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012 Am09 Presentations   Mecum 012 Am09 Presentations Mecum Document Transcript

  • How Does Your Practice Compare? • 2007 RPA Survey Report – 2007 Participants How Does Your Practice – 2007 Results Compare? • National • Regional 2007 RPA Benchmarking Survey • Large, Mid-Size, Benchmark, VAC • Trends RPA Annual Meeting • What does this mean for your practice? March 23, 2009 Survey Participation RPA 2007 Nephrology Survey Participation Practice Business 1600 Number of Participants 1400 Total Number of 1200 Participating Practices Benchmarking Survey 1000 Total Number of 800 Nephrologists 600 Report Total RPA Members 400 Represented in Data 200 0 2003 2004 2005 2007 Year Survey Participation Survey Participation US GEOGRAPHIC REPRESENTATION OF PARTICIPATING PRACTICES Practice Characteristics 100% 100.00% 90% 90.00% % Reporting 30% 32% 80.00% 36% 37% 80% 70.00% 2007 60.00% Percent of Practices 50.00% 2005 70% 40.00% 30.00% 2004 East 60% 20.00% South 10.00% 38% 50% 37% 30% 0.00% Midwest 38% West 40% Sin MS MS So Gr Ac Ot he o ad lo gl e 30% up w/ w/ r Pr em 16% 16% 16% Sp Pr Sp Pr ac ic 20% im ac 14% ec ec t ic Pr ar tic ialt ialt e a 10% 18% yC e 16% cti 15% y y 11% ce ... ar 0% e 2003 2004 2005 2007 Type of Practice Year N=73, 76, 106, 212 1
  • 2007 National Results 2007 National Results Providers Staff per FTE per FTE Total Nephrologist Total Nephrologist FTE Clerical Staff 1,939.1 1.56 FTE Nephrologists 1,383.7 Non-Interventional 1,271.4 0.96 FTE Clinical Support Staff 1,086.9 1.10 Interventional 112.3 0.24 FTE Ancillary Staff 127.9 0.50 FTE Interventional Radiologists 24.0 0.47 FTE Vascular Surgeons 37.0 0.63 FTE Admin/Mgt Staff 442.4 0.43 FTE NP / PA 297.4 0.38 Total FTE non-provider staff 3,596.3 3.59 2007 National Results 2007 National Results Mean Revenue per FTE Practice Characteristics Nephrologist Gross FFS Charges $1,127,660 per FTE Net FFS Revenue 541,050 Total Nephrologist Satellite Offices 479 0.65 Dialysis Units Serviced 1,852 1.77 Total Other Income 94,890 Hospitals Serviced 1,158 1.17 Dialysis Patients Serviced 111,718 82.01 Total Net Practice Revenue 641,520 (cash basis) 2007 National Results 2007 National Results Mean Expenses per FTE Mean Physician Compensation Nephrologist Total Personnel Expenses $118,170 Total Physician Benefits Total Occupancy Expenses 34,500 $48,090 Total Medical Supplies Expense 68,830 Total G&A Expenses 55,230 Total Physician Compensation Total Operating Expenses $276,730 $283,010 2
  • Geographic Regions Regional Results 2007 Results (Regional) 2007 Results (Regional) TOTAL INCOME PER FTE NEPHROLOGIST BY REGION MEAN PHYSICIAN COMPENSATION PER FTE NEPHROLOGIST BY REGION (Revenue - Adjustments + Other Income) 100% 12% 100% 13% 16% 17% 19% 90% 15% 90% 22% 9% 26% 26% 29% 80% 80% 21% 29% Percent of Practices 23% Percent of Practices 70% 26% 70% 29% 16% 27% $400K or more $800K or more 60% 60% 41% 33% 29% $300K-$399.9K $600K-$799.9K 50% 50% $200K-$299.9K 35% $400K-$599.9K 29% 40% 44% 40% 27% Under $200K Under $400K 43% 39% 53% 30% 30% 29% 33% 20% 20% 37% 29% 28% 10% 25% 18% 10% 12% 13% 8% 13% 5% 0% 0% National East M idwest South West National East Midwe st South West 2007 Results (Regional) 2007 Results (Regional) Financial Highlights Mean Rev / Exp per FTE Total Relative Value Units per FTE Nephrologist $600,000 18,000 15,901 RVU per FTE Nephrologist 16,349 15,566 16,200 $400,000 16,000 12,999 14,000 $200,000 12,000 10,000 $- 8,000 6,000 National East South Midwest West 4,000 2,000 Net Practice Revenue(cash) Total Operating Exp 0 Total Other Income Total Phys Comp National East South Midwest West 3
