From Volume to Value: Going Beyond RVUs—The new blueprint for fair compensation in care

In healthcare, we measure almost everything. But for decades, one metric has quietly shaped the entire financial structure of physician work: the work Relative Value Unit (wRVU). It determines physician productivity, compensation, and even hiring decisions. Yet a newly published paper in Heart Rhythm—co-authored by Dr. Rahul Chaudhary, Chief Medical Officer at HBox—argues that wRVUs are not only outdated, but fundamentally incapable of capturing the true value of specialist care.

And at HBox, we’re applying the same reforms to our own virtual-care teams.

This article explains why wRVUs fall short, what the new research proposes, and how HBox is already putting these principles into action through our new CareCoach Effort Unit (CEUs) performance model.

Why wRVUs Are Broken—and Why It Matters

For years, wRVUs have been treated as objective, universal truth. Produce more RVUs, earn more compensation. But as the Heart Rhythm authors explain, this simplicity is exactly the problem.

wRVUs measure only one thing: volume.They do not measure effort.They do not measure complexity.They do not capture cognitive work, care coordination, or the technical difficulty of modern procedures.

For electrophysiologists—who perform long, intricate cases, make high-stakes decisions, and generate tremendous downstream value for hospitals—this system is especially unfair. The paper highlights several critical flaws:

• Complex procedures are undervalued despite hours of labor and years of specialized training.

• RVU caps suppress compensation, even for the most productive and skilled physicians.

• Administrative, cognitive, and non-procedural work goes unrecognized.

• Burnout increases when physicians see their effort devalued while demands rise.
  

The authors propose a multi-factor model that captures true physician value by evaluating skill, complexity, effort, care coordination, and long-term patient benefit.

This is the future of physician compensation—and a core belief at HBox.

Dr. Rahul Chaudhary Brings These Principles to HBox

As one of the paper’s authors and the Chief Medical Officer of HBox, Dr. Rahul Chaudhary brings firsthand ex

pertise to this discussion. But he also brings something else: action.

While the Heart Rhythm article focused on physicians, the underlying problem is universal across healthcare teams. If you measure people only on speed or volume, you inevitably undervalue those doing high-quality, complex, emotionally intensive work.

This is especially true for care coaches, whose daily responsibilities include:

• motivating patients

• diffusing anxiety

• managing complex chronic conditions

• escalating clinical concerns

• coordinating with practices

• handling tough conversations

• providing ongoing emotional and educational support
  

None of that fits neatly into a “call count.”

So HBox designed something better.

Introducing CareCoach Effort Units: A Modern Framework for Modern Care

In 2025, HBox launched the CareCoach Effort Unit (CEU) model—a next-generation performance framework directly inspired by the same best-practice principles proposed in the new Heart Rhythm publication. Rather than rewarding only the number of interactions, CEUs measure:

1. Effort

Certain patient interactions are simple check-ins. Others require deep effort—investigation, compassion, education, or troubleshooting. CEUs distinguish between them.

2. Complexity

Coaching a patient with uncontrolled hypertension and multiple comorbidities is far more complex than calling a healthy patient with stable readings. The new framework weights these differences appropriately.

3. Clinical Significance

An escalation that prevents deterioration, a successful medication adherence intervention, or a care-navigation event counts more than a routine reminder.

4. Quality of Engagement

Coaches are evaluated on clarity, empathy, problem-solving, and follow-through—not just speed.

5. Actual Value Delivered

Did the engagement help the patient stay on track? Did it support the practice? Did it reduce risk? CEUs quantify value, not volume.

This approach is exactly what the Heart Rhythm paper recommends for specialists: a multi-factor, effort-based, quality-focused compensation model that recognizes real work. HBox applied the principle beyond physicians—right into the heart of virtual care delivery.

Why This Matters for Healthcare’s Future

The U.S. healthcare system is shifting rapidly toward virtual care, personalized engagement, and chronic condition management. In this world, simplistic productivity metrics simply don’t work. Care quality, patient experience, and meaningful human interaction matter more than ever. The Heart Rhythm study calls on health systems to rethink how they measure and reward physicians.

HBox is doing the same for care coaches, because the value they deliver is too important—and too complex—to reduce to a single number. By aligning incentives with quality, effort, and true patient impact, we’re building a future where excellence—not volume—defines value. And that’s the kind of healthcare transformation patients deserve.