Physician productivity has been measured with relative value units for decades, serving as the primary metric for determining physicians’ compensation, creating benchmark standards and more.
But as healthcare shifts towards value-based care metrics, the role of RVUs has begun to shift.
Here are six things to know about the past and future of RVUs in healthcare:
1. The use of RVUs began in the late 1980s and early 1990s with the American Medical Association’s relative value scale. In 1991, a relative value scale update committee was created to act as an advisor to CMS and has updated RVU values by CPT code every five years. Today, the uses of RVUs vary, but they are often used as a means to determine reimbursement’ measure and evaluate provider productivity’ measure cost; benchmark standards for surveys; determine provider compensation and serve as a basis for negotiating contract rates with payers.
2. Physicians are logging more work than ever, but their productivity isn’t translating into higher reimbursement, according to Kaufman Hall’s “Physician Flash Report,” published Aug. 11. Productivity, measured in work RVUs per FTE, reached 6,449 for physicians in the second quarter of 2025, according to the report. That marks a 12% increase for physicians year over year.
3. In September, CMS proposed an efficiency adjustment to its physician fee schedule that represented a 2.5% pay reduction for thousands of procedures. This decrease in wRVU assumes that specialists have become more efficient in certain common procedures. However, multiple organizations have objected to this premise, contending that time, costs and complexities are increasing.
4. Radiation oncology, radiology and some surgical specialties would unfairly see a decrease in RVUs, according to Livonia, Mich.-based Trinity Health, one of the organizations that submitted comments to CMS regarding this update. Renton, Wash.-based Providence, a 51-hospital system, said that the “efficiency adjustment is not the appropriate way to bring more timeliness to the RVU process.” The health system said the Medicare Economic Index has annually grown 3% to 5%, which “would compound the proposed 2.5% reduction to a more than 5% cut in non-time-based codes each year.”
5. Some systems have already begun to create and implement new systems for measuring physicians’ productivity and determining compensation. Morgantown, W.Va.-based WVU Medicine’s Heart and Vascular Institute has grown from 25 providers to more than 200, expanding from a $225 million regional program to a $2 billion healthcare destination in less than a decade — all as the organization has shifted away from wRVUs and toward value-based care.
“Many programs are compensated based on a salary base with an at-risk component for productivity,” Vinay Badhwar, MD, executive chair of the institute, told Becker’s. “To truly enact a functional heart team model in a new environment with new procedures and changing evidence, we needed to eliminate any motivations of activity other than a commitment to evidence-based, quality-first care.”
6. According to SullivanCotter’s 2025 “Physician Compensation and Productivity Survey,” healthcare organizations are gradually expanding their productivity and compensation measures outside of RVUs. For example 75% of organizations now include productivity and patient experience measures, and outcomes-based metrics increased 4.6% year over year. Additionally, 90% and 52% of survey respondents reported using sign-on bonuses and student loan repayment, respectively, as recruitment incentives.