  • 2007 Results (Practice Type) 2007 Practice Types • Large: 10 or more FTE Nephrologists FTEs per FTE Nephrologist (n=34) National Large Mid-size Benchmark VAC Clerical Staff 1.56 1.38 1.22 1.42 2.04 • Mid-Size: 2 – 7 FTE Nephrologists (n=130) Clinical Support Staff 1.10 0.80 0.92 0.96 1.51 Ancillary Staff 0.50 0.21 0.58 0.46 0.29 • Benchmark: Greater than median Net Admin/Mgt Staff 0.43 0.36 0.32 0.40 0.44 Income before Phys Exp ($333,098) and less Total non-provider staff 3.59 2.75 3.04 3.24 4.28 than median Total Operating Exp per NP/PAs 0.38 0.28 0.4 0.35 0.28 RVU ($18) (n=39) • VAC: participating in a Vascular Access Center (n=43) 2007 Results (Practice Type) 2007 Results (Practice Type) Financial Highlights Mean RVUs per FTE Nephrologist Mean Rev / Exp per FTE $800,000 20,000 $600,000 18,000 16,000 $400,000 14,000 12,000 RVUs $200,000 10,000 8,000 $- 6,000 National Large Mid-size Benchmark VAC 4,000 2,000 Net Practice Revenue(cash) Total Operating Exp 0 National Large Mid-size Benchmark VAC Total Other Income Total Phys Comp Patient Load, NP/PA Trends Dialysis Patient, NP/PA Increases 100 0.40 0.35 Patients per FTE 80 NP/PA per FTE 0.30 0.25 Survey Trends 60 0.20 40 0.15 0.10 20 0.05 0 0.00 2003 2004 2005 2007 Dialysis patients NP,PA 4
  • Increasing Complexity Staffing Trend High Level E&M Trends FTE Staff / FTE Nephrologist 60% percent of total 50% 4.00 40% 3.50 30% 20% 3.00 10% 2.50 0% 2.00 99244 99245 99254 99255 99214 OV 99215 OV 1.50 Office Office Hosp Hosp level 4 level 5 Consult Consult Consult Consult 1.00 level 4 level 5 level 4 level 5 0.50 0.00 2003 2004 2005 2007 1999 2000 2001 2003 2004 2005 2007 Financial Trends 2007 RPA Nephrology Practice Business Benchmarking Custom Report Key Financial Indicators 600 30.00 500 25.00 Net FFS rev/FTE RVU in 1,000s 400 20.00 $ in 1,000s Total Other Inc/FTE 300 15.00 Phys comp /FTE Nephrology Associates USA (NAUSA) Total op exp/FTE 200 10.00 RVU / FTE 6 Nephrologists 100 5.00 0 0.00 Located in the Eastern Region 2003 2004 2005 2007 Your Practice is included in the following sorts: Practice ID: xxx Financial Information National East Large VAC Fees for Service Charges per FTE Nephrologist 2007 RPA Nephrology Practice Business Benchmarking Custom Report Your Practice National East Benchmark Large VAC **** CONFIDENTIAL **** Sources of Income (000's) Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Gross Fees for Service Charges $1,050.98 $1,127.66 -$76.68 -6.80% $1,021.65 $29.33 2.87% $1,286.77 -$235.79 -18.32% $1,482.70 -$431.72 -29.12% $1,455.61 -$404.63 -27.80% Total Adjustments to Fees for Service Charges $544.64 $586.61 -$41.97 -7.15% $536.49 $8.15 1.52% $658.47 -$113.83 -17.29% $847.16 -$302.52 -35.71% $829.31 -$284.67 -34.33% Net Fees for Service Revenues $506.34 $541.05 -$34.71 -6.42% $485.16 $21.18 4.36% $628.29 -$121.95 -19.41% $635.54 -$129.20 -20.33% $626.30 -$119.96 -19.15% Fees received by the practice and/or individuals of the practice for Dialysis Facility Medical Directors $61.99 $68.14 -$6.15 -9.02% $56.38 $5.61 9.94% $101.00 -$39.01 -38.62% $81.36 -$19.37 -23.80% $84.90 -$22.91 -26.99% Practice Characteristics Reimbursement for Research Activity $3.85 $4.55 -$0.70 -15.40% $6.65 -$2.80 -42.09% $1.46 $2.39 164.29% $9.39 -$5.54 -58.98% $9.46 -$5.61 -59.30% Legal Work $0.15 $0.11 $0.04 37.02% $0.21 -$0.06 -29.78% $0.00 $0.15 $0.07 $0.08 115.43% $0.21 -$0.06 -29.87% Employees per FTE Nephrologist Royalties $0.00 $0.003 $0.00 -100.00% $0.00 $0.00 -100.00% $0.003 $0.00 -100.00% $0.004 $0.00 -100.00% $0.003 $0.00 -100.00% Rents $0.33 $0.26 $0.07 27.66% $0.42 -$0.09 -21.93% $0.02 $0.31 1557.44% $0.07 $0.26 393.20% $0.05 $0.28 519.47% Your Practice National East Benchmark Large Other $10.62 $21.82 -$11.20 -51.34% $18.01 -$7.39 -41.04% $10.26 $0.36 3.48% $57.08 -$46.46 -81.39% $58.75 -$48.13 -81.92% Total Other Income $76.94 $94.89 -$17.95 -18.91% $81.68 -$4.74 -5.81% $112.74 -$35.80 -31.75% $147.96 -$71.02 -48.00% $153.38 -$76.44 -49.84% Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Total Income $583.28 $635.94 -$52.66 -8.28% $566.85 $16.43 2.90% $741.03 -$157.75 -21.29% $783.50 -$200.22 -25.55% $779.68 -$196.40 -25.19% Non-Interventional Nephrologist 0.98 0.96 0.02 2.31% 0.97 0.01 1.42% 0.93 0.05 4.93% 0.89 0.09 10.10% *Percent change can not be calculated, because the average for the sort was zero. Interventional Nephrologist 0.46 0.24 0.22 90.99% 0.27 0.19 70.17% 0.29 0.17 57.34% 0.14 0.32 219.99% Percentage of Total Income Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Interventional Radiologists 0.60 0.47 0.13 28.98% 0.70 -0.10 -14.29% 0.07 0.53 800.00% 0.17 0.43 260.30% Gross Fees for Service Charges 167.40% 170.10% -2.70% 172.10% -4.70% 173.59% -6.19% 192.43% -25.03% 183.54% -16.14% Vascular Surgeons 0.69 0.63 0.06 9.53% 0.54 0.15 28.92% 0.04 0.65 1556.00% 0.25 0.44 178.19% Net Fees for Service Revenues 88.20% 86.73% 1.47% 85.30% 2.90% 85.26% 2.94% 83.15% 5.05% 80.20% 8.00% Nurse Practitioners/Physician Assistants 0.40 0.38 0.02 6.40% 0.39 0.01 2.87% 0.35 0.05 14.32% 0.28 0.12 41.73% Fees received by the practice and/or Clerical Staff 1.22 1.56 -0.34 -21.81% 1.45 -0.23 -15.99% 1.42 -0.20 -13.82% 1.38 -0.16 -11.60% individuals of the practice for Dialysis Facility Clinical Support Staff 0.92 1.10 -0.18 -16.20% 0.86 0.06 7.52% 0.96 -0.04 -3.86% 0.80 0.12 15.14% Medical Directors 8.00% 9.07% -1.07% 9.71% -1.71% 13.12% -5.12% 10.13% -2.13% 11.61% -3.61% Reimbursement for Research Activity 1.18% 1.03% 0.15% 1.87% -0.69% 0.21% 0.97% 1.43% -0.25% 2.30% -1.12% Ancillary Staff 0.58 0.50 0.08 17.16% 0.58 0.00 -0.77% 0.46 0.12 27.37% 0.21 0.37 171.75% Legal Work 0.07% 0.04% 0.03% 0.11% -0.04% 0.00% 0.07% 0.01% 0.06% 0.14% -0.07% Administrative/Management Staff 0.32 0.43 -0.11 -26.11% 0.38 -0.06 -16.47% 0.40 -0.08 -20.10% 0.36 -0.04 -12.30% Royalties 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Satellite Offices 0.62 0.65 -0.03 -3.98% 0.47 0.15 32.80% 0.52 0.10 18.49% 0.35 0.27 74.75% Rents 0.07% 0.05% 0.02% 0.09% -0.02% 0.00% 0.07% 0.01% 0.06% 0.01% 0.06% Dialysis Units Serviced** 1.59 1.77 -0.18 -10.34% 1.37 0.22 16.08% 1.80 -0.21 -11.43% 1.07 0.52 48.25% Other 2.49% 3.07% -0.58% 2.91% -0.42% 1.41% 1.08% 5.27% -2.78% 5.73% -3.24% Hospitals Serviced** 0.99 1.17 -0.18 -15.63% 0.85 0.14 16.94% 1.03 -0.04 -3.54% 0.71 0.28 38.74% Total Other Income 11.80% 13.27% -1.47% 14.70% -2.90% 14.74% -2.94% 16.85% -5.05% 19.80% -8.00% Total Income 100.