2020 AMGA Medical Group
Transcript of 2020 AMGA Medical Group
©2020 AMGA Consulting, LLC. All rights reserved.
2020 AMGA Medical Group Operations and Finance Survey Overview
October 28, 2020
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Speaker Introduction
Kelsi O’Brien is a Director with AMGA Consulting. Her areas of expertise includecompensation plan design, operations optimization and improvement, changemanagement and provider utilization. Mrs. O’Brien has been in health careconsulting for over 6 years. Prior to consulting she held a Director level position witha major academic medical center for 4 years. [email protected]
Rose Wagner is Chief Operating Officer with AMGA Consulting. Rose possessesstrategic and tactical expertise that results in successful financial, operational andclinical outcomes. She is a collaborative leader and applies this style working withcomplex teams of internal and external stakeholders. With more than 25 years ofexperience working inside both private practice and integrated delivery systems,Rose has honed keen analytic skills to assess, develop and implement plans to meetan organization’s desired outcomes. [email protected]
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Objectives
• Discuss market insights
• Share the evolution of the survey
• Provide an overview of the participants and survey content
• Highlight key examples from the report
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Market Insights
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COVID-19
COMPENSATION
NET REVENUE
REGULATORY
• Unknown long-term implications
• Continues to rise
• Continues to decline
• Potential change in E/M Codes
Industry Pressures
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Medical Group Cost Structure
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Survey Areas of Focus
01
06 03
02
0405
Patient Access
Provider Staffing
Complement
Revenue and
Expenses
Clinic Staffing
Operational Overhead
Revenue Cycle
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Survey Evolution
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2
3
4
5 2020
2008-2012• Embedded in the AMGA Compensation and Productivity Survey
• Data included revenue, provider salary, support department staffing and
operational expenses
2013• Greater granularity in operational support staff department
• Increase in the overall financial indicators at the
organization level
2016• First year produced as a stand-alone book.
• Added clinic hours, scheduling capacity and scribe usage
• Financial portion of the survey report streamlined to
mirror a standard P&L statement
2019• Data reported at the per provider level due to
increased utilization of APPs
• Additional revenue cycle and access metrics
provided
• Expanded operational support departments, clinic
staffing roles and financial information
• Transition to online platform
• Addition of telehealth prevalence questions
• Added patients visits as an additional volume measure
An Evolving Resource
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2020 Key Survey Changes
• Clarifications to medical group/organization structure
• Enhanced revenue cycle metrics
• Expanded call center benchmarks
• Updated operational support department data
• Consolidated clinic level staffing and expense data
• Largest survey response to date
• Online reporting platform
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Survey Details
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Total
providers
represented:
XX,XXX
Custom data reports may be requested (sample size dependent):
-Regional -Academic -Group-size -Additional percentiles
3,371
Clinic Sites
Represented
2020 Overview
Survey data can be purchased online at http://www.amga.org/
+20,000
Providers
Represented
608
Median FTE
Providers –
System
Affiliated
65
Specialties
8
Roll-up
Specialties
177
Median FTE
Providers –
Independent
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2020 AMGA Finance and Operations Metrics
Survey Data
• Access information• Revenue cycle metrics• Operational support
staffing• Clinic staffing• Clinic expenses
Data Cuts
• Per physician• Per provider• Per 10,000 wRVUs• Per 5,000 visits
Data Groups
• Median percentiles• Independent practices
and system affiliated
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Survey Participants
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Access
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SCHEDULING
