012 Am09 Presentations Mecum

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012 Am09 Presentations Mecum

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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

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