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% Dialysis Patients Serviced** 69.42 82.01 -12.59 -15.35% 76.65 -7.23 -9.43% 93.87 -24.45 -26.04% 102.30 -32.88 -32.14% **This line does not refer to employees per FTE Nephrologist instead it is either units, hospitals, or patients per FTE Nephrologist Comparison of Total Income per FTE Nephrologist Comparison of Number of Employees per FTE Nephrologist $900 2.20 $800 2.00 $700 1.80 Employees per FTE Neph $600 Income (000's) 1.60 $500 1.40 $400 1.20 $300 1.00 $200 0.80 $100 0.60 $0 0.40 Your Practice National East Benchmark Large VAC 0.20 0.00 Non-Interventional Interventional Nephrologist Interventional Radiologists Vascular Surgeons Nurse Clerical Staff Clinical Support Staff Ancillary Staff Admi Comparison of Sources of Total Income per FTE Nephrologist Nephrologist Practitioners/Physician Assistants 100% 90% 80% Percent of Total Income Dialysis Patient Location 70% 60% Percentage of Dialysis Patients Total Other Income* 50% Net Fees for Service Revenue 40% Your Practice National East Benchmark Large 30% Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent 20% In Center 84.54% 85.52% -0.98% 84.23% 0.31% 86.19% -1.65% 88.99% -4.45% 10% At Home 11.32% 8.99% 2.33% 10.05% 1.27% 8.35% 2.97% 4.88% 6.44% Transient 4.14% 5.49% -1.35% 5.72% -1.58% 5.46% -1.32% 6.13% -1.99% 0% Your Practice National East Benchmark Large VAC *Total Other Income includes Fees for Medical Directors, Reimbursement for Research Activity, Legal Work, Royalties, Rents, and Other. 5
  • Nurse Practitioner or Physician Assistant Compensation and Benefits Financial Information Annual Compensation and Benefits per FTE Nurse Practitioner/Physician Assistant Income and Expenses (Cash Basis) per FTE Nephrologist Your Practice National East Benchmark Large VAC Your Practice National East Benchmark Large VAC Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Sources of Income (000's) Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Nurse Practitioner or Physician Assistant $90.43 $87.80 $2.63 3.00% $88.06 $0.00 #DIV/0! $92.95 -$2.52 -2.71% $88.76 $1.67 1.88% $91.64 -$1.21 -1.32% Total Net Practice Revenue $573.30 $641.52 -$68.22 -10.63% $594.62 -$21.32 -3.59% $716.64 -$143.34 -20.00% $788.90 -$215.60 -27.33% $789.28 -$215.98 -27.36% Physicians with 2 Years of Less Experience Compensation Total Personnel Expenses $105.49 $118.17 -$12.68 -10.73% $117.46 -$11.97 -10.19% $118.43 -$12.94 -10.92% $144.75 -$39.26 -27.12% $152.87 -$47.38 -30.99% Total Occupancy Expenses $30.68 $34.50 -$3.82 -11.07% $32.04 -$1.36 -4.25% $35.25 -$4.57 -12.97% $43.08 -$12.40 -28.78% $43.28 -$12.60 -29.12% Average Annual W-2 Compensation Your Practice National East Benchmark Large VAC Total Medical Supplies Expenses $58.76 $68.83 -$10.07 -14.63% $70.34 -$11.58 -16.47% $48.48 $10.28 21.21% $84.73 -$25.97 -30.65% $85.10 -$26.34 -30.95% Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Total General and Administrative Expenses $48.27 $55.23 -$6.96 -12.60% $53.02 -$4.75 -8.96% $48.63 -$0.36 -0.73% $65.56 -$17.29 -26.37% $74.82 -$26.55 -35.49% Physicians with 2 years or less experience $171.87 $170.08 $1.79 1.06% $161.64 $10.23 6.33% $179.95 -$8.08 -4.49% $166.21 $5.66 3.40% $172.72 -$0.85 -0.49% Total Operating Expenses $243.20 $276.73 -$33.53 -12.12% $272.87 -$29.67 -10.87% $250.78 -$7.58 -3.02% $338.11 -$94.91 -28.07% $356.08 -$112.88 -31.70% Net Income Before Physician Expenses $330.10 $364.79 -$34.69 -9.51% $321.75 $8.35 2.59% $465.86 -$135.76 -29.14% $450.78 -$120.68 -26.77% $433.20 -$103.10 -23.80% Compensation for Practice's Physician Owners Total Physician Benefit Costs $45.59 $48.09 -$2.50 -5.19% $48.19 -$2.60 -5.40% $54.43 -$8.84 -16.24% $55.20 -$9.61 -17.41% $50.31 -$4.72 -9.38% Modified Shared Plus Productivity Percentage Split Net Income After Physician Expenses $284.51 $316.70 -$32.19 -10.17% $273.56 $10.95 4.00% $411.43 -$126.92 -30.85% $395.58 -$111.07 -28.08% $382.89 -$98.38 -25.69% Your Practice National East Benchmark Large VAC Total Physician Compensation $249.93 $283.01 -$33.08 -11.69% $258.42 -$8.49 -3.28% $348.01 -$98.08 -28.18% $353.63 -$103.70 -29.32% $349.67 -$99.74 -28.52% Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Shared 50.16% 52.44% -2.28% 59.71% -9.55% 50.66% -0.50% 37.50% 12.66% 63.40% -13.24% Productivity 49.84% 47.56% 2.28% 40.29% 9.55% 49.34% 0.50% 62.50% -12.66% 36.60% 13.24% Percentage of Total Net Practice Revenue Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Total Net Practice Revenue 100.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% Comparison of Compensation and Benefits for Nurse Practitioners/Physician Assistants and Physicians With Less Than 2 Years Experience* Total Personnel Expenses 18.48% 18.44% 0.04% 19.91% -1.43% 15.86% 2.62% 18.31% 0.17% 19.53% -1.05% Total Occupancy Expenses 5.29% 5.36% -0.07% 5.09% 0.20% 4.94% 0.35% 5.47% -0.18% 5.49% -0.20% $200 Total Medical Supplies Expenses 9.74% 10.02% -0.28% 10.80% -1.06% 6.15% 3.59% 9.90% -0.16% 10.07% -0.33% Total General and Administrative Expenses 8.58% 8.81% -0.23% 8.94% -0.36% 6.86% 1.72% 8.97% -0.39% 9.70% -1.12% $180 Total Operating Expenses 42.10% 42.64% -0.54% 44.74% -2.64% 33.81% 8.29% 42.65% -0.55% 44.78% -2.68% $160 Net Income Before Physician Expenses 57.90% 57.36% 0.54% 55.26% 2.64% 66.19% -8.29% 57.35% 0.55% 55.22% 2.68% Total Physician Benefit Costs 8.45% 7.93% 0.52% 8.39% 0.06% 7.97% 0.48% 7.37% 1.08% 7.04% 1.41% Dollars in Thousands $140 Net Income After Physician Expenses 49.45% 49.43% 0.02% 46.87% 2.58% 58.23% -8.78% 49.98% -0.53% 48.18% 1.27% $120 Total Physician Compensation 45.17% 45.62% -0.45% 45.07% 0.10% 49.26% 1.64% 45.63% -0.46% 45.01% 0.16% Nurse Practitioners/Physician Assistants Physicians w/less than 2 yrs experience $100 $80 Comparison of Net Practice Revenue and Physician Compensation per FTE Nephrologist $60 $900 $40 $800 $20 $700 $0 Your Practice National East Benchmark Large VAC Dollars in Thousands $600 *Compensation for Physicians with less than 2 years