97) times 52 weeks a year (5044). If this a APP, they would collect $353,483.52 (5044 * $70.08). If it was a MD, they would collect $428,740.

What is the difference between visit codes and procedure codes?
Visit codes are often referred to Evaluation and Management (E&M) codes; this is not an extensive list. Usually there are only 5 levels of E&M codes depending on the setting of the visit. On the other hand, the procedure codes vary (lots to choose form).

Is there a difference between new patient visits vs. regular patient visits?
There is a difference, a new patient visits is worth more, the assumption being that if this is the first time a provider is seeing a patient that it takes more work. An established patient or as you referred a “regular” patient visit is worth less than a new patient as the provider should not have to do as extensive evaluation since there is a history with the provider or practice.

Why do the insurance companies only pay 85% of the collections for the APP, vs. 100% for the MD?
The assumption is the cost of an APP is less than an MD, so they don’t need to pay the full price. Additionally, because Medicare pays 85% of what they will pay an MD, most private payers follow suit.

What are productivity benchmarks?
The healthcare industry compiles productivity benchmarks for salary, productivity and practice expense to name a few. There are several different sources for productivity benchmarks, AMGA like we use, MGMA, Sullivan Cotter and many specialties may generate their own productivity benchmarks. They are often self-reported data from those organizations participating membership.

How do productivity benchmarks relate to the calculator?
How it relates to the calculator is it is the basis for the assumptions that the calculator uses. It is assuming that when hiring an APP that you should be able to expect this level of production out of that person. It is only a benchmark and of course any given provider or market can outperform or underperform that benchmark. Also benchmarks are often self-reported data, so the data can vary over time, especially from year-to-year.

How do you keep the calculator up to date with current data?
Typically you need to purchase the productivity data from the above mentioned organizations. Because the data constantly changes, once a year the data is purchased to ensure the calculator model is current.