4/30/2015 1 NERVES Summary of Survey Trends April 4, 2014 Michael N. Heaton, CPA/ABV/PFS, CFP, CHBC, CVA May 1, 2015 2 ▪ Survey questionnaires in Excel format were distributed electronically to the entire membership (300 practices) and additional non-member practices in September 2014. ▪ Participants and responses are confidential, i.e. only KSM has access to the specific data. ▪ KSM now screens for certain “critical data questions.” If those questions are not answered, a survey is rejected or additional information is requested. Overview 3 For each statistic reported by individual neurosurgeon, we have presented the data by practice ownership. Therefore, for each statistic, there are the following detail pages: Overall Physician-Owned Academic Hospital-Owned Overview
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4/30/2015
1
NERVES
Summary of Survey Trends
April 4, 2014
Michael N. Heaton, CPA/ABV/PFS, CFP, CHBC, CVA
May 1, 2015
2
▪ Survey questionnaires in Excel format were distributed
electronically to the entire membership (300 practices) and
additional non-member practices in September 2014.
▪ Participants and responses are confidential, i.e. only KSM has
access to the specific data.
▪ KSM now screens for certain “critical data questions.” If those
questions are not answered, a survey is rejected or additional
information is requested.
Overview
3
For each statistic reported by individual neurosurgeon, we have
presented the data by practice ownership. Therefore, for each
statistic, there are the following detail pages:
Overall
Physician-Owned
Academic
Hospital-Owned
Overview
4/30/2015
2
4
For each statistic reported by individual neurosurgeon, we have
presented the number of neurosurgeons and practices that
responded.
If eight or more physicians responded, and three or more
practices responded, the data was reported.
Overview
5
The question regarding physician’s primary focus of practice, Clinical vs. Academic, was removed.
The Hybrid category for ownership type was removed.
Malpractice insurance data was collected and reported at the neurosurgeon and practice level.
On the Academic tab, FTE data for mid-level providers was reported.
New in 2014
6
• For the 2014 report, we developed an additional editing process for the practice data. We used the editing process to identify reporting errors and potential outliers in the data. Data determined to be outliers were either reviewed with the survey preparer for correction or excluded from the survey. In regards to the editing process, we used the following additional guidelines:
Overall
All neurosurgeon compensation and statistics were normalized to report compensation on a 1.0 clinical full-\time equivalent (FTE) imputed basis as described below.
▪
New in 2014-Data Editing
4/30/2015
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7
Academic Physicians
▪ Any neurosurgeon with a clinical FTE that was reported to be equal to or greater than .5 clinical FTE was considered to be a 1.0 clinical FTE for calculation and presentation purposes.
▪ Any neurosurgeon which was reported to be less than a .5 clinical FTE was analyzed as follows:
▫ If the imputed compensation per clinical FTE was greater than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the Academic ownership category, the data was excluded from the survey.
▫ If the imputed compensation per clinical FTE was less than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the Academic ownership category, the data was included in the survey.
▪
New in 2014-Data Editing
8
Physician-Owned/Hospital-Owned Physicians
▪ Any neurosurgeon with a clinical FTE that was reported to be equal to or greater than .5 clinical FTE was normalized as described in the “Overall” section above.
▪ Any neurosurgeon which was reported to be less than a .5 clinical FTE was analyzed as follows:
▫ If the imputed compensation per clinical FTE was greater than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the ownership category, the data was excluded from the survey.
▫ If the imputed compensation per clinical FTE was less than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the ownership category, the data was included in the survey.
New in 2014-Data Editing
9
▪ MGMA does not standardize any of the data but instead
categorizes providers into full-time and part-time
categories based on the following FTEs:
▫ Full-time: .08 – 1.0
▫ Part-time: .40 – .60
▫ Excluded: .61 – .79
▪ The actual survey only reports the full time physician data.
▪ The part time physician data is provided in the data mining
resources.
Data Editing – MGMA Physician
Compensation and Production Survey
4/30/2015
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10
▪ The Academic MGMA Survey requests both the FTE and the
Clinical FTE.
