Confidential Europe • Asia • Americas · Confidential Europe • Asia • Americas Section Table of Contents Slide 1 Background, purpose, methodology and demographics 4 2 Private

Europe • Asia • Americas Confidential

Slide: 1


2009 Rheumatology Economic

Survey

Final Report

May 18, 2010

2


Section Table of Contents Slide

1 Background, purpose, methodology and demographics 4

2 Private practice only 10

Geographic Breakouts 70

Age Breakouts 89

3 Academia only 108

Geographic Breakouts 132

Age Breakouts 140

4 Shared findings between academia and private practice 148

5 Comparisons with1999 ACR National Economic Survey 158

6 Comparisons with 2006 Workforce Study 182

3

2009 Benchmark Survey


Section 1

Background, objectives, methodology and demographics

4



Background

The ACR Committee on Rheumatologic Care (CORC), which is

composed of practicing physicians, expressed the desire to conduct a

benchmark study to update previous benchmark survey information

from 1999 and 2003.

While some of the demographic and academic questions were carried

forward from the 2003 administration, a large number of questions

were added to the 2009 administration.

dmrkynetec was selected to conduct the survey, which was fielded in

mid 2009.

5



Purpose of this Study

The ACR’s primary purpose for this project is to ensure an adequate

rheumatology workforce in an era of increased numbers of uninsured

and underinsured in the general population; increased chronic and

musculoskeletal diseases; and an expanding population of aging

citizens.

The goals were to collect nationwide information regarding practice

situations, including productivity, compensation, types of contracted

arrangements, practice costs, and perceived work force requirements.

Data was collected and comparisons were made for rheumatologists in

academic settings and those in private practice.

6



Methodology

A high rate of survey participation by the rheumatology membership was

desired. It was estimated that approximately 60% of the 6,800 current members

of the ACR would qualify as potential respondents for the third Rheumatology

Economic Survey (n = 4,200).

The primary qualification was that the respondent was currently a full-time,

actively practicing rheumatologist, either in academia or in private practice.

In order to make the survey as convenient to complete as possible, dmrkynetec

recommended that an on-line, web based survey be conducted. This allowed

the physicians to complete the survey at a time that was convenient for them.

In addition, the on-line questionnaire was programmed in such a manner that

participating rheumatologists who needed to temporarily suspend their surveys,

would be able to do so without losing the information they had already entered.

7



Methodology (cont.)

Each potential respondent in the sample of eligible rheumatologists received a

cover letter from the ACR explaining the importance of the survey.

Email letters with unique login information were sent to the majority of

respondents. Those rheumatologists who did not have a current email address

on file were given login information via postal mail. All email and phone

contacts were conducted by the ACR. Mailed information was conducted by

dmrkynetec.

An eight page worksheet, designed to help the rheumatologists to collect

information needed to complete the on-line survey, accurately and completely,

was sent to each potential respondent via email or postal mail.

The online survey was hosted by dmrkynetec and was open from June 26 to

November 30, 2009.

Reminder email and mail letters were sent on a periodic basis to each physician

who had not yet completed the on-line survey. Follow-up phone calls to

encourage participation were made by the staff at ACR.

8



Demographics

23

2

5

2

2

4

319 rheumatologists from across

the US and Puerto Rico participated

in the 2009 Economic Survey.

7

7

4

1

1

3

4

9

4

3 3

28

9 14

4

15 1

5

19

10

10

2

30

9

2

10

3

6

20

6 2

2

8 2

4

Puerto Rico = 2

3 1

DC = 3

1

11

2



Section 2

Private Practice Findings

10

2009 Benchmark Survey – Private Practice Findings


Predominant Source of Payment [Physicians answering “private practice” and “other” in Q3.]

Q31. Which of the following is your predominant source of payment? What is the number of rheumatologists/physicians?

(n=176)

11

Mean # of

Physicians

3.7 Rheum

54.0 All Phys

*Note: The single practice

administrator has been added into

the multi-specialty group for all

subsequent questions.

5.2 Rheum

(n=64)

(n=52)

(n=59)

(n=1)

There is a fairly even split between solo private practice (36%), single specialty group (30%) and multi-

specialty group practices (34%). There is an average of five rheumatologists within the single specialty

group and four within the multi-specialty group.



Percent of Practice - Adult, Primary Care and Pediatric

Q32. What percentage of visits makes up your clinical practice in each of the following areas?

(n=186)

12

Fifty-three percent of rheumatologists in private practice report all of their practice is adult rheumatology,

while 44% report that 50% or more of their practice is adult rheumatology. A large majority report no

primary care (80%) or pediatric rheumatology (70%).



Percent of Practice - Adult, Primary Care and Pediatric

13

% of Income Total n=186

Solo Private

Practice n=64

Single Specialty

Group n=52

Multi-Specialty

Group n=60

Adult

Rheumatology

Practice

Under 50% 2.7% 1.6% 1.9% 5.0%

50-99% 44.1% 42.2% 38.5% 53.3%

100% 53.2% 56.2% 59.6% 41.7%

Primary Care

0% 80.1% 73.4% 96.2% 73.3%

Under 50% 17.2% 21.9% 3.8% 23.3%

50-99% 2.7% 4.7% - 3.3%

Pediatric

Rheumatology

Practice

0% 69.9% 79.7% 63.5% 61.7%

Under 50% 29.0% 20.3% 34.6% 36.7%

50-99% 1.1% - 1.9% 1.7%

Q32. What percentage of visits makes up your clinical practice in each of the following areas?

Over half of the rheumatologists in private practice report that their practice is made up of 100% adult

visits. Eighty percent report no primary care visits and 70% report no pediatric visits.



Percentage of Desire to be Dedicated to Rheumatology [Physicians answering “primary care” in Q32.]

Q32a. What percentage of your practice do you desire to be dedicated to rheumatology?

(n = 37)

14

Rheumatologists in small to medium private practice settings tend to have a greater desire to be solely

dedicated to rheumatology than rheumatologists in the largest settings.



Type of Compensation

Q33. What type of compensation method does your practice have? Q33a. What type of incentive bonus does your practice have?

(n=186)

15

(n=34)

Type of Incentive Bonus

[Other responses <2% of total mentions]

[Those answering “salary plus incentive bonus” in Q33]

The majority of rheumatologists in private practice are compensated by their fee for services rendered. This is

particularly true for single physician clinics. Those practices that offer salary plus incentive bonus drive their bonus

mainly off productivity.



Personal Sources of Compensation (see next slides for breakout by % of income)

Q35. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from each of

the following.

(n=186)

16

Rheumatologists practicing in private practice indicate nearly three-fourths of all personal sources of

compensation come from direct patient care.



Personal Sources of Compensation – Direct Patient Care

17


Solo Private

Practice n=64

Single Specialty

Group n=52

Multi-Specialty

Group n=60

0% 3.8% - 1.9% -

1-50% 17.2% 10.9% 38.5% 8.3%

51-75% 30.1% 32.8% 30.8% 30.0%

76-99% 31.7% 37.5% 23.1% 38.8%

100% 17.2% 18.8% 5.8% 23.3%

Mean 72.0% 78.4% 62.2% 79.7%


the following.

Seventy-two percent of rheumatologists practicing in private practice state that all personal sources of

compensation come from direct patient care, with multi-specialty averaging the highest at almost 80%,

followed by solo private practice at 78% and single specialty at 62%.



Personal Sources of Compensation – Infusion Therapies

18

% of Income

Total n=186

Solo Private

Practice n=64

Single Specialty

Group n=52

Multi-Specialty

Group n=60

0% 45.7% 45.3% 25.0% 55.0%

1-50% 51.6% 53.1% 71.2% 41.7%

51-75% 2.7% 1.6% 3.8% 3.3%

Mean 9.1% 8.7% 11.2% 9.0%


the following.