VISIT MIX
PANEL SIZE
EMERGING TRENDS
• Patient Contact Hours
• No-Show Rate
• Fill Rate
• Established vs. New
• Physician and APP
• Primary Care and Specialty Care
• APP
• Physician
• Methodology
• Scribe Utilization
• Virtual / Telehealth Visits
Access Metrics
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Scheduling
Schedule Fill Rate by Organization Type and Specialty Type
All GroupsSystem
Affiliated Independent
Specialty Type Median Median Median
Primary Care 85.1% 85.1% 82.0%
Medical Specialties 86.9% 82.6% 86.9%
Surgical Specialties 84.1% 83.5% 75.0%
No Show Rate by Organization Type and Specialty Type
All GroupsSystem
Affiliated Independent
Specialty Type Median Median Median
Primary Care 5.0% 5.5% 5.0%
Medical Specialties 6.5% 7.0% 5.0%
Surgical Specialties 5.9% 6.2% 3.0%
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Contact Hours and ShiftsPatient Contact Hours per Week
Specialty Type Median
Primary Care 36.0
Medical Specialties 36.0
Surgical Specialties 36.0
Hours per Shift
Specialty Type Median
Urgent Care 12.0
Hospitalists 12.0
Emergency Medicine 12.0
Shifts per Month
Specialty Type Median
Urgent Care 14.0
Hospitalists 15.0
Emergency Medicine 13.0
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Visit Mix
Primary Care: Physicians Primary Care: APPsOther Specialties:
PhysiciansOther Specialties: APPs
Established Patient Visits 90.5% 92.2% 75.4% 78.2%
New Patient Visits 5.8% 7.5% 13.4% 10.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Patient Visit Mix - Median
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Panel InformationPrimary Care Panel Size
Median Average
Physicians 1,600 1,586
APPs 756 832
Yes61%
No39%
APP Independent Panel
Yes36%
No64%
Panel Size Risk Adjusted
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Scribe Utilization
Scribe Utilization by Specialty Type
Specialty Type
Median Percent of Providers Using
Scribes
Primary Care 9%
Medical Specialties 10%
Surgical Specialties 13%
72%
28%
Yes
No
0% 50% 100%
Percent of Groups Utilizing Scribes
74%
4%
22%
Scribe Location
Onsite
Virtual
Both
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APP to Physician Ratios
0.56
0.65 0.660.63
0.71
0.57
Primary Care Medical Specialties Surgical Specialties
APP to Physician - Specialty Type
2018 2019
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Revenue Cycle
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Revenue Cycle Metrics
CLAIMS
CBO RESOURCES
BAD DEBT
• Lag Time: Date of Service to Submittal
• Coding Lag
• Staff Types
• Per Provider FTE
• All Groups, Integrated and Independent
• Organization Type
• % of Gross and Net Revenue
DAYS IN A/R • 30, 60, 90 and 120 Day Metrics
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Outsourced Revenue Cycle
0%
8%
10%
12%
15%
20%
25%
15%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Revenue Cycle Management/Leadership
Professional Coding
Payment Posting/RefundProcessing /Cashier
Accounts Receivable/Account Follow-Up
Customer Service (post-visit)
Collections /Delinquent Accounts
Other business office functions(exclude front-end functions such as scheduling…
All Business Office Functions
Percent of Groups with Outsourced Business Office Functions
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Days in A/R
Aged A/R as a Percent of Total Billed A/R – ALL GROUPS
Gross Dollars Net Dollars
ALL Median Median
Current to 30 days 55% 60%
31 to 60 days 13% 13%
61 to 90 days 8% 7%
91 to 120 days 5% 5%
Over 120 days 15% 11%
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Revenue Cycle: CBO Staffing Resources
Median Business Office Staffing
Per Physician Per Provider Per 10,000 wRVUs
Revenue Cycle Management/Leadership 0.04 0.03 0.07
Professional Coding 0.11 0.07 0.21
Accounts Receivable/ Account Follow-Up 0.13 0.09 0.22
Payment Posting/Refund Processing /Cashier 0.06 0.05 0.22
Customer Service (post-visit) 0.06 0.04 0.16
Other business Office Functions 0.08 0.06 0.16
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Operational Support Staffing
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Operational Support Department Staffing
FTE, Salary and Benefits information was captured for the following operational overhead departments per physician and per provider:
General Accounting/FinanceInformation Technology/ EHRsManaged Care ContractingQuality/Patient Safety/RiskPI/Department of ExcellenceCare CoordinatorsPopulation HealthOperational Leadership/AdministrationHuman Resources
