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2009 Rheumatology Economic Survey

2009 Rheumatology Economic Survey. Final Report May 18, 2010. 2009 Benchmark Survey. 2009 Benchmark Survey. Section 1 Background, objectives, methodology and demographics. 2009 Benchmark Survey. Background

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2009 Rheumatology Economic Survey

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  1. 2009 Rheumatology Economic Survey Final Report May 18, 2010

  2. 2009 Benchmark Survey

  3. 2009 Benchmark Survey Section 1 Background, objectives, methodology and demographics

  4. 2009 Benchmark Survey 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. 2009 Benchmark Survey 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. 2009 Benchmark Survey 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. 2009 Benchmark Survey 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. 2009 Benchmark Survey Demographics 6 1 2 2 1 3 10 30 19 4 2 2 10 9 20 14 7 1 2 10 3 1 1 15 DC = 3 2 4 7 8 2 5 4 28 9 2 4 6 3 3 3 4 2 4 5 23 Puerto Rico = 2 11 319 rheumatologists from across the US and Puerto Rico participated in the 2009 Economic Survey.

  9. 2009 Benchmark Survey – Private Practice Findings Section 2 Private Practice Findings

  10. 2009 Benchmark Survey – Private Practice Findings Predominant Source of Payment[Physicians answering “private practice” and “other” in Q3.] 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. Mean # of Physicians (n=64) 5.2 Rheum (n=52) 54.0 All Phys 3.7 Rheum (n=59) (n=1) *Note: The single practice administrator has been added into the multi-specialty group for all subsequent questions. (n=176) Q31. Which of the following is your predominant source of payment?What is the number of rheumatologists/physicians?

  11. 2009 Benchmark Survey – Private Practice Findings Percent of Practice - Adult, Primary Care and Pediatric 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%). (n=186) Q32. What percentage of visits makes up your clinical practice in each of the following areas?

  12. 2009 Benchmark Survey – Private Practice Findings Percent of Practice - Adult, Primary Care and Pediatric 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. Q32. What percentage of visits makes up your clinical practice in each of the following areas?

  13. 2009 Benchmark Survey – Private Practice Findings Percentage of Desire to be Dedicated to Rheumatology[Physicians answering “primary care” in Q32.] 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. (n = 37) Q32a. What percentage of your practice do you desire to be dedicated to rheumatology?

  14. 2009 Benchmark Survey – Private Practice Findings Type of Compensation 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. Type of Incentive Bonus [Other responses <2% of total mentions] (n=34) [Those answering “salary plus incentive bonus” in Q33] (n=186) Q33. What type of compensation method does your practice have? Q33a. What type of incentive bonus does your practice have?

  15. 2009 Benchmark Survey – Private Practice Findings Personal Sources of Compensation (see next slides for breakout by % of income) Rheumatologists practicing in private practice indicate nearly three-fourths of all personal sources of compensation come from direct patient care. (n=186) 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.

  16. 2009 Benchmark Survey – Private Practice Findings Personal Sources of Compensation – Direct Patient Care 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%. 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.

  17. 2009 Benchmark Survey – Private Practice Findings Personal Sources of Compensation – Infusion Therapies Private practice rheumatologists report that infusion therapies for personal sources of compensation averaged only 9%. 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.

  18. 2009 Benchmark Survey – Private Practice Findings Percent of Revenue Obtained From Insurance – Fee Based 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. Q36a. Indicate below the percentage of revenue that is obtained from each of the following types of insurance.

  19. 2009 Benchmark Survey – Private Practice Findings Type of Insurance Patients Carry Rheumatologists in private practice state that one-quarter of their patients carry PPOs, followed by HMOs and classic indemnity. Q65. On average, what type of insurance do your patients have?

  20. 2009 Benchmark Survey – Private Practice Findings Percent of Revenue Obtained From Insurance – Capitated 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. Q36b. Indicate below the percentage of revenue that is obtained from each of the following types of insurance. [Multiple mentions accepted]

  21. 2009 Benchmark Survey – Private Practice Findings Restriction of Insurance Carriers 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. (n=186) Q37. Do you restrict any insurance carriers?

  22. 2009 Benchmark Survey – Private Practice Findings Restricted Insurance Carriers[Physicians answering “yes” in Q37] 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. Q37. Do you restrict any insurance carriers? Which ones?

  23. 2009 Benchmark Survey – Private Practice Findings Percent of Booked Charges Collected About 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. Mean Percent 69.7 (n=186) 74.5 (n=64) 69.5 (n=52) 69.3 (n=60) Percentage of Rheumatologists Q38. Of your total booked charges, what percentage is collected?

  24. 2009 Benchmark Survey – Private Practice Findings Percent of Total Collections to Physician Compensation About 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%. Mean Percent 43.6 (n=186) 46.4 (n=64) 39.3 (n=52) 47.9 (n=60) Percentage of Rheumatologists Q39. What percentage of your total collections goes directly to physician compensation and benefits, insurance and professional liability?

  25. 2009 Benchmark Survey – Private Practice Findings Overhead Percentages The three biggest overhead categories for rheumatologists in their practice are clerical labor, followed by expenses to maintain an office, and supplies. [Mean percents] 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?

  26. 2009 Benchmark Survey – Private Practice Findings Number of Support Personnel in Practice Secretarial staff and medical assistants make up the greatest portion of support personnel. [Mean number of personnel] Q41. How many support personnel are employed in your practice? [Indicate The Full Time Equivalency (Fte) Per MD].

