Wouldn’t it be nice to know whether a given physician or group is high cost or low cost, is efficient or inefficient? If they are high cost, is it due to their own unit costs, the high cost of the hospital they admit to, or just their inefficiency? The GlobalRVUs allow you to measure unit price and efficiency across physician groups for accountable care organizations, shared saving and total cost of care programs, bundled payment and other capitated arrangements. GlobalRVUs are essentially an extension of Medicare’s RBRVS so that every medical service has an RVU. The RVUs are based on HCPCS, DRG or Pharmacy NDC and are not affected by the contractual allowed amount.
For example, the table below shows that Group B is significantly higher cost driven by high unit prices and worse than average efficiency while Group C is better than average for both resulting in about a 20% difference. By looking deeper at the Group B experience we were able to determine that while they had low use of diagnostic services in a physician office setting their use of the higher cost outpatient hospital setting for diagnostic tests (e.g. imaging, lab, cardiovascular) was a significant driver of the high unit costs.
|Primary Care Group||Risk Adjusted Allowed PMPM||Relative Cost||Risk Adjusted RVUs PMPM||Conversion Factor||Relative Unit Price||Utilization Efficiency|
This report is created by using member PCPs or attributed PCPs, concurrent risk scores, and GlobalRVUs assigned to each claim service line. This type of analysis is very powerful in identifying opportunities to reduce costs and increase physician group income. For example, using these reports, the physician group can understand the relative unit cost of the hospitals and specialists that they refer to. Easy savings may be available just by changing referral patterns. A common opportunity is to use the GlobalRVUs to understand the relative cost of imaging and lab services in different settings and the potential savings to the at-risk physician group.
The Milliman GlobalRVUs white paper describes the GlobalRVUs in detail.