Key Findings from MD Ranger's 2017 Facility Totals Benchmarks
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In this webinar we will review our key findings from the new Total Facility Benchmarks, as well as compare them to the past seven years' reports to uncover trends.
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Key Findings from MD Ranger's 2017 Facility Totals Benchmarks
- 1. 1 Key Findings from MD Ranger’s 2017 Facility Totals Benchmarks
- 2. Our agenda • MD Ranger intro • Benchmarking your organization • About our Facility Totals benchmarks • Key takeaways from MD Ranger’s 2017 Facility Totals benchmarks 2
- 3. 275+ Physician Benchmarks • Call coverage rates • Medical direction payments • Administrative and leadership services rates • Hospital-based service stipends • Diagnostic testing, etc. • Clinic & hourly rates Online Platform • Benchmark lookups • Contract proposal tools • Contract reports by facility and service • Total facility costs + benchmarks Compliance Documentation • Contract-specific FMV documentation reports • Reports to assist with real-time monitoring and annual reviews Research and Support • Resources for education and training • On-call experts to help subscribers use benchmarks and tools 3
- 4. The foundation of your contracting process Standardize processes and rates Document FMV Access 275+ payment benchmarks Review contracts and monitor with ease Have smarter, data-driven physician negotiations Mitigate compliance risks 4
- 5. 5 Our database and subscribers
- 6. 6 Our benchmarks • Call Coverage (55+) • Medical direction (85+) • Hospital-based services (15+) • Administrative • Medical Staff Leadership • Diagnostic/other services e.g. ROP, autopsy, dialysis • Hospital-based stipends • Clinics, professional services • Telemedicine • Residency/teaching/GME • Uncompensated care • Meeting attendance, peer review, IT/EHR and quality initiatives • 13 Pediatric services, with more emerging each year Hospital-characteristics drill down for ADC, bed size, trauma status, urban/rural, stroke centers, and more. Used in academic medical centers, integrated delivery systems, and hospital organizations.
- 7. Our methodology: key differences • Providers vs. facilities • Verified data • Thorough data audits • Physician contract experts on-call to review/advise on challenging contracts 7
- 8. Comprehensive data collection practices 8 MD Ranger collects comprehensive physician contract data every year from each subscriber. Data includes payments for all non-employment contracts, including medical direction, administrative and leadership services, call coverage, hospital-based services and diagnostic testing. This means we can calculate benchmarks on overall hospital payments for non-employed physicians —which we’ll discuss today.
- 9. About your host 9 • Chief Marketing Officer at MD Ranger • Decade in the industry, developed expertise specifically pertaining to the hospital/physician relationship
- 11. 11 Why benchmarking is important 1. Understanding the market for physician services 2. Establishing appropriate physician payments relevant to your organization 3. Measuring performance to certain standards
- 12. Use compensation benchmarking for payment rates, FMV documentation • Healthcare organizations often use market benchmarks to set physician payment rates • Benchmarks can help in the documentation process, too 12
- 13. Identifying benchmarks 13 • Find the best, most appropriate match for the service • Compare similar organizations (MD Ranger allows you to look up data slices based on hospital demographics) • Check sample size • Examine the full market range, and ask: • What’s the median? What is the 75th percentile? • Are there reasons for my hospital rates to be higher than the median? • Are there characteristics of my hospital, the service or the physician that could impact FMV?
- 14. Overall spend benchmarks • While benchmarking on a contract by contract level basis is straightforward, benchmarking your organization on overall spend is more nuanced • Using facility-wide benchmarks can help a hospital or health system identify opportunities to reduce costs, address or document outliers, or revise payment policies Facility total benchmarks allow hospital-wide comparisons that give perspective on your payment practices compared to other facilities 14
- 15. ABOUT OUR FACILITY TOTALS BENCHMARKS 15
- 16. Our benchmarks • MD Ranger calculates a facility’s total non-salary estimated physician spend • The benchmarks are calculated from call coverage, medical direction, other administrative positions and hospital-based contracts • The benchmarks do not include collection guarantees (when we don’t have enough information) and positions with no net annual payment data 16
- 17. Our benchmarks Facility Total Benchmarks provide insight into the scope and type of payments made by hospitals with different characteristics such as size and trauma status. 17
- 18. Other benchmarks • Percent paying • Number of positions • Number of paid positions by service 18
- 19. 19 KEY FINDINGS
- 20. Facility totals: all hospitals 20 Mean $7,877,890 $- $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 $12,000,000 $14,000,000 $16,000,000 25% 50% 75% 90% Percentiles Source: MD Ranger, Inc.
