Shadowfax digs deep and looks at some of the finer points: “The RVU adjustment is more important. As you may recall, in 2007 the value of the cognitive RVUs for physicians increased substantially, about 15% for ER physicians. But the requirement that the changes be budget neutral pulled about 10% of that back, and CMS applied this to the value of the work RVUs. Changing this to apply to the conversion factor helps because many of our commercially contracted payor rates are based on the RVU work value, and these RVUs will now increase as they were intended to. I believe that Tricare and Medicaid rates should also increase proportionately, but I am not certain about this. So that will provide a nice bonus to ER docs, and I suspect to other office-based physicians as well.”