experience does not include benefits. $500 Net Practice Revenue Physician Compensation Malpractice Insurance $400 Annual Cost per FTE Physician (000's) Your Practice National East Benchmark Large VAC $300 Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Physicians (including Nephrologists) $12.80 $12.76 $0.04 0.29% $12.67 $0.13 0.99% $13.91 -$1.11 -7.97% $12.61 $0.19 1.52% $13.14 -$0.34 -2.56% $200 Malpractice Insurance Classified by Risk $100 Annual Cost per FTE Physician (000's) Your Practice National East Benchmark Large VAC $0 Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Your Practice National East Benchmark Large VAC Minor Risk $12.20 $12.77 -$0.57 -4.43% $11.22 $0.98 8.78% $14.40 -$2.20 -15.27% $11.99 $0.21 1.73% $13.80 -$1.60 -11.57% Non-Minor Risk $13.73 $18.28 -$4.55 -24.91% $15.70 -$1.97 -12.56% $19.39 -$5.66 -29.18% $19.71 -$5.98 -30.35% $17.65 -$3.92 -22.20% -0.45% 3.81% 1.80% 8.97% 4.36% 3.16% Comparison of Distribution of Total Net Practice Revenue per FTE Nephrologist Comparison of Annual Malpractice Insurance Cost per FTE Physician 100% Percent of Total Net Practice Revenue $14 90% $12 80% 70% Dollars in Thousands $10 Remaining Revenue 60% Total Physician Compensation $8 50% Total Physician Benefit Costs 40% Total Operating Expenses $6 30% $4 20% 10% $2 0% $0 Your Practice National East Benchmark Large VAC Your Practice National East Benchmark Large VAC Charges, Payments, and Accounts Receivable Percent of Total Total Relative Value Units (RVUs) Your Practice National East Benchmark Large VAC RVU Total per FTE Nephrologist Charges by Payer Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Your Practice National East Benchmark Large VAC Medicare 65.04% 64.27% 0.77% 64.72% 0.32% 63.34% 1.70% 61.18% 3.86% 63.37% 1.67% Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Medicaid 6.50% 7.39% -0.89% 6.88% -0.38% 8.89% -2.39% 10.93% -4.43% 9.28% -2.78% RVU Total per FTE Nephrologist 13,926.90 15,566.47 -1,639.57 -10.53% 15,901.33 -1,974.43 -12.42% 19,188.28 -5,261.38 -27.42% 16,262.48 -2,335.58 -14.36% 16,596.16 -2,669.26 -16.08% Commercial (non-managed care) 13.39% 14.40% -1.01% 14.98% -1.59% 13.10% 0.29% 14.76% -1.37% 15.74% -2.35% Managed Care 10.99% 9.83% 1.16% 9.40% 1.59% 10.88% 0.11% 8.83% 2.16% 8.39% 2.60% Self-pay 1.58% 1.91% -0.33% 1.82% -0.24% 1.80% -0.22% 2.44% -0.86% 1.63% -0.05% Comparison of Total Relative Value Units per FTE Nephrologist Charity Care 0.53% 0.60% -0.07% 0.65% -0.12% 0.39% 0.14% 0.48% 0.05% 0.37% 0.16% Other (Champus, VA, Miscellaneous) 1.96% 1.60% 0.36% 1.55% 0.41% 1.59% 0.37% 1.37% 0.59% 1.23% 0.73% 20,000 18,000 Payments by Payer by Actual Receipts Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent 16,000 Medicare 58.93% 58.99% -0.06% 59.00% -0.07% 61.33% -2.40% 58.50% 0.43% 60.31% -1.38% Medicaid 4.70% 5.54% -0.84% 5.42% -0.72% 5.46% -0.76% 7.06% -2.36% 6.25% -1.55% 14,000 Commercial (non-managed care) 17.60% 18.08% -0.48% 18.19% -0.59% 16.81% 0.79% 16.89% 0.71% 18.86% -1.26% 12,000 Managed Care 12.99% 11.71% 1.28% 11.04% 1.95% 12.59% 0.40% 11.92% 1.07% 9.84% 3.15% RVU's Self-pay 2.53% 2.62% -0.09% 3.32% -0.79% 2.10% 0.43% 2.51% 0.02% 1.88% 0.65% 10,000 Charity Care 0.17% 0.25% -0.08% 0.24% -0.07% 0.08% 0.09% 