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Practice Benchmarking for the Rheumatologist

This report was completed in October 2003 by the Committee on Rheumatologic Care, based on a survey conducted in 2002. The Executive Summary and abridged report are available online; the complete report, incuding all graphs and exhibits, is available as a PDF file. Download the report .

NOTE: Exhibits to the report are available separately.
Exhibit A: Overview of Respondents
Exhibit B: Coding Distribution; Established Patients & Office Visits
Exhibit C: Full Summary of Results
Exhibit E: Formulas for Benchmarks

I. EXECUTIVE SUMMARY

1. Purpose of Survey

• Develop a repository of practice management data for single specialty rheumatology groups;
• Educate ACR Members regarding benchmarking;
• Provide cost-effective alternative to in-person practice management consulting

2. Scope and Methods

• Measured respondents on 21 data points (e.g., gross receipts per physician FTE, net income per physician FTE)
• Immediate feedback/variance report comparing respondent data against external benchmarks developed from existing published data (e.g., MGMA, Sullivan Cotter, National Association of Health Care Consultants)

3. Respondents

• 48 medical practices with 119 physicians
• 77% of responding practices are single specialty, established private practices -- remainder are multispecialty, hospital owned or start-ups
• 75% are practices with three physicians or less
• Even geographic distribution across U.S.
• 25% of respondents employ a nurse practitioner or physician’s assistant

4. Findings

• Median gross receipts ($620,037) and net income per physician FTE ($211,016) exceeded existing external benchmarks by 66% and 21% respectively. This is likely due to (a) the increasing provision of ancillary services (infusion, DEXA, lab, x-ray, PT, ultrasound), and (2) self-selection of respondents (those who had good results are more attuned to value of benchmarking surveys).
• Gross receipts and overhead were strongly effected by ancillary services. Responding practices with large ancillary revenue had revenues of more than $800,000 per year versus $350,000 for other responding practices, but higher overhead as well: 69% of receipts versus 50% for other practices.
• In line with the above-average financial results, as described above, respondents’work effort as measured by encounters and work RVUs was at or above the average, even with a conservative definition of how many patient hours define a minimal FTE. Patient encounters per physician FTE were measured at 3,574 (without injections), which is comparable to the external benchmark of 3,749 reported by the MGMA, but work RVUs per physician FTE were 4,158, compared with an expected benchmark of 3,650, a difference of 22%.
• Respondents coded slightly higher than the nationwide CMS averages for rheumatology. This may be attributable to the fact that many of the physicians who self-report to CMS as rheumatologists likely have a substantial non-rheumatology component to their practices, whereas respondents, as ACR members, likely have a more “pure”rheumatology practice and therefore a generally sicker patient population.
• Staff payroll costs were measured at 26.1% of annual practice receipts, with a median 3.72 staff FTEs per provider FTE. These numbers were not appreciably different from existing external benchmark data.
• Respondent practices appear to be successful in collecting their charges promptly. Average number of days of charges in accounts receivable was only 40, compared with the existing external benchmark of 72 days. Nearly 90% of respondent receivables were less than 60 days old.
• Respondents reported better-than-expected patient availability. Average waiting time was 21 working days to next available, non-emergency consult (compared with an external benchmark of 30.8 days) and 8 days to next available, non-emergency follow-up (versus an external benchmark of 20.3 days). However, scheduled patient hours per provider were not appreciably higher than predicted: 32.67 hours per week for respondents versus an external benchmark of 30.4 hours per week.
• There is very limited use of advanced practice clinicians (nurse practitioners or physicians assistants). Although 25% of respondents reported using them, that use was very sparing. The mean number of advanced practice clinicians per physician FTE was only 0.18.
• Respondents employed a median of 2.3 exam rooms and 1,380 square feet per physician FTE. (Existing published data provides no rheumatology-specific benchmarks on these data points.)

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