PRODUCTIVITY METRICS USED IN HOSPITAL FUNDING AGREEMENTS
PRODUCTIVITY METRICS USED IN HOSPITAL
2006 ACE Annual Meeting
Las Vegas, Nevada
Sunday, February 19, 2006
Speaker: Anthony J.
What is a Hospital Funding Agreement?
Business decision that requires hospital funding of a
physician practice (or department) to advance
recruitment start-up funding
deficit funding of mission critical programs
Why Review Physician Productivity?
Most valuable resource
Accountability to business enterprise
Identification of “other” factors
CLINICAL PRODUCTIVITY REVIEW COMMITTEE
-comprised of physician leadership, administrator
and project staff:
review current productivity levels – individual
and aggregate WRVU’s (from billing system)
determine national standards for similar
practices as a benchmark
develop WRVU based goals/targets that
support financial and service needs
Clinical Full Time Equivalents
HOW DO PHYSICIANS SPEND THEIR TIME?
IDENTIFY UNFUNDED/UNDER FUNDED WORK
Negotiate funding or change behavior
“Drill down” clinical schedules
Based on time available for clinic, not funding sources
Site 1 Site 2 Site 3 R&T Admin Total
Physician A 0.57 0.00 0.00 0.33 0.00 0.90
Physician B 0.51 0.00 0.30 0.19 0.00 1.00
Physician C 0.10 0.00 0.00 0.90 0.00 1.00
Physician D 0.32 0.45 0.00 0.13 0.10 1.00
Physician E 0.38 0.00 0.02 0.20 0.40 1.00
Physician F 0.40 0.00 0.20 0.40 0.00 1.00
Physician G 0.00 0.82 0.00 0.18 0.00 1.00
Physician H 0.40 0.10 0.00 0.00 0.00 0.50
Physician I 0.86 0.10 0.00 0.04 0.00 1.00
Totals 3.54 1.47 0.52 2.37 0.50 8.40
MEDICAL ONCOLOGY – review committee
recognized the lack of comparable data as an early
RADIATION ONCOLOGY – required a better “fit” with
similar institutions than the industry surveys provided
due to low survey participation.
In both cases, it was believed that industry benchmarks
(MGMA, UHC, SROA) fell short of the needs of the
MEDICAL ONCOLOGY – Hired a consultant to survey
the National Comprehensive Cancer Network (NCCN)
centers. Conducted site visits to 2 comparable cancer
centers to observe operational and staffing efficiencies.
RADIATION ONCOLOGY – Designed a survey (modeled
after the 2003 SROA tool) with participation from 4
similar organizations. Survey questions covered:
staffing and operational structure
Radiation Oncology Physician
UW Survey 8,089
UW Performance 9,436
Median Academic Practice Work Relative Value Units Per
Clinical FTE Physician:
Other Radiation Oncology
Medical physicists per accelerator
Number of patients per nursing FTE
Tx plans per dosimetrist
Beam treatments per therapist
Support staff per CFTE physician
Annual Tx requiring anesthesia
Annual seed implants
HDR Tx by sub-specialty
Levels of hospital support
Radiation Oncology Results
Set physician productivity benchmark at 8,089 WRVU’s
Validated the need to recruit additional physicians.
Built benchmarks into funding agreement.
Used benchmarks to determine future recruitment needs.
Validated that physicist, dosimetrist, nursing and support
staffing levels were acceptable at current productivity
levels when compared to comparable institutions.
Cited several facility/equipment issues that would need to
2002 MGMA Median 2,854
2002 NCCN Median 3,251
UW Performance Level 2,825
Benchmark Selection Criteria
Recognition that a legitimate funding gap existed.
Benchmark performance would be expected in
order to justify future support.
Would take into consideration the significant
research and teaching effort of faculty.
Group vs. individual performance measure.
Benchmark would become a component of
Individual Benchmarks Based
on Percentage Research and Teaching (R&T)
Adopted NCCN median as benchmark, and established
goals that reflect research and teaching effort as follows:
LOW 35% R&T 2,167 Goal
MODERATE 45% R&T 1,799 Goal
HIGH 55% R&T 1,439 Goal
Funding Agreement Principles
WRVU Goal Met = 100% Shortfall Funding:
salary metrics (AAMC)
department overhead rate cap
WRVU Goal Not Met:
funding up to level had goal been met
imputed revenue based on historic
collections per WRVU
remainder of shortfall shared
Example: Medical Oncology Funding Agreement
Medical Oncology Example GOAL MET GOAL NOT MET
WRVU Revenue WRVU Revenue
Physician A 2,167 $ 112,684 2,167 $ 112,684
Physician B 1,799 $ 91,749 1,350 $ 68,850
Physician C 1,439 $ 83,462 1,200 $ 69,600
Group Performance 5,405 $ 287,895 4,717 $ 251,134
Revenue Per WRVU $53.00 $53.00
Financial Shortfall (per income statement) (300,000) (336,761)
Amount of Support had Goal Been Met 300,000 300,000
Remaining Shortfall - (36,761)
Additional Hospital Support - 24,507
Department Share of Shortfall - 12,254
Medical Oncology Results
Validated assumptions regarding physician shortages and
initiated recruitment activity.
Set baseline WRVU targets that took into consideration
Utilized “aggregate” measures to establish financial
Established systems to enhance internal data collection
needed to track productivity accurately.
Regular reporting to faculty on performance.
Adopted several clinic operational improvement and
Physician “buy-in” essential
Industry benchmarks not perfect
Get creative with benchmarks:
EASIER TO WORK WITH OUR