0.44% -0.27% 0.37% -0.20% 8,000 Bad Debt Write-Off 1.08% 0.82% 0.26% 0.51% 0.57% 0.44% 0.64% 0.29% 0.79% 0.52% 0.56% Other (Champus, VA, Miscellaneous) 1.99% 1.98% 0.01% 2.28% -0.29% 1.20% 0.79% 2.40% -0.41% 1.98% 0.01% 6,000 4,000 Accounts Receivable Days Outstanding Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent 2,000 Current to 30 50.04% 51.80% -1.76% 53.44% -3.40% 53.44% -3.40% 57.97% -7.93% 54.27% -4.23% 0 31 to 60 16.13% 16.35% -0.22% 18.18% -2.05% 16.59% -0.46% 11.78% 4.35% 14.17% 1.96% Your Practice National East Benchmark Large VAC 61 to 90 8.98% 8.69% 0.29% 8.18% 0.80% 9.48% -0.50% 7.28% 1.70% 7.70% 1.28% 91 to 120 9.11% 7.92% 1.19% 7.02% 2.09% 5.91% 3.20% 6.45% 2.66% 6.03% 3.08% 121 or more 15.74% 15.25% 0.49% 13.19% 2.55% 14.59% 1.15% 16.51% -0.77% 17.83% -2.09% Visit Codes- Office Visits CPT Codes 99211-99215 Your Practice National East Benchmark Large VAC Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Office Visit Level 1 4.78% 4.76% 0.02% 7.68% -2.90% 2.25% 2.53% 5.78% -1.00% 4.58% 0.20% Characteristics of Units Serviced by Medical Directors Office Visit Level 2 4.34% 4.73% -0.39% 5.32% -0.98% 5.08% -0.74% 4.18% 0.16% 5.07% -0.73% Office Visit Level 3 40.23% 37.96% 2.27% 32.82% 7.41% 46.05% -5.82% 34.15% 6.08% 36.78% 3.45% Average Units, Stations, or Shifts Office Visit Level 4 46.28% 47.51% -1.23% 48.25% -1.97% 42.49% 3.79% 50.01% -3.73% 48.74% -2.46% Your Practice National East Benchmark Large VAC Office Visit Level 5 4.37% 5.05% -0.68% 5.93% -1.56% 4.12% 0.25% 5.87% -1.50% 4.82% -0.45% Difference Difference Difference Difference Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference Total Dialysis Units Serviced 4.40 6.31 -1.91 -30.28% 4.79 -0.39 -8.13% 6.92 -2.52 -36.41% 14.17 -9.77 -68.95% 12.35 -7.95 -64.37% Visit Codes- Initial Hospital Care Average Number of Stations at Dialysis Units 19.20 19.67 -0.47 -2.38% 20.90 -1.70 -8.13% 19.23 -0.03 -0.15% 22.29 -3.09 -13.85% 20.51 -1.31 -6.40% CPT Codes 99221-99223 Average Number of Dialysis Shifts per Day 2.60 2.64 -0.04 -1.69% 2.76 -0.16 -5.80% 2.61 -0.01 -0.33% 2.72 -0.12 -4.27% 2.65 -0.05 -1.89% Your Practice National East Benchmark Large VAC (at facilities where Med Director Services are provided) Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Initial Hospital Care Level 1 5.15% 5.99% -0.84% 7.71% -2.56% 7.47% -2.32% 4.91% 0.24% 5.23% -0.08% Initial Hospital Care Level 2 33.72% 37.09% -3.37% 35.42% -1.70% 41.90% -8.18% 45.22% -11.50% 41.82% -8.10% Initial Hospital Care Level 3 61.14% 56.92% 4.22% 56.87% 4.27% 50.64% 10.50% 49.87% 11.27% 52.95% 8.19% Visit Codes- Hospital Visit Procedures Performed CPT Codes 99231-99232 Percent of Physicians Performing Specific Procedures Your Practice National East Benchmark Large VAC Your Practice National East Benchmark Large VAC Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Hospital Visit Level 1 15.11% 17.50% -2.39% 22.10% -6.99% 20.15% -5.04% 11.92% 3.19% 11.64% 3.47% Permanent Catheter Placements (Tunneled) 9.57% 11.33% -1.76% 8.64% 0.93% 15.66% -6.09% 14.96% -5.39% 21.95% -12.38% Hospital Visit Level 2 62.51% 61.69% 0.82% 62.93% -0.42% 62.50% 0.01% 66.99% -4.48% 66.54% -4.03% Temporary Catheter Placements (Non-tunneled) 