- 21. Facility totals: call coverage 21 Mean $3,135,310 $- $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 25% 50% 75% 90% Percentiles Source: MD Ranger, Inc.
- 22. Facility totals: medical direction and administration 22 Mean $1,628,540 $- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 25% 50% 75% 90% Percentiles Source: MD Ranger, Inc.
- 23. MD Ranger hospital-based services 23 • Anesthesia • OB Anesthesia • Critical Care • Pediatric Critical Care • Emergency • Hospitalists • OB Hospitalists • Pediatric Hospitalists • Psych Hospitalists • Neonatology • Pathology/Clinical Laboratory • Perinatology • Maternal/Fetal Medicine • Radiology • Trauma
- 24. Facility totals: hospital based services 24 Mean $3,370,160 $- $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 $9,000,000 25% 50% 75% 90% Percentiles Source: MD Ranger, Inc.
- 25. Number of paid coverage services 25 0 2 4 6 8 10 12 14 16 18 20 25% 50% 75% 90% Percentiles Source: MD Ranger, Inc. Mean 13
- 26. Who is most likely paid? 26
- 27. Number of paid directorships and administrative services 27 Mean 38 0 10 20 30 40 50 60 25% 50% 75% 90% Percentiles Source: MD Ranger, Inc.
- 28. Trauma status matters • Significant differences between trauma and non- trauma hospitals, resulting from higher payments AND more services. • Level I and II trauma centers pay on average 32% more for call coverage agreements and have more services on call and more medical directorships 28
- 29. Trauma vs. Non-Trauma total facility spending 29 $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 25% 50% 75% 90% Percentiles Non-Trauma Centers Trauma Centers Source: MD Ranger, Inc.
- 30. Demographics and total spending 30 $- $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 $12,000,000 $14,000,000 $16,000,000
- 31. Using Facility Totals Benchmarks • Compare your facility based on key characteristics • Compare facilities within a system to identify outliers and opportunities for standardization • Compare total payments for types of services within a facility and across a system of facilities 31
- 32. Need help with benchmarking? 32 Do you feel confident in your organization’s physician contracting and FMV documentation process? Do you get the sense you are spending too much on physician agreements? Do you have too many medical directors? Do you want an in-house source for high quality benchmarks for a broad range of physician contracts? We can help! Reach out: apullins@mdranger.com or 650-692-8873
Editor's Notes
- Hi everyone, thanks for joining us today for our webinar on our facility totals benchmarks. Before I begin, a few housekeeping items. My colleague Julia is on the line to help with any incoming questions or issues. If we’re unable to follow up with you during the webinar, we will send you an email or call you following the presentation. Everyone will receive a copy of this presentation in a day or two, and a recording will be made available on our website before the end of the month.
- Here’s how we’re going to spend our half hour together today. First, I want to do a quick MD Ranger intro. We have some new folks on the line and I want to make sure that they know what we do and where We’ll then make a case for why benchmarking should be a part of your physician contracting process at your organization. And not just for contract by contract compensation benchmarks, but for more holistic benchmarks that capture payment practices. Then we’ll tell you about our facility totals benchmarks—how they are calculated, and why we are able to create them. Then, we’ll show you some benchmarks and share key takeaways from our benchmarks.
