Background/Purpose: Relative value units (RVUs) are a payer-neutral measure of clinical work. The federal government uses a multi-component formula to convert this measure into reimbursement. The Association of Administrators in Academic Pediatrics (AAAP) surveys its practitioners to derive benchmark RVU data, aided by its affiliation with a leading medical management group (MMG). No other benchmarks exist for pediatric rheumatologists (PRs).  While PRs largely practice at academic centers, they also work in a variety of settings. PR reimbursement follows a number of models, lacking uniformity or national consensus for practice diversity.  Reimbursement estimates may also derive from adjusted adult rheumatology (AR) or various MMG putative standards. Providers can use RVU data to advocate for additional PR clinical support. Through a cross-sectional survey of all board-certified US PRs administered by the American Academy of Pediatrics (AAP), this study’s objective was to determine clinical productivity through annual RVU data, obtain demographic and CPT coding data, and establish national benchmarks independent of an MMG.

Methods: An IRB-approved survey asked PRs (N=206) to provide data about their annual RVUs for fiscal year 2008-09, and detailed demographics including clinical full time equivalent (FTE) status. Statistical analysis included the two-sample Kolmogorov-Smirnov test for distribution and t-test for comparison of means.

Results: The overall response was 65% (n=133); 60% of respondents (80/133) provided RVU data including one high volume outlier. AAAP RVU data obtained from 38 centers in the same survey year served as controls (n=79).  AAP and AAAP RVU data were normally distributed (p=0.129); but, their means were significantly different (p=0.013) [Table].  AAP demographic data revealed: median FTE=0.6 (0.1-1); 99% PR and 8% AR board certification; median practice years=16.2 (range by 5-yr intervals: <5 to >30); median patients/week=25; median work weeks/year=48.5 (range by intervals: <30 to 52); academic location: 66% (n= 69); states represented=34 of 42 supported by PRs (incl. DC); median salary=$158,000; median initial access to care= 6 weeks (1-32), previously 2 weeks (2005 AAP survey). Asked if their institution uses the RVU model to measure clinical productivity, 76% affirmed (n=90); 8% did not know (n=10).

Table: Annual RVUs
Quartile	AAP	AAAP
1st	1000	2073
2nd	1737	3310
3rd	2616	4700
Total	8377	7943
Interquartile range	1616	2627
N	80	79

Conclusion: AAAP RVUs sample only academic sites, limiting generalizability. Further, AAAP adjusts RVUs from partial to full FTE, uniformly inflating data. This practice and AAAP alignment with a commercial MMG preclude its role as the best available PR benchmark. AAP RVUs are normally distributed, representing 81% of the states where PRs practice, with mature demographics and wide practice diversity; they serve as a national benchmark.  During the latter half-decade, the shift from a 2 to 6 week wait to access initial PR care is concerning and indicative of the pressing need for sustained workforce advocacy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pediatric-rheumatology-productivity-results-of-the-american-academy-of-pediatrics-2010-workforce-survey/