Radiology should consider ditching RVUs for a time-based productivity metric, study suggests

Relative value units do not accurately capture radiologists’ productivity and the specialty should consider adopting a time-based alternative, according to a new investigation published on Wednesday.

Medicare has long used such units to measure the value of physician work in the United States. Yet they’ve led to contention in both private practice and academic radiology when used to gauge productivity, noted the University of Pennsylvania’s Ronnie Sebro, MD, PhD.

Harnessing data from one institution’s electronic health record, Sebro aimed to assess whether the current RVU system allows for a fair comparison between radiologists. He discovered that one physician could work as little as 41% of the time as a peer in the same subspecialty but record the same number of such value units.

“The data shows that the current RVU system for evaluating radiologist productivity is inaccurate and does not adequately capture physician work/effort,” Sebro, an assistant professor with Penn’s Department of Radiology, wrote Feb. 10 in Clinical Imaging. “Because of this, the current RVU system likely contributes to radiologist burnout because of the propensity to underestimate the true radiologist work effort in terms of time,” he added later.

To reach his conclusions, Sebro analyzed more than 600,000 imaging studies performed and interpreted between 2018-2019 at a single tertiary care hospital. He further excluded those interpreted with the help of trainees or other software systems.

Landing on a final set of 241,627 studies, the author calculated study ascribable times—an alternative measure of productivity—for each CPT code. And he further calculated the number of days it would require a physician to achieve the Association of Administrators in Academic Radiology’s 65th percentile interpretation time.

Bottom line: Variability in radiologists time to hit that benchmark was highest in musculoskeletal imaging (reaching a range of nearly 198 days) and lowest for thoracic imaging (84 days). Neuroimaging and body imaging, meanwhile, fell in the middle at 162 days and 186 days, respectively.

“The [study ascribable time] increases the likelihood that a radiologist working for a given number of hours has the same perceived productivity regardless of the imaging study types on work list or regardless of the work schedule or work list he/she is assigned,” Sebro noted in the study’s discussion session. “A metric that accounts for the time worked is an objective measurement, however it does not take into account the intensity of the work.”

For all these reasons, he noted that RVUs are still needed and should not be done away with, since they are critical to determining reimbursement. And the study ascribable time metric is “not a panacea,” as it can vary from one hospital to the next, and likely only remain valid within the institution.

“We suggest that using a data-driven, time-based RVU metric could reimburse all activity equally in radiology,” he added later.

You can read much more of the analysis in Clinical Imaging here.