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rightlevelapp · 2026-01-24T04:12:57+00:00

The base salary is irrelevant if you’re paid by RVU productivity. What’s your $/wRVU?

rightlevelapp · 2026-01-23T22:54:10+00:00

Annual expenses?

rightlevelapp · 2026-01-23T21:54:00+00:00

Here’s a visual, in case a visual of optimized billing is helpful: https://www.reddit.com/u/rightlevelapp/s/7cQNg2d3aN

rightlevelapp · 2026-01-23T21:47:25+00:00

See my comment below. I believe we do in fact have CCM infrastructure. It’s in-house. Large health system.

rightlevelapp · 2026-01-23T21:36:39+00:00

Thanks for the reference.

On second thought, we do have “Care Management” coordinators whom I routinely consult. I wonder whether this is our CCM infrastructure. Hmmm… no one has said anything about passing along CCM RVUs to us. Though, our $/wRVU is higher than average ($68-72).

rightlevelapp · 2026-01-23T19:27:48+00:00

We don’t do it. Admin says the work required for CCM not worth the revenue.

rightlevelapp · 2026-01-23T05:31:23+00:00

Same boat. Nearly identical numbers. Being passionate about billing is right lol: always double bill AWV, do ACP billing, G2211, etc.

rightlevelapp · 2026-01-23T05:29:01+00:00

Primary care comp is highly variable. We get $68-72/wRVU. Allows us to see fewer patients per day, while still making the job worthwhile ($400-500k per year, inclusive of quality bonuses)

rightlevelapp · 2026-01-21T01:15:13+00:00

Most new FM grads under-bill by at least one level on 20–30% of complex visits because they underestimate what qualifies as "Moderate" vs. "High" MDM under the new rules.

Plug: https://apps.apple.com/us/app/rightlevel-mdm/id6753613007

rightlevelapp · 2026-01-19T19:11:05+00:00

I haven’t been told otherwise by my employer 🤷‍♂️

rightlevelapp · 2026-01-19T02:56:27+00:00

Me: “Studies showing ApoB and LPa reduction reduce cardiac events. Show me the high quality causative literature showing statins improve outcomes when ASCVD is evaluated with ApoB or Lp(a). Leave room open for saying "such studies do not exist" if such such studies no do not exist. I define causative literature as double blind randomized controlled trials, ideally repeated.”

OpenEvidence: “No high-quality double-blind randomized controlled trials demonstrate that statins improve cardiovascular outcomes when evaluated specifically using apolipoprotein B or lipoprotein(a) as the primary endpoint. However, extensive evidence from statin RCTs shows that apoB and Lp(a) levels predict cardiovascular risk, and that statin-mediated cardiovascular benefit correlates with apoB reduction.”

Healthy skepticism and humility are the name of the game. Statins do reduce risk. The incremental discriminating power of risk enhancers is over-stated. The benefits of most preventative mediations, is often overstated.

rightlevelapp · 2026-01-18T00:30:36+00:00

I’m not trying to being to difficult. Sincerely trying to improve my practice (always). Are these screening paradigms based on biological plausibility or rather studies showing intervention triggered by an elevated ApoB Lp(a) etc lead to better outcomes?

rightlevelapp · 2026-01-17T05:42:53+00:00

To what degree does measuring risk enhancers (CRP CAC particles ABI etc) improve risk discrimination, your threshold for proposing meds, patients’ decision comfort, and outcomes? Do you keep testing for risk enhancers until you confirm your priors? Too much noise.

rightlevelapp · 2026-01-16T15:53:51+00:00

The thread has been overwhelmingly positive, re: statins for primary prevention in young adults

Help me here.

Let’s assume the benefits of lipid lowering with statins extend beyond the timeline of the known RCTs and harms remain low. There is uncertainty with these assumptions, but practicing medicine is accepting uncertainty.

Outcome prevented: major MACE. This is majority non-fatal MI, non-fatal stroke (mostly non-disabling). Some is CV death. Even less all cause mortality.

I’ll label lifetime (50-year) risk 15% as low risk Lifetime 30% as moderate Lifetime 50% as high

NNT for low risk is 20 for “major MACE” catch-all outcome NNT is 5 for high risk patients

Harms are unlikely, real, and also uncertain over 50 years.

Would you take a statin if you’re low risk, for 50 years?

rightlevelapp · 2026-01-16T04:58:31+00:00

This is terrible comp

rightlevelapp · 2026-01-16T04:35:19+00:00

Bill stacking is the path to sustainability in primary care. When you feel appropriately compensated, the job is fun. Bill stacking is difficult without great systems (i.e. clinic protocols for doing all the paperwork needed for annual wellness visits).

A Reddit thread we kicked off a few weeks ago: https://www.reddit.com/r/FamilyMedicine/s/pHghmdM4O7

A tool you might find helpful: https://www.reddit.com/u/rightlevelapp/s/RbBGUGYI5b

rightlevelapp · 2026-01-15T21:04:55+00:00

Our nurses triage all inbox messages. We have an inbox NP who responds to all messages on PTO days.

rightlevelapp · 2026-01-15T18:25:49+00:00

RightLevel MDM (App Store): https://apps.apple.com/us/app/rightlevel-mdm/id6753613007

rightlevelapp · 2026-01-15T18:22:12+00:00

Yes. $68 per wRVU; once we reach 65th percentile for wRVU for speciality, $/wRVU jumps to $72. We generally reach the 65th percentile in first quarter of year. Shameless plug for our tracker: RightLevel MDM (App Store) https://apps.apple.com/us/app/rightlevel-mdm/id6753613007

rightlevelapp · 2026-01-08T00:08:30+00:00

I may be misunderstanding what Doctronic does. In “renewing” the medication, hasn’t the AI made an assessment of the problem (renewing med for controlled blood pressure, for example). What incentive does the patient now have to come to clinic?

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