▪ The academic survey only reports 1.0 FTE.
▪ Statistics are reported using the following methodologies:
▫ Percentage of Billable Clinical Activity (0%-33%, 34%-66%,
and 67%-100%)
▫ Standardized to equal 100% Billable Clinical Activity
Data Editing – MGMA Academic Practice Compensation
and Production Survey for Faculty and Management
11
▪ Sullivan Cotter:
▫ All compensation and productivity data is standardized to
reflect 1.0 FTE.
▪ AMGA – Compensation and Financial Survey:
▫ All compensation and productivity data is standardized to
reflect 1.0 FTE.
Data Editing – Sullivan Cotter & AMGA
Compensation and Financial Survey
12
2010 2011 2012 2013 2014
Distributed(NERVES Members) 335 331 331 322 300
Responses(NERVES Members) 72 71 73 63 81
Response Rate(NERVES
Members) 21% 21% 22% 20% 27%
Neurosurgeons 390 464 432 415 580
Non-Physician Providers 111 123 117 131 560
Practices Reporting NPP 42 31 48 46 57
MGMA: Overall Response
Rate* 19% 23% 8% 35% 28%
MGMA: Reporting
Neurosurgeons* 256 261 312 344 355
Demographics – Practice
*SOURCE: Medical Group Management Association’s Annual Physician Compensation and Production Survey
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Geographic Region 2010 2011 2012 2013 2014
East 10% 8% 7% 13% 11%
South 35% 43% 52% 43% 45%
Midwest 32% 24% 21% 29% 23%
West 23% 25% 21% 14% 21%
Demographics - Practice
14
Ownership 2010 2011 2012 2013 2014
Private 69% 64% 64% 60% 60%
Hospital 7% 10% 16% 16% 15%
Academic 24% 21% 15% 21% 25%
Hybrid N/A 5% 4% 3% N/A
Composition
Single Specialty 39% 43% 67% 54% 55%
Multi-Specialty 29% 37% 33% 46% 45%
Academic 32% 20% N/A* N/A* N/A*
Demographics - Practice
*For 2012 - 2014, the academic category was removed from practice type since it was reported in practice ownership.
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Practice Accounts Receivable Data
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16
Accounts Receivable
$347,908
$240,822
$309,614
$567,376
$505,551 $532,456
$446,629 $446,235 $442,867 $452,152
$566,723
$537,410 $526,870
$542,556
$594,875
$200,000
$300,000
$400,000
$500,000
$600,000
2010 2011 2012 2013 2014
A/R per FTE Provider
A/R per FTE Physician
A/R per FTE Neurosurgeon
N= 56 68 70 60 90
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A/R Aging
52% 50% 48%50% 49%
14% 15%16%
16%16%
9% 8%8%
8% 9%
5% 6%5%
6% 6%7% 7%
6%
7% 8%
10% 10%15%
6% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014
180+ Days
121 to 180 Days
91 to 120 Days
61 to 90 Days
31 to 60 Days
Current to 30 Days
N= 62 69 69 59 87
*Please note that the total will not equal 100% due to the response are the plot of the medians.
18
Median Days in A/R
49.0848.65
47.95
45.5
50.44
43
44
45
46
47
48
49
50
51
2010 2011 2012 2013 2014
N= 57 72 66 56 91
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Median Gross Coll. %
25.00%
27.00%
29.00%
31.00%
33.00%
35.00%
2010 2011 2012 2013 2014
Overall
Academic
Hospital-Owned
Physician-Owned
32.23%
29.19%
32.96%
32.03%
28.57%
26.60%
28.50%
30.37%
N= 63 72 67 58 95
*Please note that the median gross collection percentage was not calculated by ownership prior to 2014.
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Practice Income
21
Avg % Practice Revenue
30.17% 29.83%
21.29%21.38%
30.57%
7.78%10.11%
6.67%
7.69%
9.15%
46.37%
41.52%
54.30%
36.29%
37.85%
12.84%
19.13%23.94% 15.23%
6.33%
3.89%7.43% 8.26%
4.37% 2.91%
1.74% 3.16% 2.12%1.90% 0.57%
5.50% 6.90% 9.65%10.54% 12.62%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014
Other
Workers Comp FFS - % Chgs.