  27. 2009 Benchmark Survey – Private Practice Findings Utilization of Nurse Practitioners and Physician Assistants 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%). Q42. How does your practice utilize nurse practitioners and physician assistants? [Multiple answers accepted]

  28. 2009 Benchmark Survey – Private Practice Findings Hiring Additional Rheumatologists Within the Next Five Years 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. Hiring Plan Number of Hires (n=186) (n=69) Q44. Does your practice plan to hire additional rheumatologists within the next five years? If yes, how many do you plan to rehire?

  29. 2009 Benchmark Survey – Private Practice Findings Number of Physician Associates in the Practice Forty percent of private practice rheumatologists are in solo practice, followed by one-third in practices of five to nine rheumatologists. (n=186) Q43. Number of physician associates in your practice (excluding yourself)?

  30. 2009 Benchmark Survey – Private Practice Findings Replacement of Retiring Rheumatologists 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. Replacing Retiring Rheumatologists Number of Replacements (n=186) (n=42) Q45. Does your practice plan to replace retiring rheumatologists within the next five years?  If yes, how many do you plan to replace?

  31. 2009 Benchmark Survey – Private Practice Findings Hiring Additional Nurse Practitioners or Physician Assistants 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. Hiring Plan Number of Hires (n=186) (n=44) 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?

  32. 2009 Benchmark Survey – Private Practice Findings Waiting Time (in weeks) to Next Consultation With a Physician The average waiting time in weeks to the next consultation with a rheumatologists is five weeks. Mean number of weeks = 5.0 (n=186) Q47. What is the waiting time (in weeks) to next consultation with a physician?

  33. 2009 Benchmark Survey – Private Practice Findings Waiting Time (in weeks) to Next Return Visit With a Physician 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. Mean number of weeks = 3.8 (n=186) Q48. What is the waiting time (in weeks) to the next return office visit with a physician?

  34. 2009 Benchmark Survey – Private Practice Findings Waiting Time (in weeks) to Next Consultation With a PA or NP The average waiting time in weeks to the next consultation with a PA or NP is one week. Mean number of weeks = 1.2 (n=186) Q47. What is the waiting time (in weeks) to next consultation with a PA or NP?

  35. 2009 Benchmark Survey – Private Practice Findings Waiting Time (in weeks) to Next Return Visit With a PA or NP 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. Mean number of weeks = 1.2 (n=186) Q50. What is the waiting time (in weeks) to next return office visit with a PA or NP?

  36. 2009 Benchmark Survey – Private Practice Findings Time (in hours) Spent Filling Out Prior Authorizations 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. Mean number of hours = 3.1 Single specialty group = 4.2 Solo private practice = 3.1 Multi-specialty group = 2.5 (n=186) Q51. How much time in a typical day do you or your staff spend filling out prior authorizations (include phone calls)? [Hours per day]

  37. 2009 Benchmark Survey – Private Practice Findings Summary of Productivity / Scheduled Hours Per Week(See slides 72-78 for breakouts) 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.

  38. 2009 Benchmark Survey – Private Practice Findings Scheduled Hours Per Week – Time Interval for New Patients Forty-eight minutes is the average time reported for a new patient visit. 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.

  39. 2009 Benchmark Survey – Private Practice Findings Scheduled Hours Per Week – Return Patients The average time reported for a return patient visit is 22 minutes. 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.

  40. 2009 Benchmark Survey – Private Practice Findings Number of Hospital Visits Rheumatologists report an average of three hospital visits in a fully scheduled week. Mean number of visits = 3.0 (n=186) 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.

  41. 2009 Benchmark Survey – Private Practice Findings Number of Hospital Consultations Rheumatologists report an average of two hospital consultations in a fully scheduled week. Mean number of visits = 2.0 (n=186) 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.

  42. 2009 Benchmark Survey – Private Practice Findings Number of Arthrocentesis, Joint, Tendon or Bursa Injections 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. Mean number of visits = 15 (n=186) 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.

  43. 2009 Benchmark Survey – Private Practice Findings Office No-Show Rate 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. Mean percentage = 7% (n=186) 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.

  44. 2009 Benchmark Survey – Private Practice Findings Number of RVU Work Components Per Week Nearly 90% of rheumatologists surveyed did not know the number of RVU work components per week. Mean # of RVUs = 53 (n=186) 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.

  45. 2009 Benchmark Survey – Private Practice Findings Number of Hours Charged to Specific Visit Codes in the Last Fully Scheduled Week Data in this table show mean hours for each code by payment source. 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.

  46. 2009 Benchmark Survey – Private Practice Findings Number of Hours Charged to Specific Visit Codes in the Last Fully Scheduled Week (cont.) 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.

  47. 2009 Benchmark Survey – Private Practice Findings Collection of Measures of Function and Disease Activity 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. (n=186) (n=64) (n=52) (n=60) 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. 2009 Benchmark Survey – Private Practice Findings Reporting of Data for Pay-for-Performance/Other Quality Measures Encouraged/Required By Payers One-quarter of rheumatologists surveyed are encouraged or required by payers to report data for pay for performance or other quality measures. (n=186) (n=64) (n=52) (n=60) Q55. Are you encouraged / required by payers to report data for pay for performance or other quality measures?

  49. 2009 Benchmark Survey – Private Practice Findings New Patient Requirement to Have a Physician Referral Just over half (55%) of the participating rheumatologists require patients to have a physician referral. (n=186) (n=64) (n=52) (n=60) Q56. Do you require new patients to have a physician referral?

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