GlobalRVUs are a relative value system that covers the entire range of healthcare services. Relative Value Units (RVUs) are commonly used with payment schedules to define relative cost between services and enable comparison of cost schedules. Other RVU systems are limited, because they only focus on one type of provider and do not relate services for different types of providers. GlobalRVUs correct this disconnect by providing an RVU system that covers all healthcare services.
Using GlobalRVUs for better data analysis
Conversion factors are calculated by dividing total dollars by the RVUs assigned to services. This can be done by individual procedure or aggregated at any level—including in total across all services.
Once these conversion factors are calculated, they can be compared and analyzed. Because the GlobalRVUs are broadly applicable, you can:
- Evaluate claims experience and separate unit cost versus resource use.
- Analyze provider contracts that require the aggregation of physician and hospital services.
- Develop episodes of care and bundled payments in order to understand and remove unit cost biases from the experience data.
- Set and analyze global risk targets, particularly across multiple provider organizations with differing contract structures, such as accountable care organizations. Use GlobalRVUs to analyze opportunities for improvement—for example, identifying high-cost specialists or hospitals in the experience data.
- Normalize allowed dollar claims and put services on a common basis to permit a range of analyses. If charges are not available, global RVUs can still be used as a proxy for charge levels to allow different types of utilization efficiency analyses (for example, episodes and PMPM) as well as case mix studies.
- Maintain confidentiality provisions in utilization analyses. Since potentially confidential average charges are not being used, your utilization analysis results can be released externally without breaching confidentiality. With RVUs in place of allowed charges, limitations on distribution of the analysis may be removed.
The GlobalRVUs can be attached to any data set easily using Milliman software. In addition to an interface to run the RVU assignment software, we provide a series of Microsoft Excel reports that allow you to review the quality of the data input, ensure that the RVUs have been properly assigned, and review the results of the RVU assignments.
Components of GlobalRVUs
There are three separate components of GlobalRVUs:
- Medicare physician RVUs. Physician claims are assigned GlobalRVUs based on Medicare’s fee schedules, including DME, Lab, Ambulance, and Anesthesia. For services paid using Medicare’s RBRVS RVUs for physicians, the GlobalRVUs are equal to Medicare’s RVUs. The GlobalRVU adjudication process reflects Medicare’s claim adjudication rules to the adjust the assigned RVUs for modifiers, multiple procedure discounting, and bundling.
- RBRVS for Hospitals™. This proprietary Milliman product contains an RVU schedule for hospitals that is consistent with Medicare’s physician RVU schedule.
- Prescription drug RVUs. Prescription drug RVUs are developed based upon average wholesale price (AWP) information. AWP is assigned to each claim by NDC, adjusted for discounts, dispensing fees, and anticipated rebates, then converted to an RVU that is consistent with Medicare’s physician RVUs and the RBRVS for Hospitals RVUs.
If you are looking to utilize a relative value system that covers the entire range of healthcare services, contact us to learn more about our GlobalRVUs.