- MD Ranger is an online platform that integrates over 250 physician compensation benchmarks with a suite of compliance and financial tools. A secure, web-based Contract Data Tool to collect and organize contracts Analytics to benchmark contracts, review expenditures, identify compliance issues, and compare facilities Cost and compliance reports to compare your contracts to MD Ranger benchmarks Resources and research to support compliance efforts And Support from experts in physician compensation, FMV documentation, and compliance
- IN fact, we aim to be the foundation of their physician contract compliance programs, all in an integrated, easy to use platform. MD Ranger helps subscribers standardize their physician contracting process in the way that is best for their organization. Because our benchmarks and online platforms can be integrated into all types of compliance and legal processes, we can be a resource to all types of organizations. . These types of financial arrangements can be very risky to organizations and to physicians—given federal regulations and hightened scrunity by the government. Our subscribers use the MD Ranger platform to mitigate that risk and monitor risky arrangements.
- We began producing benchmarks in 2009 have have grown from a database of 4,000 to 28,000 contracts since. This is a map of our subscribers and contract database MD Ranger has more than 225 participating healthcare organizations. We work with all types of facilities from large urban trauma centers to small, rural critical access facilities, surgery centers, dialysis centers and everything in between.
- Here is a comprehensive list of the types of different physician agreements we benchmark. We drill down all our benchmarks by meaningful hospital demographics, like hospital size, trauma status, and more.
- We have some key differences in our approach and methodology that I wanted to share. First of all, when it comes to sample size and reporting benchmarks, we take a more conservative approach. ATSZ guidelines require that a minimum of five providers be included to publish a compensation benchmark. While some surveys interpret the word provider to mean physician, we interpret it to mean hospital owner or corporation—not physician or even hospital! This ensures that our sample size has enough data to produce meaningful benchmarks. Instead of collecting data from physicians themselves, we get our data from hospitals and healthcare organizations contracting with doctors for services. We feel this approach is more reliable, especially when it comes to reporting annual hours.
- The other big difference in our collection methodology is our comprehensive practice of collcting our member organization’s entire scope of physician agreements. MD Ranger subscribers submit all physician contracts to us on at least an annual basis. Agreements include all non employed physician services like XXXX. What this means we can do is calculate some benchmarks on a facility-wide basis that are not only extremely interesting, but also helpful to healthcare organizations.
- And for those of you new to our webinars, here’s me your host. My career has been focused on the hospital/physician relationship
- Before we get into the facility totals benchmarks themselves, I want to spend a few minutes talking about the reasons for benchmarking your organization, and I’d argue, the importance of using benchmarks at your organization.
- First of all, using benchmarks for physician contracting on a contract by contract level basis is an established best practice. Even if a cost valuation is used to establish a payment rate for a given contract, market data benchmarks are used as a part of that assessment. Physician compensation benchmarks help us understand what the market is like for any particular physician service. Benchmarks also help you understand where on the market ranges you are paying at your organization and can help you stay within organizational guidelines you have set. Ultimately benchmarks help measure your organization’s performance against some sort of standard.
- Organizations typically use benchmarks to both set rates and document that they are FMV.
- Here are some straightforward best practices to use benchmarking in your contract level analysis. Look at the full range of the benchmarks, paying special attention to the median and the 75th percentile. Also ask yourself (questions)
- When we’re talking about more organization-wide benchmarks, many organizations aren’t tapping into potential insights from them because they simply don’ tknow where to find them, or they are so busy focusing on the minutea of negotiating and documenting contracts on a contract by contract level basis. Ultimately though, facility-wide benchmarks can help healthcare organization identify cost reduction opportunities, determine if there are any services or service lines that are outliers in terms of spend, or even revise payment policies that aren’t serving the organization.
- So let’s talk about the benchmarks that MD Ranger is able to offer hospitals and healthcare organizations on total spend at facilities.