Private practice rheumatologists report that infusion therapies for personal sources of compensation

averaged only 9%.



Percent of Revenue Obtained From Insurance – Fee Based

19


Solo Private

Practice n=64

Single Specialty

Group n=52

Multi-Specialty

Group n=60

Medicare 37.9% 40.9% 42.2% 35.7%

PPO/HMO 33.4% 34.7% 33.2% 34.3%

Classic indemnity 14.8% 20.3% 16.7% 5.6%

Medicaid/Chronic

children’s programs 4.8% 4.1% 4.7% 6.2%

Self-Pay 4.2% 4.8% 2.2% 2.5%

Uninsured 3.0% 1.6% 0.9% 2.4%

Discounted fee for

service 2.2% 2.1% 2.0% 2.3%

Q36a. Indicate below the percentage of revenue that is obtained from each of the following types of insurance.

Rheumatologists practicing in private practice receive the greatest portion of their revenue from Medicare

and PPO/HMO insurance programs, regardless of the type of practice they are in.



Type of Insurance Patients Carry

20


Solo Private

Practice n=64

Single Specialty

Group n=52

Multi-Specialty

Group n=60

PPO 24.7% 26.3% 29.0% 25.2%

HMO 20.6% 20.0% 18.4% 22.3%

Classic indemnity 19.9% 17.9% 18.5% 18.9%

Medicare risk 13.7% 13.0% 7.9% 15.0%

Traditional Medicare 13.7% 13.0% 7.9% 15.0%

Discounted indemnity 12.4% 8.3% 10.8% 12.9%

Medicaid 8.2% 8.6% 6.8% 9.3%

Uninsured 7.6% 4.8% 2.5% 6.7%

Q65. On average, what type of insurance do your patients have?

Rheumatologists in private practice state that one-quarter of their patients carry PPOs, followed by HMOs

and classic indemnity.



Percent of Revenue Obtained From Insurance – Capitated

21


Solo Private

Practice n=64

Single Specialty

Group n=52

Multi-Specialty

Group n=60

HMO 16.7% 14.1% 11.5% 25.0%

Medicare risk 12.9% 12.5% 13.5% 15.0%

Subcap for

rheumatology 4.8% 4.7% 3.8% 6.7%

Cap for primary care 4.8% 3.1% 1.9% 10.0%

None of the above 73.1% 81.2% 71.2% 66.7%

Q36b. Indicate below the percentage of revenue that is obtained from each of the following types of insurance. [Multiple mentions accepted]

Nearly three out of four private practice rheumatologists state that none of their revenue obtained from

capitated insurance was obtained from the four types of insurance listed in the survey.



Restriction of Insurance Carriers

Q37. Do you restrict any insurance carriers?

(n=186)

22

Fifty-five percent of rheumatologists practicing in private practice restrict certain insurance carriers in their

practice. Fewer physicians in the smaller practice size (2-5) restrict insurance carriers.



Restricted Insurance Carriers [Physicians answering “yes” in Q37]

Q37. Do you restrict any insurance carriers? Which ones?

23


Solo Private

Practice n=44

Single Specialty

Group n=29

Multi-Specialty

Group n=27

Medicaid 37.3% 45.5% 41.4% 22.2%

HMOs 13.7% 15.9% 13.8% 11.1%

Aetna 10.8% 15.9% 10.3% 3.7%

Medicare 9.8% 13.61% 6.9% 7.4%

United Healthcare 6.9% 6.8% 10.3% 3.7%

Humana 6.9% 6.8% 3.4% 11.1%

Don’t know/refused 9.8% 2.3% 10.3% 18.5%

One in three rheumatologists practicing in private practice who restrict insurance carriers report they do

not accept Medicaid. However, multi-specialty groups do not restrict Medicaid at the same level as solo

private practices or single specialty groups.



Percent of Booked Charges Collected

Percentage of Rheumatologists

Q38. Of your total booked charges, what percentage is collected?

24

(n=186)

(n=64)

(n=52)

About

(n=60)

69.7

Mean

Percent

74.5

69.5

69.3

Rheumatologists practicing in private practice report, on average, that 70% of their total booked charges

are collected. Solo private practices collect slightly higher total booked charges than the average.



Percent of Total Collections to Physician Compensation


Q39. What percentage of your total collections goes directly to physician compensation and benefits, insurance and professional liability?

25

(n=186)

(n=64)

(n=52)

About

(n=60)

43.6

Mean

Percent

46.4

39.3

47.9

Rheumatologists practicing in private practice report that an average of 44% of total collections go

directly to their compensation and benefits, insurance and professional liability. The average is slightly

lower in single specialty group clinics, at 39%.



Overhead Percentages

26

Number of Rheumatologists

Overhead Categories Total

(n=186)

Solo (n=74)

2-5 (n=62)

5-9 (n=27)

>10

(n=23)

Clerical labor 36.1% 35.7% 39.9% 35.4% 28.6%

Expenses to maintain an

office 31.2% 31.4% 27.7% 35.2% 34.9%

Supplies 20.7% 21.6% 19.4% 18.6% 23.4%

Procedure-specific equip. 6.8% 6.2% 8.2% 7.2% 4.6%

Overhead equip. 5.2% 5.0% 4.8% 3.5% 8.5%

Don’t know / Refused 10.2% 4.1% 14.5% 14.8% 13.0%

Q40. The remaining revenue not applied to physician compensation and benefits, insurance and professional liability (Q.39) is generally referred to as

overhead. Overhead may be direct or indirect. What are your overhead percentages for the following types of costs?

[Mean percents]

The three biggest overhead categories for rheumatologists in their practice are clerical labor, followed by

expenses to maintain an office, and supplies.



Number of Support Personnel in Practice

27


Support Personnel Total

(n=186)

Solo (n=74)

2-5 (n=62)

5-9 (n=27)

>10

(n=23)

Secretarial / front desk 4.6 2.7 4.1 7.0 9.7

Medical assistants 3.5 1.1 4.2 4.6 8.1

Lab, x-ray and bone

density technicians 1.7 0.8 1.2 3.4 3.6

RNs 1.2 0.5 1.2 1.8 3.2

LPNs / LVNs 1.1 0.4 0.9 1.1 3.4

Research support 0.6 0.4 0.8 0.9 0.8

Mid-level providers 0.5 0.3 0.6 0.9 0.7

Q41. How many support personnel are employed in your practice? [INDICATE THE FULL TIME EQUIVALENCY (FTE) PER MD].

Secretarial staff and medical assistants make up the greatest portion of support personnel.

[Mean number of personnel]



Utilization of Nurse Practitioners and Physician Assistants

28


Utilization of Personnel Total

(n=186)

Solo (n=74)

2-5 (n=62)

5-9 (n=27)

>10

(n=23)

Do not utilize 62.9% 81.1% 54.8% 40.7% 52.2%

Follow-up routine patients 36.0% 18.9% 45.2% 55.6% 43.5%

Work-ins 25.8% 10.8% 32.3% 44.4% 34.8%

Patient education 19.4% 6.8% 22.6% 29.6% 39.1%

Screening new patients 14.5% 9.5% 24.2% 14.8% 4.3%

Q42. How does your practice utilize nurse practitioners and physician assistants? [Multiple answers accepted]

Overall, sixty-three percent of participating rheumatologists do not utilize nurse practitioners and physician

assistants. When utilized, they are used primarily to follow-up with routine patients (36%) and as work-ins

(36%).



Hiring Additional Rheumatologists Within the Next Five Years

Q44. Does your practice plan to hire additional rheumatologists within the next five years? If yes, how many do you plan to rehire?

