Beyond relative value units: Redefining clinician workload and panel accountability in value-based care

ABSTRACT: Relative value units (RVUs) were developed to standardize reimbursement within a fee-for-service payment system by quantifying discrete clinical services. Although effective for encounter-based compensation, RVUs were not designed to measure the longitudinal, coordination-intensive, and complexity-adjusted work required in contemporary value-based care environments. As health systems assume greater accountability for population outcomes and financial risk, reliance on RVU-dominant productivity models may create misalignment between workforce expectations and organizational goals. This policy analysis synthesizes historical literature on the development of RVUs, empirical studies examining clinician workload and panel complexity, and contemporary workforce research to evaluate structural limitations of encounter-based productivity metrics. Evidence demonstrates that indirect care activities, multimodal clinical engagement, interdisciplinary coordination, and management of complex patient panels substantially influence workload but are inconsistently represented in RVU calculations. Research within nurse practitioner practice provides illustrative examples of these measurement gaps. A multidimensional clinician workload and panel accountability framework that incorporates panel metrics, multimodal clinical activity, and indirect work provides a more accurate and equitable approach to workforce evaluation in value-based systems. Modernizing productivity measurement may enhance workforce sustainability, improve operational planning, and strengthen performance in accountable care environments.