Are Tokens the New RVU? Why Healthcare's Measurement System Is About to Break

What if the way we measure a doctor's productivity is completely wrong?Software companies have already abandoned "lines of code" as a productivity metric — they now budget in tokens, the fundamental unit of AI work. Some developers spend $10,000-20,000 a month on AI agents. Microsoft says 30% of its code is AI-written. The old measurements are dead.Meanwhile, healthcare is still stuck on RVUs — a system where physicians spend two hours on EHR documentation for every one hour with patients, family doctors lose 86 minutes every night to "pajama time" charting, and Medicare physician payment has declined 26% since 2001 after adjusting for inflation. Value-based care was supposed to fix this. It didn't. CMS's own innovation center actually increased federal spending by $5.4 billion between 2011 and 2020.In this episode, I lay out the case for replacing RVUs with token-based measurement — shifting the question from "How many patients did you see?" to "How much agentic activity did you perform to improve population health?" I walk through the data from JAMA, McKinsey, MedPAC, and the AMA's own admission that MIPS is broken, and explain why AI-augmented healthcare systems should receive better reimbursement, not worse.This isn't a theoretical framework. The AMA just added 26 new CPT codes for clinical AI solutions. CMS launched the ACCESS Model in February 2026. The transition is already underway — the only question is whether your organization is measuring what matters.Full sources and the deep dive: danmccoymd.substack.comWant a personal walk through, check out our AI consultancy at RocketTools.io.