(n=186)

Number of Hires Hiring Plan

29

(n=69)

Nearly 40% of rheumatologists report that they plan to hire additional rheumatologists within the next five

years. Among practices intending to hire, 68% plan to add one additional rheumatologist.



Number of Physician Associates in the Practice

Q43. Number of physician associates in your practice (excluding yourself)?

(n=186)

30

Forty percent of private practice rheumatologists are in solo practice, followed by one-third in practices of

five to nine rheumatologists.



Replacement of Retiring Rheumatologists

Q45. Does your practice plan to replace retiring rheumatologists within the next five years? If yes, how many do you plan to replace?

(n=186)

Number of Replacements Replacing Retiring Rheumatologists

31

(n=42)

Slightly over half of rheumatologists state their practice does not plan to replace retiring rheumatologists

within the next five years. Of the 23% of practices intending to replace a retiring rheumatologist, nearly

70% plan to replace one.



Hiring Additional Nurse Practitioners or Physician Assistants

Q46. Does your practice plan to hire additional nurse practitioners or physician assistants within the next five years? If yes, how many do you plan to

hire?

(n=186)

Number of Hires Hiring Plan

32

(n=44)

Twenty-four percent of rheumatologists reported that their practice plans to hire additional nurse

practitioners or physician assistants within the next five years. Seventy-three percent of practices plan to

hire one employee.



Waiting Time (in weeks) to Next Consultation With a Physician

Q47. What is the waiting time (in weeks) to next consultation with a physician?

(n=186)

33

Mean number of weeks = 5.0

The average waiting time in weeks to the next consultation with a rheumatologists is five weeks.



Waiting Time (in weeks) to Next Return Visit With a Physician

Q48. What is the waiting time (in weeks) to the next return office visit with a physician?

(n=186)

34


The average waiting time in weeks to the next return visit with a rheumatologists is four weeks. Nearly half

of rheumatologists report a one to two week waiting time and a quarter report three to four weeks.



Waiting Time (in weeks) to Next Consultation With a PA or NP

Q47. What is the waiting time (in weeks) to next consultation with a PA or NP?

(n=186)

35


The average waiting time in weeks to the next consultation with a PA or NP is one week.



Waiting Time (in weeks) to Next Return Visit With a PA or NP

Q50. What is the waiting time (in weeks) to next return office visit with a PA or NP?

(n=186)

36


The average waiting time in weeks to the next return visit with a PA or NP is one week. However, 71% of

rheumatologists report this situation does not apply to their practice.



Time (in hours) Spent Filling Out Prior Authorizations

Q51. How much time in a typical day do you or your staff spend filling out prior authorizations (include phone calls)? [Hours per day]

(n=186)

37

Mean number of hours = 3.1

Single specialty group = 4.2

Solo private practice = 3.1

Multi-specialty group = 2.5

Rheumatologists or their staff spend an average of 3.1 hours per day filling out prior authorizations

(including phone calls). This average is consistent across practice sizes but does vary somewhat by

payment source.



Summary of Productivity / Scheduled Hours Per Week (See slides 72-78 for breakouts)

38

Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial

patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.

Based on the number of scheduled hours of office time per week Means

Time interval, in minutes, for

New patients 48 Min.

Return patients 22 Min.

Number of patients seen per week

New patients 12

Return patients 79

Number of

Hospital visits 3

Hospital consultations 2

Arthrocentesis, joint, tendon or bursa injections performed per week 15

Office no-show rate (a percentage) 7 %

RVU work components per week (if known) 53



Scheduled Hours Per Week – Time Interval for New Patients

39


Time Interval in Min. Total

(n=186)

Solo (n=74)

2-5 (n=62)

5-9 (n=27)

>10

(n=23)

0 1.6% 1.4% 3.2% - -

1 – 15 Min. 2.7% 1.4% 3.2% 3.7% 4.3%

16 – 30 Min. 21.0% 21.6% 19.4% 18.5% 26.1%

31 – 45 Min. 32.3% 35.1% 35.5% 33.3% 13.0%

46 – 60 Min. 38.7% 36.5% 37.1% 37.0% 52.2%

More than 60 Min. 3.8% 4.1% 1.6% 7.4% 4.3%

Mean # of Minutes 48 47 46 56 49



Forty-eight minutes is the average time reported for a new patient visit.



Scheduled Hours Per Week – Return Patients

40


Time Interval in Min. Total

(n=186)

Solo (n=74)

2-5 (n=62)

5-9 (n=27)

>10

(n=23)

0 1.6% 1.4% 3.2% - -

1 – 15 Min. 56.9% 55.4% 48.4% 66.7% 73.9%

16 – 30 Min. 38.7% 40.5% 46.8% 25.9% 26.1%

31 – 45 Min. 1.1% 2.7% - - -

46 – 60 Min. - - - - -

More than 60 Min. 1.6% - 1.6% 7.4% -

Mean # of Minutes 22 19 23 35 17



The average time reported for a return patient visit is 22 minutes.



Number of Hospital Visits



(n=186)

41

Mean number of visits = 3.0

Rheumatologists report an average of three hospital visits in a fully scheduled week.



Number of Hospital Consultations



(n=186)

42

Mean number of visits = 2.0

Rheumatologists report an average of two hospital consultations in a fully scheduled week.



Number of Arthrocentesis, Joint, Tendon or Bursa Injections



(n=186)

43

Mean number of visits = 15

Rheumatologists report an average of 15 arthrocentesis, joint, tendon or bursa injections in a fully

scheduled week. Nearly 20% of rheumatologists report more than 20 injects per week.



Office No-Show Rate



(n=186)

44

Mean percentage = 7%

On average, the reported office no-show rate is seven percent. One-quarter of rheumatologists surveyed

report a no-show rate of three percent or less.



Number of RVU Work Components Per Week



(n=186)

45

Mean # of RVUs = 53

Nearly 90% of rheumatologists surveyed did not know the number of RVU work components per week.



Number of Hours Charged to Specific Visit Codes in the Last

Fully Scheduled Week

46

Payment Source

Visit Codes Total

(n=186)

Solo (n=64)

Single Specialty (n=52)

Multi-Specialty (n=60)

New patient /office

99203 2 1 0 2

99204 2 2 1 3

99205 1 1 1 2

Total new 5 4 3 7

Established patient/office

99213 25 28 23 24

99214 30 32 36 26

99215 4 4 3 4

Total established 58 65 62 54



Data in this table show mean hours for each code by payment source.




Fully Scheduled Week (cont.)

47

Payment Source

Visit Codes Total

(n=186)

Solo (n=64)



Consult/office

99243 2 2 1 3

99244 6 5 5 7

99245 3 2 5 3

Total consult 11 10 11 12

Consult/inpatient

99253 1 0 0 1

99254 1 1 1 2

99255 1 0 0 1

Total established 3 2 1 4

Mean weeks worked per year 46 47 46 47





Collection of Measures of Function and Disease Activity

Q54. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc?

48

(n=186)

(n=64)

(n=52)

(n=60)

Approximately 50% of rheumatologists report they routinely collect measures of function and disease

activity from their patients,(e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc). Sixty-seven

percent of single specialty groups routinely collection these measures.



Reporting of Data for Pay-for-Performance/Other Quality

Measures Encouraged/Required By Payers

Q55. Are you encouraged / required by payers to report data for pay for performance or other quality measures?

49

(n=186)

(n=64)

(n=52)

(n=60)

One-quarter of rheumatologists surveyed are encouraged or required by payers to report data for pay for

performance or other quality measures.



New Patient Requirement to Have a Physician Referral

Q56. Do you require new patients to have a physician referral?