Workers Comp FFS - Sched.
Commercial FFS - % Chgs.
Commercial FFS - Sched.
Medicaid
Medicare
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Other Relevant Practice Issues
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New Data in 2014
Questions N 2014 % Yes
Does your practice utilize Work Relative Value
Units(WRVUs) for compensation purposes?
Does your practice utilize Work Relative Value
Units(WRVUs) for practice management?
94
93
37.23%
40.86%
How you undergone a Government HIPPA audit in the last
twelve months?
91 3.30%
24
Relevant Issues in 2013 and 2014Questions N 2013 % Yes N 2014 % Yes
Allocation of General Overhead in Determining Physician
Compensation:
• Equal• Variable based on a measure of productivity
• Blend of Equal and Variable
• If Blended
• Percentage allocated equally
• Percentage allocated variably• Other
4133
31
19
1714
42.59%25.93%
31.48%
57.00%
47.00%35.71%
3229
20
16
167
36.36%32.95%
22.73%
54.12%
45.88%7.95%
Time to Complete Survey?
• 1 – 2 Hours
• 3 – 4 Hours• 4+ Hours
63
6363
8.47%
38.98%52.54%
87
8787
12.64%
20.69%66.67%
Are you currently participating in an ACO?
• Have you participated greater than 1 year?
Are you participating in a shared savings ACO?
• Have you received any savings?
62
21
57
13
27.42%
42.86%
19.30%
7.69%
90
22
78
17
24.44%
59.09%
21.79%
29.41%
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Relevant Issues in 2013 and 2014
Question N 2013 % Yes or # N 2014 % Yes or #
Are you participating in National
Neurosurgery Quality and
Outcomes Database (N2QOD) or an alternative spine registry?
What type of registry?
• N2QOD• Other
59
9
15.25%
77.78%22.22%
88
2
23.86%
87.5%12.5%
How many FTEs are assigned to
N2QOD or an alternate spine
registry?
9 1.11 2 *
26
Relevant Issues in 2013 and 2014Question N 2013 % Yes or # N 2014 % Yes or #
Does your practice receive additional revenue for
Medical Directorship?
What type of medical directors?• Cranial/Brain Tumors Neurosurgery
*Please note the median overhead is calculated on a per FTE Neurosurgeon basis only and is not ownership specific.
78
2014 N 2012 2013 2014
Total Compensation 580 $784,519 $743,243 $670,100
Professional Services 551 $593,006 $540,517 $528,200
Call Pay 256 $149,466 $123,865 $139,958
Ancillary Net Income: ASC 50 $167,844 $178,500 $98,800
Ancillary Net Income: Imaging 112 $80,000 $80,000 $27,336
Ancillary Net Income: PT or OT 12 $11,308 * *
Ancillary Net Income: Other 64 $46,667 $59,055 $60,507
Three-year Comparison per FTE
Neurosurgeon
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79
2014 N 2012 2013 2014
Research 27 $55,938 $55,382 $37,364
Medical Directors 72 $55,136 $80,199 $70,051
Teaching: Dept. Chair 12 $243,222 * *
Teaching: Dept. Professor 27 $51,256 * $67,900
Teaching: Assoc. Professor 12 $80,000 * *
Teaching: Asst. Professor 56 $49,739 $66,667 $42,250
Teaching: Instructor 1 * * *
Other 147 $28,376 $34,915 $51,100
Three-year Comparison per FTE
Neurosurgeon (con’td)
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▪ Due to new data editing process, it is recommend to use statistics within each ownership type.
▪ The mix of respondents changed in 2014
▫ The number of academic respondents increased from 136 in 2013 to 238 in 2014, an increase of 75%.
▫ The number of private practice respondents increased from 178 in 2013 to 277 in 2014, an increase of 55.6%.
▫ The number of hospital owned respondents increased from 54 in 2013 to 65 in 2014, an increase of 20.4%.
▫ The hybrid category in 2013 was 11% of total respondents. This category was eliminated in 2014.