- MD Ranger calculates a facility’s total non-salary estimated physician spend as well as the number of paid physician positions across the organization The benchmarks are calculated from call coverage, medical direction, other administrative positions and hospital-based contracts The benchmarks do not include collection guarantees (when we don’t have enough information) and positions with no net annual payment data
- Because we are able to slice our facility wide benchmarks by meaningful hospital demographic, just like our contract-level benchmarks, we can report benchmarks for different types of organizations like large hospitals, or trauma centers We slice data by Hospital size by beds and by ADC Trauma status Payer mix—both medicare days as a percent total and DSH hospitals Urban and rural hospitals Shortly in our presentation, we’ll be comparing data by facility type and demonstrating that there can be significant differences for different types of facilities.
- Our collection methodolgy allows us to produce some other unique benchmarks. For example, for any service benchmark we report we can tell you what percentage of our subscribers pay for the service in the first place. This benchmark can be helpful in establishing whether or not it may be commercially reasonable to pay for the service in the first place. We also count the number of positions that exist at organizations.
- Now let’s discuss what we found in our facility total benchmarks from this year.
- This benchmark is the aggregated totals amounts for all hospitals across all different types of physician agreements. The average GAC hospital in our database spends 7.87 million per year on non-employment physician agreements.
- This benchmark shows how much hospitals spend on ED coverage agreements every year. The average GAC hospital in our database spends just over 3 million per year on call coverage contracts. That is not a small chunk of change!
- This benchmark shows how much all hospitals in our database spend on both medical direction and administrative payments annually The average hospital is spending about 1.6 million on these types of physician admin agreements. These totals don’t only include all medical directorships at a facility, but also physician administrative positions like peer review, directors of HER, any payments to chair committees or attend meetings, and similar positons.
- Before we get into hospital based stipend benchmarking, I wanted to show which types of hospital-based agreements we benchmark Over the past few decades, hospital-based services have really been pushed into the spotlight, particularly with the proflieration of the general hospitalist and the specialized hospitalist like laborists and psy hospitalists. It is becoming more common for hospitals to provide stipends to hospital based groups providing these services, for services like hospitalists, intensivists, and anesthesiologists in particular.
- Now let’s look at hospital-based stipend spending. The average GAC hospital in the MDR database spends just shy of 3.4 million per year in these agreements.
- The next few slides highlight call coverage as this is an area of increasing concern for hospital administrators. If you don’t pay physiicans to take call at your organization, congratulations! However, for many of our subscribers, paying physicians to take ED call is a reality. The average hospital pays for 13 services to cover the ED.
- The most common services we see getting paid are as follows.
- Let’s turn our attention to the number of paid administrative positions and directorships. The average hospital has nearly 40 of these paid positions—38 to be exact. Keep in mind that directorships are your more typical medical directorships like GI, GS, etc. Administrative positions are those non-medical directorship roles like IT/EHR, quality initiatives, etc.
- The benchmarks demonstrate the stark differences physician payments between trauma and non-trauma hospitals. On a contract-by-contract basis these differences can be observed in the MDR service benchmarks as well. Trauma centers pay on average 32% more for call coverage agreements. However, these payment differences don’t fully account for higher facility payments because trauma centers also tend to have more positions covered in the ED as well as more medical directorshipsthus explaining much larger differences in facility-wide benchmarks.
- Show you data from across MDR’s demographic slices. These represent total facility payments at the median.
- So, if you are an MD Ranger subscriber on the line, you might be wondering how to put this wealth of information to use. The good news is that you can always call us and discuss ideas. But here are a few that I am going to throw out today. First, compare your facility! Use your MD Ranger platform to show your overall spend—we calculate it for you—and see where you fall on our benchmarks. Are you average? Above or below? You can also use your analytics platform to compare facilities across your organization. Benchmark those facilities by the most appropriate demographic data slice in our facility totals benchmarks to see if they fall into line. Are there any facilities that jump out at you in terms of spending too much? Maybe you’ve found an outlier faclity that spends less than others—what are they doing right? It’s also a good idea to compare service line spending across the organization. You can do this within your analytics platform, too.
- Thanks for joining us today. We’re glad to have you. If you haven’t already, please sign up on our website to receive MD Ranger materials or follow us on twitter @MDRanger