50

(n=186)

(n=64)

(n=52)

(n=60)

Just over half (55%) of the participating rheumatologists require patients to have a physician referral.



Participation in the 2007 Physician Quality Reporting

Initiative Program

Q57. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program?

51

(n=186)

(n=64)

(n=52)

(n=60)

Overall, twenty percent of rheumatologists participated in the 2007 Physician Quality Reporting Initiative

Program. Single specialty group rheumatologists had the highest participation in the program at 35% and

solo private practice the lowest at 11%.



Receipt of 2007 PQRI Program Bonus

Q57a. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program? If yes, did you receive your bonus?

52

(n=37)

(n=7)

(n=18)

(n=12)

One hundred percent of the seven solo rheumatologists who participated in the 2007 program received

their bonus, whereas, 50% of rheumatologists overall received their bonus.



Participation in the 2008 PQRI Program

Q58. Did you or your practice participate in the 2008 PQRI program?

53

(n=186)

(n=64)

(n=52)

(n=60)

Participation in the 2008 PQRI program (21% of rheumatologists surveyed) was very similar to 2007

(20%). Slightly fewer single specialty group physicians and more from multi-specialty participated in

2008 than 2007.




Q58a. Did you or your practice participate in the 2008 PQRI program?

54

(n=39)

(n=6)

(n=16)

(n=17)

Receipt of bonuses for the 2008 PQRI program (44% of rheumatologists) was also very similar to 2007

(46%).



Use of E-Prescribe on Eligible Prescriptions

Q59. Do you currently e-prescribe all eligible prescriptions using a qualified system?

(n=186)

55

Nearly half (47%) of rheumatologists practicing in private practice report they currently use e-prescribe,

with 24% planning to begin within the next year. Smaller clinics report less usage of e-prescribe, while the

majority of large clinics are using e-prescribe at the present time.



EHR Use in Your Practice

Q60. Do you use an EHR in your practice? (n=186)

56

About 50% of rheumatologists practicing in private practice report they use EHR in their practice, with one in ten using

EHR along with paper charts. Fifteen percent do not use EHR in their practice and have no intention of implementing any

EHR system within the next three years. Solo clinics have not adopted EHR use as much as the larger clinics and will be

slower to adopt EHR use in the near future.



EHR Systems [Physicians answering “Yes” at Q60]

Q61. s your EHR CCHIT certified? Q62. Which EHR system do you currently have in your office?

(n=96)

Current EHR System Is your EHR system certified?

57

(n=96)

[Other mentions <4.0% of total]

Among the rheumatologists practicing in private practice who report using an EHR system, five in ten indicate their EHR

system is CCHIT certified. One third do not know whether their EHR system is CCHIT certified. The top mentioned EHR

systems currently being used are Allscripts, eClinical works, EPIC, Centricity, CPRS (VA) and LastWord.



Year EHR Was Implemented

Q63. In what year did you implement EHR in your practice? (n=96)

58

Seventy-three percent of rheumatologists in private practice report they implemented EHR in their

practice within the last seven years.



Various Functions Performed By EHR

Q64. I use my EHR to perform the following functions:

Enter and review lab orders

Basic functions (i.e., review chart info., create visit notes)

Update and review medication lists

Scan and store paper reports

Enter and review radiology orders

Print prescriptions

Update and review problem lists

Electronically place radiology orders

Electronically transmit prescriptions

Electronically place lab orders

Disease-based registries (built or fed into your EHR)

Rheumatologists report that their EHR is used primarily to update and review medication lists (95%), for

basic functions like reviewing chart information (95%) and updating and reviewing problem lists (92%).


59


Contracts with Organizations

60

Payment Source

Organizations Total

(n=186)

Solo (n=64)



HMO (Yes) 30.1% 35.9% 30.8% 28.3%

Don’t know 34.9% 21.9% 28.8% 51.7%

Mean # of sub-

capitation contracts 19 45 1 2

Mean # of fee-based

contracts 4 4 5 3

PHO (Yes) 22.6% 37.5% 21.2% 11.7%

Don’t know 44.6% 31.2% 42.3% 60.0%

Mean # of contracts 4 4 6 4

Q66. Do you have contracts with the following? Do any of these alliances involve equity?

HMO was mentioned by 30% of rheumatologists surveyed, followed by PHO (23%) and IPA (21%). PHO

appears to be more common in solo practices and less common in multi-specialty practices.

Ninety-seven percent of the rheumatologists report that these alliances do not involve equity (Q66a).



Contracts with Organizations (cont.)

61

Payment Source

Organizations Total

(n=186)

Solo (n=64)



IPA (Yes) 21.0% 31.2% 25.0% 10.0%

Don’t know 41.9% 23.4% 46.2% 56.7%

Mean # of Contracts 3 3 2 4

Hospital networks 7.5% 6.2% 5.8% 11.7%

Don’t know 36.0% 25.0% 34.6% 46.7%

Mean # of Contracts 1 1 2 1

PPMs 1.1% 1.6% - 1.7%

Don’t know 52.7% 48.4% 46.2% 63.3%

Mean # of Contracts 1 1 - 1

Q66. Do you have contracts with the following? If yes, how many?



Have You Sold Equity In Your practice?

Q67. Have you sold equity in your practice? To whom have you sold equity in your practice?

62

(n=186)

(n=64)

(n=52)

(n=60)

Two percent of the participating rheumatologists report their practice has sold equity.

Of the three rheumatologists who report their practice has sold equity, two reported the practice sold equity

to a hospital and one stated a foundation.



Merger With Another Practice in the Last Five Years

Q68. Have you merged your practice with another in the last five years?

63

(n=186)

(n=64)

(n=52)

(n=60)

Overall, 5% of rheumatologists report their practice has merged with another practice in the last five years.

Multi-specialty groups are more likely to merge (10%) compared to single specialty (4%) and solo

practices (2%).



Reduced or Denied Charges During the Last Year

Q69. Have you had your charges reduced or denied during the last year?

64

(n=186)

(n=64)

(n=52)

(n=60)

Fifty-four percent of the rheumatologists, overall, have had charges reduced or denied during the last year.

Charges have been reduced or denied for three-quarters of single specialty rheumatologists, followed by

53% of solo practices and 42% for multi-specialty groups.



Percentage of Reduced or Denied Charges [Physicians answering “yes” in Q69.]

Q69a . What percentage of the charges have been reduced or denied during the last year?

65

(n=100)

Mean % = 15.2

Of the 100 rheumatologists who had charges reduced or denied, nearly 50% of the charges were reduced

by one to five percent. Another 20% had charges reduced or denied by more than 20%.



Most Frequent Problem for Having Charges Reduced or Denied

[Physicians answering “yes” in Q69]

66

Total n=100

Solo Private

Practice n=34

Single Specialty

Group n=39

Multi-Specialty

Group n=25

Payment schedule by third-party

payer is inadequate 48.0% 47.1% 46.2% 48.0%

Denial of E/M visit and injection on

same day 32.0% 41.2% 23.1% 32.0%

Reduction of E/M code level 24.0% 26.5% 23.1% 20.0%

Denial of Dual Energy X-ray

Absorptiometry (DEXA) 16.0% 20.6% 15.4% 12.0%

Denial of infusion therapy service 16.0% 23.5% 12.8% 12.0%

Denial of interpretative charges for

imaging procedure 5.0% 5.9% 2.6% 8.0%

Denial of an in office MRI 5.0% 5.9% 5.1% 4.0%

Denial of an in office ultrasound 3.0% 5.9% - 4.0%

Bundle lab and x-ray 3.0% - 7.7% -

Other 11.0% 14.7% 5.1% 16.0%

Q69b. What was your most frequent problem for having your charges reduced or denied during the last year?