38.67% 39.80% -1.13% 38.26% 0.41% 39.56% -0.89% 42.24% -3.57% 46.54% -7.87% Hospital Visit Level 3 22.37% 20.80% 1.57% 14.97% 7.40% 17.36% 5.01% 21.09% 1.28% 21.82% 0.55% Peritoneal Dialysis Catheters 6.58% 7.87% -1.29% 8.57% -1.99% 8.45% -1.87% 7.16% -0.58% 16.85% -10.27% Visit Codes- Office Consult Interventional Nephrology Procedures 7.57% 8.90% -1.33% 9.57% -2.00% 10.49% -2.92% 17.07% -9.50% 20.23% -12.66% Kidney Biopsies 34.65% 38.08% -3.43% 37.90% -3.25% 34.87% -0.22% 37.93% -3.28% 36.59% -1.94% CPT Codes 99241-99245 Your Practice None of the Above 45.65% 41.03% 4.62% 45.60% 0.05% 38.73% 6.92% 36.26% 9.39% 31.83% 13.82% National East Benchmark Large VAC Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Office Consult Level 1 0.40% 0.35% 0.05% 0.61% -0.21% 0.21% 0.19% 0.30% 0.10% 0.36% 0.04% Office Consult Level 2 1.38% 1.67% -0.29% 1.63% -0.25% 1.35% 0.03% 1.42% -0.04% 2.76% -1.38% Office Consult Level 3 15.48% 16.64% -1.16% 15.85% -0.37% 16.16% -0.68% 18.21% -2.73% 17.42% -1.94% Office Consult Level 4 50.80% 52.11% -1.31% 50.20% 0.60% 49.46% 1.34% 51.75% -0.95% 53.27% -2.47% Office Consult Level 5 31.94% 29.23% 2.71% 31.71% 0.23% 32.81% -0.87% 28.31% 3.63% 26.19% 5.75% Clinical Research Funding Funding Sources Visit Codes- Hospital Consult Your Practice National East Benchmark Large VAC CPT Codes 99251-99255 Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Your Practice National East Benchmark Large VAC Federal/State 8.51% 5.52% 2.99% 8.00% 0.51% 0.00% 8.51% 1.57% 6.94% 0.78% 7.73% Difference Difference Difference Difference Difference Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Pharmaceutical 88.54% 91.62% -3.08% 88.67% -0.13% 100.00% -11.46% 98.29% -9.75% 97.22% -8.68% Hospital Consult Level 1 0.40% 0.40% 0.00% 0.45% -0.05% 0.20% 0.20% 0.28% 0.12% 0.34% 0.06% Other 2.94% 2.86% 0.08% 3.33% -0.39% 0.00% 2.94% 0.14% 2.80% 2.00% 0.94% Hospital Consult Level 2 2.78% 2.63% 0.15% 2.77% 0.01% 2.39% 0.39% 2.07% 0.71% 1.97% 0.81% Hospital Consult Level 3 19.79% 19.73% 0.06% 21.76% -1.97% 22.19% -2.40% 18.39% 1.40% 17.77% 2.02% Hospital Consult Level 4 49.38% 50.31% -0.93% 50.01% -0.63% 51.32% -1.94% 52.15% -2.77% 53.98% -4.60% Hospital Consult Level 5 27.65% 26.93% 0.72% 25.01% 2.64% 23.89% 3.76% 27.11% 0.54% 25.95% 1.70% NAUSA NAUSA (per FTE Nephrologist) A/R Management 30 2.5 Percentage of total A/R Dialysis patients 69.42 FTE Clerical Staff per 25 2.0 Staffing: FTE Neph 20 1.5 Clerical Staff 1.22 15 1.0 10 Clinical Support Staff 0.92 0.5 5 Ancillary Staff 0.58 0 0.0 Admin/Mgt Staff 0.32 l e h st C A k st na t es rg ar ut VA US Ea we tio So La hm W total staff 3.04 id NA Na nc M Be Data Sort NP/PAs 0.40 A/R % > 90 days Clerical Staff 6
  • NAUSA NAUSA Actual Receipts by Payer Charges by Payer % of total receipts Mean % bad debt 70.00% 1.20% 60.00% 1.00% 70.00% Mean percentage 50.00% 0.80% 60.00% 40.00% 0.60% 50.00% 30.00% 0.40% 20.00% 40.00% 0.20% 10.00% 30.00% 0.00% 0.00% 20.00% 10.00% l NA e Be VAC A st k na 0.00% rg ar US Ea tio La hm Na nc Be VA Ea La Na NA nc st rg C tio US e hm na A l ar Medicare Medicaid Commercial k Managed Care Bad Debt MedicaidData Sort Medicare Commercial Managed Care Suzanne Mecum, CPA, FACMPE scm@metrolinanephrology.com 7