Conclusions
81
▪ Number of practices that have cancelled third party payor contracts decreased from 25.40% in 2013 to 6.74% in 2014.
▪ The average commercial reimburse as a % of Medicare has decreased from 177.02% in 2013 to 163.59% for 2014.
▪ Practices planning on recruiting new physicians and non-physicians continues to decrease from 72.31% in 2010 to 59.57% in 2014.
▪ 90% of practices are using an EMR system.
Conclusions
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82
▪ Of the practices using EMR systems, the number attesting to Year 1 Medicare Meaningful Use Standards increased from 71% in 2013 to 76.54% in 2014.
▪ 24.44% of practices are participating in an ACO. This is a decrease of 2.98% from the 2013 amount.
▪ For those practices participating in an ACO, the percentage that received savings increased from 7.69% in 2013 to 29.41% in 2014.
▪ Staff turnover rate for the past 12 months increased from 16% in 2013 to 21% in 2014.
Conclusions (cont’d)
83
▪ Median collections for professional services per neurosurgeon continues to decrease. Over the last five years, collections have decreased by ownership type:
2010 2014
▫ Overall $1,033,796 $858,597
▫ Physician-Owned $1,103,495 $1,043,718
▫ Hospital-Owned * $750,454
▫ Academic $935,602 $708,817
▪ Median WRVUS per neurosurgeon continues to decrease. Over the last five years, WRVUs have decreased by ownership type:
2010 2014
▫ Overall 10,662 9,618
▫ Physician-Owned 12,211 11,316
▫ Hospital-Owned * 11,706
▫ Academic 10,132 7,791
Conclusions (cont’d)
84
▪ With the exception of Academic, collections per WRVU have decreased over the last four years. Variances by ownership type include:
2011 2014
▫ Overall $83 $80
▫ Physician-Owned $91 $87
▫ Hospital-Owned $75 $69
▫ Academic $81 $81
▪ Compensation per WRVU has decreased over all ownership types, except Academic, since 2011. The variances over the last four years include:
2011 2014
▫ Overall $68 $67
▫ Physician-Owned $79 $64
▫ Hospital-Owned $89 $66
▫ Academic $65 $72
Conclusions (cont’d)
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▪ The composition of practice has shifted over the last five years
from cranial and spine to other specialties.
▫ In 2010 cranial and spine together were 85% of practice compared
to 71% in 2014.
- Cranial decreased 10%
- Spine decreased 4%
▫ Other specialties, including pediatric, endovascular and functional,
made up 15% of practice in 2010 compared to 26% in 2014.
Conclusions (cont’d)
86
▪ The compiled data continues to show variance in the median daily call pay rate between geographic regions. The south geographic region has the highest daily call pay amount compared to the other regions.
▪ The median overall daily call pay per contract decreased from $1,775 in 2013 to $1,612 in 2014.
▪ The median overall daily call pay per contract for trauma increased from $2,000 in 2013 to $2,315 in 2014.
▪ The median overall daily call pay per contract for Level 1 Trauma increased from $2,175 in 2013 to $2,389 in 2014, while the daily rate for Level 2 Trauma was consistent between the two years.
Conclusions (cont’d)
87
▪ New Time Line
▫ June 15th-Send questionnaire to NERVES members
▫ August 15th-Deadline for all questionnaires to be submitted to KSM
▫ December 1st-Final surveys are mailed to participating members
▪ Survey will request both FTE and Clinical FTE status
Michael N. Heaton CPA/ABV/PFS/ CFP,CHBC,CVA – Partner
Michael Heaton is a partner in Katz, Sapper & Miller’s Healthcare Resources Group. He has engaged in the practice of public accounting and healthcare consulting since 1976. Michael has
extensive healthcare consulting experience and provides in-depth consulting in the areas of
practice management, physician compensation, practice startups, practice valuations, third-party
reimbursement, practice mergers and reorganizations, retirement plans, personal financial
planning, managed care contracting, and group practice design. He also has expertise in the taxation of medical practices, dental practices, professional corporations, not-for-profit