Formal Audit by Medicare in the Last Year

Q70. Have you had a formal audit by Medicare in the last year? 70a. As a result of the formal audit by Medicare in the last year, how much, if any, did

you have to pay back to Medicare?

(n=186)

67

Ninety-five percent of rheumatologists surveyed report they have not had a formal audit by

Medicare in the last year. None of the rheumatologists who had an audit were able to provide an

estimate on how much the practice may have had to pay back to Medicare.



Does Your Practice Have a Web site?

Q71. Does your practice have a Web site?

68

(n=186)

(n=64)

(n=52)

(n=60)

The majority of rheumatologists in a multi-specialty group (80%) report that their practice has a

Web site, followed by single specialty groups (64%) and solo private practice (16%).



Does your practice advertise its services?

Q72. Does your practice advertise its services?

69

(n=186)

(n=64)

(n=52)

(n=60)

About half of rheumatologists in a multi-specialty group (53%) report that their practice advertises

its services, followed by single specialty groups (27%). Very few solo private practices (8%)

advertise.



Private Practice Findings by Geography

70





(n = 37)

71

Overall, about half of rheumatologists report the desire to be 51% - 99% dedicated to rheumatology. In

the W. Central region, a significantly higher percentage of rheumatologists (75%) have a desire to be

solely dedicated to rheumatology.





(n=186)

72

(n=34)





particularly true for clinics located in the NE. Those practices that offer salary plus incentive bonus drive their

bonus mainly off productivity.





(n=186)

73


practice. Practices in the SE restrict the most carriers, while clinics in the West restrict fewer insurance

carriers than clinics in other parts of the U.S.



Approximately 50% of rheumatologists reported that they routinely collect measures of function and

disease activity from their patients, (e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc). Three-

quarters of clinics in the W. Central region routinely collect these measures, while only 37% of clinics

collect them in the West.



74

(n=186)

(n=37)

(n=26)

(n=30)








75

(n=186)

(n=37)

(n=26)

(n=30)


(n=37)




76

(n=186)

(n=37)

(n=26)

(n=30)

Just over half (55%) of the participating rheumatologists require new patients to have a physician referral.

A slightly higher percentage of physicians in the NE and West regions require these referrals, and a lower

percentage in the Midwest and W. Central regions.


(n=56)

(n=37)



Initiative Program


77

(n=186)

(n=37)

(n=26)

(n=30)


Program. The Midwest had the highest participation in the program (50%), and the W. Central and West

had the lowest participation (less than 10% each).


(n=56)

(n=37)




78

(n=37)

(n=8)

(n=13)

(n=3)

Nearly 70% of rheumatologists from the Midwest and West who participated in the 2007 program

received their bonus, whereas, none of the eight rheumatologists in the SE received their bonus.


(n=10)

(n=3)




79

(n=186)

(n=37)

(n=26)

(n=30)


(20%). There was slightly more participation from physicians in the NE and less participation from

physicians in the SE and Midwest regions in 2008 than 2007.





80

(n=39)

(n=5)

(n=11)

(n=4)


(46%). All four participating rheumatologists in the West received their bonus; however, no one in the SE

received their bonus.


(n=15)

(n=4)



Q59. Do you currently e-prescribe all eligible prescriptions using a qualified system? (n=186)

81

Nearly half (47%) of rheumatologists practicing in private practice report they currently use e-prescribe

with 24% planning to within the next year. More physicians in the W. Central region report the usage of

e-prescribe (70%), while fewer physicians in the West (33%) and SE (35%) report usage at the time of

the study.





82



EHR system within the next three years. Clinics in the W. Central region appear to have adopted EHR use more quickly

than clinics in other regions.





83

Nearly 50% of rheumatologists in private practice report they implemented EHR in their practice within

the last three to four years.



Two percent of the participating rheumatologists report that their practice has sold equity.

There were no rheumatologists in the W. Central or West regions that report their practice sold equity.

Have you sold Equity in your practice?


84

(n=186)

(n=56)

(n=26)

(n=30)



Overall, 5% of rheumatologists report their practice has merged with another practice in the last five

years. W. Central clinics appear to be more likely to merge (11%) compared to SE clinics (0%).



85

(n=186)

(n=37)

(n=26)

(n=30)



Fifty-four percent of the rheumatologists, overall, have had charges reduced or denied during the

last year. Charges have been reduced or denied for about six in ten rheumatologists in the W.

Central region, followed by the Midwest (58%).



86

(n=186)

(n=37)

(n=26)

(n=30)





87

(n=186)

(n=37)

(n=26)

(n=30)

The majority of rheumatologists in the W. Central region (78%) report that their practice has a Web

site, followed by the Midwest (62%).



Does Your Practice Advertise Its Services?


88

(n=186)

(n=37)

(n=26)

(n=30)

Slightly more than half of rheumatologists in the W. Central region (54%) report that their practice

advertises its services, followed by 30% of practices in the West. In the NE, only 20% of

rheumatologists report that their practice advertises its services.


(n=56)

(n=37)


Private Practice Findings by Age

89





(n = 37)

90

Rheumatologists in the 30 – 49 age range tend to have a greatest desire to be solely dedicated to

rheumatology.





(n=186)

91

(n=34)





particularly true for physicians in the 50 - 59 age range.





(n=186)

92


practice. This appears to be fairly consistent across age categories.





93

(n=186)

(n=33)

(n=75)

(n=57)

Approximately 50% of rheumatologists report that they routinely collect measures of function and disease

activity from their patients,(e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc). This varies very

little by age of physician.






94

(n=186)

(n=33)

(n=75)

(n=57)







95

(n=186)

(n=33)

(n=75)

(n=57)

Just over half (55%) of the participating rheumatologists require patients to have a physician referral.




Initiative Program


96

(n=186)

(n=33)

(n=75)

(n=57)


Program. Rheumatologists in the 30 – 49 age range had the lowest participation in the program at 15%.





97

(n=37)

(n=5)

(n=17)

(n=12)

Nearly six in ten rheumatologists 60 and older who participated in the 2007 program received their bonus,

while only about one-third of physicians in the 50 – 59 category received their bonus.





98

(n=186)

(n=33)

(n=75)

(n=57)


(20%). Slightly more physicians in the 30 – 49 age category participated in 2008 than 2007 and slightly

less in the 60+ category.





99

(n=39)

(n=8)

(n=18)

(n=8)


(46%).




Q59. Do you currently e-prescribe all eligible prescriptions using a qualified system? (n=186)

100

Nearly half (47%) of rheumatologists practicing in private practice report they currently use e-prescribe

with 24% planning to within the next year. The use of e-prescribe varies very little by age category.





101



EHR system within the next three years. A higher percentage of rheumatologists in the 30 – 49 category report EHR use.





102

Six in ten rheumatologists in the 30 – 49 age range report they implemented EHR in their practice within

the last three to four years, compared to three in ten rheumatologists in the 60+ range.



Have You Sold Equity In Your Practice?


103

(n=186)

(n=33)

(n=75)

(n=57)

Two percent of the participating rheumatologists reported that their practice has sold equity. The

percentage is slightly higher for physicians in the 60+ ranges.





104

(n=186)

(n=33)

(n=75)

(n=57)

Overall, 5% of rheumatologists reported their practice has merged with another practice in the last five

years. A higher percentage of rheumatologists in the 60+ category report merging with another practice.





105

(n=186)

(n=33)

(n=75)

(n=57)

Fifty-four percent of the rheumatologists, overall, have had charges reduced or denied during the last year.

This appears to be consistent across age categories.





106

(n=186)

(n=33)

(n=75)

(n=57)

Rheumatologists in the 30 – 49 age category report the highest incidence of a Web site, followed by

rheumatologists in the 50 – 59 category.



