Adding to a six-figure base salary, his pay was calculated by the number of relative value units, or RVUs, he billed on behalf of the hospital. The system compensates doctors using weighted values for certain types of visits or treatment. It works like this: A doctor might be paid $100 per RVU. A routine physical might be equal to 1 RVU, or $100; a more complicated and time-consuming procedure like radiation therapy might equal 8 RVUs, or $800. In other words, the more patient visits and treatments a doctor bills to insurance, the more that doctor and the hospital earn. Weiner described this system, which is common in American medicine, as “eat what you kill.”
Jesus Christ.
I learned this a few years ago. Because my condition is lifelong and degenerative, my RVH is quite high, and so my value to insurers and doctors/hospitals has a very low ROI. My care has degraded quite obviously as my condition has deteriorated, to the point I’ve decided I’d rather die at home than bother with healthcare at this point. And I can’t afford it anyhow. That sucks, but I’ve got medical PTSD now, and I don’t want to put myself through the indignity anymore. (eta: I don’t think I deserve the indignity anymore.)
I’m by far not alone in this. I used to be a very productive member of society, and I still could be if I could get even passable healthcare, but I can’t because the system has broken me. I have very in-demand skills that I can’t use, and instead , I’m staring down homelessness now. I cannot afford food.
This system is wasting people’s potential and lives. I will not survive this administration. I likely won’t make it another year.
The US medical system wants me to die, and I feel my compatriots have now voted to accelerate that. I honestly don’t know why I’m still fighting. I feel like I shouldn’t.
I get why the shooter did this. Our lives mean less than nothing. These executives can’t even imagine what it’s like to be using washcloths because you can’t even afford toilet paper.
Eat what you kill indeed. I have a nice recipe for a pork sauce. Humans have been called ‘long pork’.
RVUs are supposed to measure how much work something takes, so it’s literally just paying someone based on how much work they do. If you’re not actually doing the work, or are doing work that shouldn’t be done, that’s certainly a problem, but I don’t think RVUs existing is a problem in and of itself.
Generally the hospital has checks and balances to prevent fraudulent billing (well not in this case, apparently).
My bigger issue with the RVU system is how it promotes sub sub specialization into procedure based specialties which are the antithesis of preventative medicine. The system valuee family medicine doctors the least despite the massive shortage in their services (especially in rural communities).
So, the surgeon that fixes the broken hip gets paid more than the doctor that gets the bone density scan done and starts meds that support bone health. The cardiologist that opens up the blocked vessel gets more than the PCP who takes the time to counsel on athersclerotic cardiovascular disease and controls risk factors medically and with lifestyle.
I’m not saying the surgeon / proceduralist shouldn’t get paid more. I’m just saying that when your system incentivizes ‘wait for the problem to happen and then fix it’ you’re going to have some bad health outcomes.