Does Your Practice Advertise Its Services?


107

(n=186)

(n=33)

(n=75)

(n=57)

About four in ten rheumatologists in the 30 – 49 age range report that their practice advertises its

services, followed by 60+ physicians (28%) and 50 – 59 physicians (25%).



Section 3

Academic Findings

108

2009 Benchmark Survey – Academic Findings


Predominant Source of Payment

Q4. Which of the following is your predominant source of payment? (n=133)

109

The majority of rheumatologists practicing in academia receive their predominant source of payment from

academic clinical practice.





110

Rheumatologists in smaller academic settings tend to receive their predominant source of payment from

academic clinical practice more so than rheumatologists in larger academic settings. Larger academic

settings also rely more on payment from both clinical and academic administration.



Percentage of Rheumatologists Who Are Clinician Teachers

Or Clinical Investigators [Physicians answering “academic clinical practice” or “clinical research” in Q4.]

Q5. Do you regard yourself primarily as a clinician teacher or clinical investigator at an academic medical center?

(n=97)

111

Among the rheumatologists who receive their predominant source of payment from academic clinical

practice or clinic research, most view themselves primarily as a clinical teacher or clinical investigator at

an academic medical center.



Number and Type of Patients Seen Per Week [Physicians answering “Yes” in Q5]

Q6. How many patients do you see per week? / Q6a. What percentage of these patients are…?

(n=90)

[Mean number of patients = 44.0]

(n=90)

Number of Patients Seen Type of Patients Seen

112

Among the rheumatologists who view themselves primarily as a clinical teacher or clinical investigator

see an average of 44 patients per week. The majority (72%) of their patients seen are established

patients.



Source of Primary Salary

Q8. Where does your primary salary come from?

(n=133)

113

More than one-third of rheumatologists practicing in academia report their primary salary source is from

clinical income, while one in five rely on grant support for their salary.



Number of Years Full-Time at the Academic Medical Center

Q9. How long have you been full-time at the academic medical center? (n=133)

[Mean number of years = 14.0]

114

Rheumatologists practicing in academia have worked an average of 14 years full-time at the academic

medical center.



Academic Rank

Q10. What is your academic rank?

(n=133)


115

Nearly three out of four rheumatologists report their academic rank as “associate professor”.



Number of Rheumatologists in Your Academic Practice

Q11. How many rheumatologists are in your academic setting? / Q11a. How many are part-time?

(n=133)

[Mean number of rheumatologists = 10.0] Number That Are Part-Time

[Mean number of PT rheumatologists = 1.8]

116

Rheumatologists report an average of 10 doctors in their academic practice, with an average of nearly

two part-time rheumatologists.



Number of Clinical and Basic Research Rheumatologists

Q12. How many clinical rheumatologists are in your academic practice?

Q13. How many basic research rheumatologists are in your academic practice?

(n=133)

[Clinical Mean = 6.2; Basic Research Mean = 2.6]

117

Rheumatologists report an average of six clinical doctors in their academic practice and an average of

three basic research doctors in their practice.



Scheduled Clinic Time

Q14. How many hours of scheduled clinic time do you have per week? / Q15. How often are you in the clinic?

(n=133)

[Mean hours = 15.8] Frequency Scheduled

Number of Hours Scheduled

118

Rheumatologists practicing in academia schedule an average of 16 hours per week of clinic time. One in

four rheumatologists are in the clinic at least once a week, one in three are in the clinic at least two to

three days per week, and nearly one-fourth are in the clinic four to six days.



Services Rendered in the Outpatient Clinic

Q16. Do you render services in the outpatient clinic? / Q16a. How many hours in a typical week do you render services in the outpatient clinic?

(n=133)

Weekly Service Hours

Rendered in Outpatient Clinic Services Rendered

[Mean hours = 15.9]

Nearly all rheumatologists (97%) render services in the outpatient clinic for an average of 15.9 hours per

week.

119



Need for More FTE Rheumatologists

Q17. Do you feel that your clinical activities need fewer, more, or about the same number of rheumatologists?

Q17a. How many more FTE rheumatologists are needed?

(n=133)

Number of FTE Rheumatologists Needed Additional FTE Rheumatologists Needed

[Mean hours = 2.2]

120

(n=74)

More than half of rheumatologists practicing in academia report they need about the same number of

FTE Rheumatologists. One in four did report they need more FTE rheumatologists and felt they needed

an average of two more FTE rheumatologists.



Number of Patients Seen Per Month in the Academic Clinic

Q18. On average, how many patients are seen per month in the academic clinic?

(n=133)

121

On average, rheumatologists practicing in academia see an average of 527 patients per month in the

academic clinic.


Mean = 527



Q19. What type of compensation method does your practice use? / Q19a. What type of incentive bonus is used?

(n=133)

122

Overall, half of the academic rheumatologists surveyed receive their compensation through salary plus an

incentive bonus. In smaller practices, compensation is more likely salary only.

(n=66)




Personal Sources of Compensation (see next slides for breakout by % of income)


the following.

(n=133)

123

Direct patient care is the most frequently mentioned source of personal compensation (50%) for academic

rheumatologists, followed by research (18%) and administration (11%).



Collaborative Arrangements with Private Rheumatologists

Q22. Are there collaborative arrangements with private rheumatologists in your geographic area?

(n=133)

Types of Collaborative Arrangements Are there collaborative arrangements?

124

[Multiple mentions allowed]

(n=19)

More than eight in ten rheumatologists practicing in academia report they do not have collaborative

arrangements with private rheumatologists in their geographic area. Among those rheumatologists

having collaborative arrangements, consultation, teaching, and research are the primary three types of

arrangements.



University Sponsored Insurance Plan

Q23. Is there an insurance plan sponsored by the university?

(n=133)

125

More than half of the rheumatologists practicing in academia reported they have a university sponsored

insurance plan. Medium to large size academic clinics tend to have a university sponsored insurance

plan more often than smaller academic clinics.



Routine Collection of Measures of Function and Disease Activity From Patients (MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.)

Q24. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.?

(n=133)

126

Forty percent of rheumatologists practicing in academia report they routinely collect measures of function

of disease activity from their patients. Smaller academic clinics are much less likely to collect this type of

information from their patients.





(n=133)

127

Overall, about 40% of rheumatologists reported that they currently e-prescribe all eligible prescriptions.

Larger academic practices are twice as likely to e-prescribe than smaller practices.




Q26. Do you use an EHR in your practice?

(n=133)

128

Nearly seven in ten rheumatologists practicing in academia report they use EHR in their practice, with one in four

using EHR along with paper charts. Eight percent do not use EHR in their practice and have no intention of

implementing any EHR system within the next three years. Smaller academic clinics have not adopted EHR use

as much as the larger clinics and will be slower to adopt EHR use in the near future.



EHR Systems [Physicians answering “Yes” at Q26]

Q27. s your EHR CCHIT certified? Q28. Which EHR system do you currently have in your office?

(n=92)

Current EHR System Is your EHR system certified?

129

(n=92)

[Other mentions <4.0% of total]

Among the rheumatologists practicing in academia who report using an EHR system, one in three indicate their EHR

system is CCHIT certified. The majority do not know whether their EHR system is CCHIT certified. The top mentioned

EHR systems currently being used are EPIC, Allscripts, custom built, CPRS (VA), Cerner, and Centricity.





130

Nearly six in ten rheumatologists practicing in academia reported they implemented EHR in their practice

within the last seven years.



Various Functions Performed By EHR

Q30. I use my EHR to perform the following functions:

Enter and review lab orders

Basic functions (i.e., review chart info., create visit notes)

Update and review medication lists

Scan and store paper reports

Enter and review radiology orders

Print prescriptions

Update and review problem lists

Electronically place radiology orders

Electronically transmit prescriptions

Electronically place lab orders

Disease-based registries (built or fed into your EHR)

Rheumatologists practicing in academia report that their EHR is used primarily used for basic functions

like reviewing chart information (96%), to update and review medication lists (84%), scan and store paper

reports (82%), and enter and review lab orders (80%).


131


Academic Findings by Geography

132





133

Seven in ten rheumatologists in the NE receive their predominant source of payment from academic

clinical practice compared to about five in ten in the SE. Payment from clinical research is highest in the

Midwest and from basic research in the W. Central region.





(n=133)

134

Overall, half of the academic rheumatologists surveyed receive their compensation through salary plus an incentive

bonus. Rheumatologists in the SE are the most likely to receive their compensation through this method, compared

to a higher percentage in the Midwest and West who receive compensation by salary alone.

(n=66)






(n=133)

135

More than half of the rheumatologists practicing in academia report they have a university sponsored

insurance plan. Academic clinics in the W. Central and West regions tend to have a university sponsored

insurance plan more often than NE and Midwest regions.





(n=133)

136

Thirty-seven percent of rheumatologists practicing in academia report they routinely collect measures of

function of disease activity from their patients. Clinics in the Midwest are most likely to collect this type of

information from their patients.





(n=133)

137

Overall, about 40% of rheumatologists report they currently e-prescribe all eligible prescriptions.

Academic practices in the Midwest are twice as likely to e-prescribe than practices in the SE. Physicians

in the West have the highest percentage reporting no plans to e-prescribe.





138

Seventy-five percent of rheumatologists practicing in the W. Central region report they use EHR in their

practice, compared to 37% in the West. In the West, 47% of rheumatologists do use EHR along with

paper charting.





139


within the last seven years, with the highest percentage of practices in the West (75%).



Academic Findings by Age

140





141

Nearly eight in ten rheumatologists in the 60+ age category report their predominant source of payment

from academic clinical practice, compared to the average of six in ten. Physicians surveyed in the 60+

category did not report payment from clinical or basic research.





(n=133)

142

Overall, half of the academic rheumatologists surveyed receive their compensation through salary plus an

incentive bonus. A higher percentage of rheumatologists in the 30 – 49 age range receive compensation

from salary only.

(n=66)






(n=133)

143

More than half of the rheumatologists practicing in academia reported they have a university sponsored

insurance plan. Physicians in the 30 – 49 age category tend to have a university sponsored insurance

plan more often than physicians in the 60+ category.





(n=133)

144

Forty percent of rheumatologists practicing in academia report they routinely collect measures of function

of disease activity from their patients. Rheumatologists in the 30 – 49 age range are more likely to collect

this type of information from their patients.





(n=133)

145

Overall, about 40% of rheumatologists report that they currently e-prescribe all eligible prescriptions.

Physicians in the 50 - 59 age category report significantly higher usage than physicians in the 60+ category.




Q26. Do you use an EHR in your practice?

(n=133)

146

Two-thirds of rheumatologists in the 50 – 59 age range use EHR in their practice, compared to one-third

in the 60+ range. When looking at the combined responses of “yes” and “yes with paper charting”, the 30

– 49 and 50 – 59 age ranges are nearly equal.





147


within the last seven years. Rheumatologists in the 30 – 49 age range implemented EHR earlier.



Section 4

Shared Findings Between Academic and Private Practice

148

2009 Benchmark Survey – Shared Findings


Practice Type of Participating Rheumatologists

Q3. What is your practice type? (n=319)

149

More than half (53%) of rheumatologists surveyed are in private practice, while one-fourth (42%) report

practicing in academia.



Yearly Compensation

Q20/Q34. What is the range of your yearly compensation?

(n=133) (n=186)

150

More than half (53%) of the rheumatologists practicing in academia report yearly compensation in the

range of $150,001-$250,000, while more than one-fourth (29%) report a compensation range of

$100,001-$150,000. Nearly one in four rheumatologists in private practice report yearly compensation of

less than $150,000, while more than one-third (37%) of rheumatologists in private practice report yearly

compensation in the range of $150,001-$250,000.



Main Practice’s Geographic Setting


Q73. What is your main practice’s geographic setting?

151

(n=319)

(n=133)

(n=186)

Eight in ten rheumatologists practicing in academia report practicing in an urban setting, while the

majority (57%) practicing in private practice/other are located in a suburban setting.



Change in Practice Type

Q74. Have you changed your practice type in the last 5 years? / Q74a. What was your practice type before you changed?

(n=319)

Practice Type Before The Change Change in Practice Type

Nearly 90% of rheumatologists have remained in the same practice type during the last five years.

152

(n=39)



Clinical and Non-Clinical Half Days Scheduled Per Week

Q75. Currently, in a typical work week, how many clinical half days do you schedule per week?

Q75a. Currently, in a typical work week, how many non-clinical half days do you schedule per week?

(n=319)

153

Clinical Half Days Non-Clinical Half Days



Age When Plan to Substantially Reduce Patient Care Hours


Q76. At what age do you plan to substantially reduce your direct patient care hours (i.e., partially retire)?

154

(n=319)

(n=133)

(n=186)

Nearly one-third of all rheumatologists report they have no plans to partially retire. The majority plan to

partially retire by the age of 64.

Mean

Age

64

65

63



Age When Plan to Completely Retire From Patient Care


Q77. At what age do you plan to completely retire from patient care?

155

(n=319)

(n=133)

(n=186)

Most rheumatologists report they plan to completely retire from patient care by age of 66+, with a mean

age of 69.

Mean

Age

69

70

69



Membership in a State Rheumatology Society


Q78. Are you a member of a state Rheumatology Society?

156

(n=319)

(n=133)

(n=186)

Four in ten rheumatologists report membership in a state rheumatology society. More than one-third

claim no membership and 21% state there is no state society available to join.



Meeting Your Practice Support Needs [Physicians answering “yes” in Q78.]


Q78a. Does your state Rheumatology Society meet your practice support needs?

157

(n=137)

(n=41)

(n=96)

Among rheumatologists reporting membership in a state society, nearly six in ten report their state

rheumatology society is meeting their needs.



Section 5

Comparisons With 1999 ACR National Economic Survey

158

Benchmark Survey Comparisons


Scheduled Clinic Time

Q14. How many hours of scheduled clinic time do you have per week?

159

The comparison between scheduled clinic time for 1999 and 2009 is shown for academic clinical practice

only, which is the only common group between the two administrations of the survey asked this question.

Benchmark Survey Comparisons - Academic



Q16. Do you render services/attend in the outpatient clinic?

160

The comparison between services rendered in the outpatient clinic for 1999 and 2009 is shown for

academic clinical practice only, which is the only common group between the two administrations of the

survey asked this question.

Benchmark Survey Comparisons - Academic


Yearly Compensation

Q20/Q34. What is the range of your yearly compensation?

161

This data is presented for visual comparison only. Please note that the compensation ranges between

1999 and 2009 are quite different.



Personal Sources of Compensation

Q21/Q35. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from

each of the following.

162

Direct patient care continues to be the largest personal source of compensation.

Benchmark Survey Comparisons – Private Practice

Please note that three new categories were added in 2009. For comparison, infusion therapies were added into in office lab, and in office MRI and

ultrasound were added into in office x-ray.


Percent of Booked Charges Collected


Q38. Of your total booked charges, what percentage is collected?

163

About In all three practice types, the percent of booked charges collected decrease slightly between 1999 and

2009.



Percent of Total Collections to Physician Compensation


Q39. What percentage of your total collections goes directly to physician compensation and benefits, insurance and professional liability?

164

About For solo and multi-specialty practices, the percent of total collections going directly to physician

compensation has remained consistent from 1999 to 2009. For single specialty groups, the percent has

decreased.



Overhead Percentages*

Q40. The remaining revenue not applied to physician compensation and benefits, insurance and professional liability (Q.39) is generally referred to as

overhead. Overhead may be direct or indirect. What are your overhead percentages for the following types of costs?

165

2009 1999


Caution: Overhead percentages in 2009 did not include a clinical labor category, so some of the 2009 categories will be naturally inflated.

*These comparisons are made between the three private practice groups that are common to both survey administrations.


Number of Physician Associates in the Practice

Q43. Number of physician associates in your practice (excluding yourself)?

166

Overall, the number of physician associates in the practice is less than half than in 1999. This is

particularly due to multi-specialty practices.



Replacement of Retiring Rheumatologists in Next Five Years

Q45. Does your practice plan to replace retiring rheumatologists within the next five years?

167

The number of practices that planned to replace retiring rheumatologists in 2009 is significantly less than

those who planned to do so in 1999.



Waiting Time (in weeks) to Next Consultation

Q47. What is the waiting time (in weeks) to next consultation with a physician?

168

Overall, the average waiting time in weeks for the next consultation with a physician has increased by

approximately one week from 1999 to 2009.



Waiting Time (in weeks) to Next Return Visit With a Physician

Q48. What is the waiting time (in weeks) to the next return office visit with a physician?

169

The average waiting time in weeks for the next return office visit with a physician has increased by

approximately one week from 1999 to 2009 as well.



Number of Support Personnel in Practice*

170

Support Personnel 2009 1999

RNs 1.2 0.3

LPNs/LVNs 1.1 0.3

Medical assistants 3.6 0.7

Mid-level providers (PAs and NPs) 0.5 0.1

Lab, x-ray and bone density technicians 1.7 0.5

Research support 0.7 0.1

Secretarial / front desk 4.8 1.7

Q41. How many support personnel are employed in your practice? [INDICATE THE FULL TIME EQUIVALENCY (FTE) PER MD].

Across all support personnel categories, the number of support personnel employed by the practice has

increased substantially since 1999.

[Mean number of personnel]


*These comparisons are made between the three private practice groups that are common to both survey administrations.


Summary of Productivity / Scheduled Hours Per Week *



Based on the number of scheduled hours of office time per week 2009

Means

1999

Means

Time interval, in minutes, for

New patients 48 Min. 49 Min.

Return patients 22 Min. 17 Min.

Number of patients seen per week

New patients 12 12

Return patients 81 71

Number of

Hospital visits 3 7

Hospital consultations 2 2

Arthrocentesis, joint, tendon or bursa injections performed per week 15 16

Office no-show rate (a percentage) 7 % 6%

RVU work components per week (if known) 54 Not reported


* These comparisons are made between the three private practice groups that are common to both survey administrations: Solo practice,

Single specialty group practice, and Multispecialty group practice .

171



Fully Scheduled Week *

Visit Codes 2009 Means 1999 Means

New patient /office

99203 1 2

99204 2 3

99205 1 2

Total new 5 6

Established patient/office

99213 25 32

99214 31 32

99215 4 4

Total established 60 68



Data in this table show mean hours for each code by payment source.


* These comparisons are made between the three private practice groups that are common to both survey administrations: Solo practice, Single

specialty group practice, and Multispecialty group practice .

172


Number of Hours Charged to Specific Visit Codes in the Last Fully

Scheduled Week * (cont.)

Visit Codes 2009 Means 1999 Means

Consult/office

99243 2 3

99244 6 6

99245 3 4

Total consult 11 13

Consult/inpatient

99253 0 2

99254 1 2

99255 1 2

Total established 3 5

Mean weeks worked per year 47 48




* These comparisons are made between the three private practice groups that are common to both survey administrations: Solo practice, Single

specialty group practice, and Multispecialty group practice .

173


Have You Sold Equity In Your Practice?

Q67. Have you sold equity in your practice?

174

The percentage of rheumatologists reporting that their practice sold equity has drastically fallen off

between 1999 and 2009.



To Whom Have You Sold Equity in Your Practice?

Q67a. If yes, to whom have you sold equity in your practice?

175

Because only three rheumatologists reported that their practice had sold equity in 2009, an accurate

comparison between 1999 and 2009 cannot be made.


[Rheumatologists reporting “yes” in Q67]




176

Across the three practice types, the percentage of rheumatologists reporting that their practice merged

with another company in the last five years is less than half than was reported in 1999.





177

The number of single specialty rheumatologists reporting that their charges were reduced or denied during

the last year has remained consistent between 1999 and 2009; however, solo practices and multi-specialty

groups report this occurs far less often in 2009.



Percentage of Reduced or Denied Charges [Physicians answering “yes” in Q69]

Q69a. What percentage of the charges have been reduced or denied during the last year?

178

The percentage of charges that were reduced or denied has decreased between 1999 and 2009.



Most Frequent Problem for Having Charges Reduced or Denied

[Physicians answering “yes” in Q69]

Q69b. What was your most frequent problem for having your charges reduced or denied during the last year?

179

The most frequent problem for having charges reduced or denied continues to be “payment schedule by a

third-party payer is inadequate”.



Formal Audit by Medicare in the Last Year

Q70. Have you had a formal audit by Medicare in the last year?

180

Overall, the percentage of rheumatologists reporting formal audits by Medicare had remained the same

from 1999 to 2009.




Q77. At what age do you plan to completely retire from patient care?

181

The average age of retirement has increased from age 64 in 1999 to age 69 in 2009.



Section 6

Comparisons With Findings of the 2006 Workforce Study

182



Comparisons with 2006 Workforce Study Some questions asked in the 2009 Rheumatology Economic Survey can be compared with

the findings of the 2006 Workforce Study of Rheumatologists. The comparisons include the

following:

Do you require new patients to have a physician referral?

The 2006 Workforce Study reported that 48% of rheumatologists were requiring their

patients to provide physician referrals. The current found that this percentage has

increased to 55%.

At what age do you plan to substantially reduce your direct patient care hours (i.e.,

partially retire)?

The 2006 Workforce Study reported that a large number of rheumatologists who were

between 50 – 59 years of age “will have greatly reduced hours of work, over the next 15

years.

The current study supports this prediction. Forty-two percent of the physicians who

participated in the 2009 Rheumatology Economic Survey report that they plan to

substantially reduce their direct patient care hours by the time they reach 60 – 65 years

of age. In addition, another 20% of the participants report that they plan to substantially

reduce their direct patient care hours when they become older than 65 years of age.

183



Comparisons with 2006 Workforce Study (cont.)

At what age do you plan to completely retire from patient care?

The 2006 Workforce Study used labor force participation rates for professionals, based

on data from the Census Bureau for 2000, to predict substantial numbers of retirements

among rheumatologists beginning at age 59 and continuing through age 68.

Beyond age 68, the retirement rate begins to level off until these older rheumatologists

approach 75 years of age. At 75 years of age, the Workforce model assumed that all

remaining rheumatologists would be retired.

Again, the current study supports this prediction. A small number of the physicians who

participated in the 2009 Rheumatology Economic Survey report that they plan to retire

between 55 – 60 years of age (6%). However, a larger group of the rheumatologists

(26%) are planning to retire when they reach 61 – 65 years of age, and 46% report that

their goal for complete retirement is somewhere between 66 – 70 years of age.

Finally, the remaining 22% of the participants report that they will completely retire when

they pass 70 years of age.

184


Confidential Europe • Asia • Americas · Confidential Europe • Asia • Americas Section Table of Contents Slide 1 Background, purpose, methodology and demographics 4 2 Private

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