Facilities ManagementPurchasing and MaterialsMarketing and Public RelationsStrategy and PlanningExecutive TeamPhysician LeadershipChairs/Medical DirectorsCBO/Patient Accounting
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Operational Support Department Staffing:By Department
Total Support Department FTEs per Provider FTE by Group
All Groups
Operational Categories Median
General Accounting / Finance 0.03
Information Technology/Electronic Health Records (EHR) 0.08
Managed Care Contracting 0.02
Quality / Patient Safety /Risk 0.02
Process Improvement / Department of Excellence 0.01
Care Coordinators 0.07
Population Health 0.02
Operational Leadership/Administration 0.12
Central Business Office /Patient Accounting 0.30
Human Resources 0.04
Facilities Management 0.03
Purchasing and Materials Management 0.01
Marketing and Public Relations 0.01
Strategy and Planning 0.01
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Clinic Staffing
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Clinic Staffing
• Survey report contains multiple iterations of the clinic staffing details:
– Per physician
– Per provider
– Per 10,000 wRVUs
– Per 5,000 visits
• Additional views:
– By organization type
– By specialty type
– By specialty
Clinical Staffing Positions
Registered Nurses
Licensed Practical Nurses
Medical Assistants/Nurses Aides
Radiology/Imaging Staff
Laboratory Staff
Pharmacy Staff
Dietician/Nutritionist
Behavioral Health/Social Work
Referral Coordinator
Medical Receptionist
Clinic Call Center Staff
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Clinic Staffing: Per PhysicianAll Groups System Affiliated Independent
Staffing Per Physician by Organization Type Median Median Median
Total Clinical Support/Direct Patient Care Staff 1.95 1.92 2.02
Registered Nurses 0.58 0.57 0.66
Licensed Practical Nurses 0.55 0.53 0.89
Medical Assistants/Nurses Aides 1.29 1.30 1.12
Radiology/Imaging Staff 0.43 0.40 0.61
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Clinic Staffing: Per PhysicianAll Groups System Affiliated Independent
Staffing Per Physician by Organization Type Median Median Median
Total Clinical Support/Direct Patient Care Staff 1.95 1.92 2.02
Registered Nurses 0.58 0.57 0.66
Licensed Practical Nurses 0.55 0.53 0.89
Medical Assistants/Nurses Aides 1.29 1.30 1.12
Radiology/Imaging Staff 0.43 0.40 0.61
Primary Care Medical Specialties Surgical Specialties
Staffing Per Physician by Specialty Type Median Median Median
Total Clinical Support/Direct Patient Care Staff 2.24 1.83 1.50
Registered Nurses 0.49 0.73 0.62
Licensed Practical Nurses 0.67 0.50 0.49
Medical Assistants/Nurses Aides 1.57 1.16 1.00
Radiology/Imaging Staff 0.35 0.89 0.35
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Clinic Staffing: Per PhysicianAll Groups System Affiliated Independent
Staffing Per Physician by Organization Type Median Median Median
Total Clinical Support/Direct Patient Care Staff 1.95 1.92 2.02
Registered Nurses 0.58 0.57 0.66
Licensed Practical Nurses 0.55 0.53 0.89
Medical Assistants/Nurses Aides 1.29 1.30 1.12
Radiology/Imaging Staff 0.43 0.40 0.61
Primary Care Medical Specialties Surgical Specialties
Staffing Per Physician by Specialty Type Median Median Median
Total Clinical Support/Direct Patient Care Staff 2.24 1.83 1.50
Registered Nurses 0.49 0.73 0.62
Licensed Practical Nurses 0.67 0.50 0.49
Medical Assistants/Nurses Aides 1.57 1.16 1.00
Radiology/Imaging Staff 0.35 0.89 0.35
Staffing Per Physician by Specialty
Registered NursesLicensed Practical
Nurses
Medical Assistants/Nurses
AidesRadiology/ Imaging
Staff
Primary Care
Family Medicine 0.64 0.69 1.71 0.44
Internal Medicine 0.50 0.67 1.57 0.33
Pediatrics and Adolescent – General 0.62 0.34 1.12 ***
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Financial Information
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Financial Information
Gross and Net Revenue
Operating Expenses
Provider Salaries and
Benefits
Staff Salaries and Benefits
Bottom Line Performance
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Financial Information: Per 10,000 wRVUsOverall Financial Summary per 10,000 wRVUs: All Groups
Financial Indicator Median
Gross Revenue
Professional Revenue $1,739,420
Ancillary Revenue $309,610
Other Medical Revenue $9,823
Total Gross Revenue $1,750,457
Net Revenue
Professional Revenue $820,152
Ancillary $71,947
Other Medical Revenue $44,352
Total Net Revenue $856,978
Non-Medical Revenue $7,573
Provider Salaries
Physician Salaries $506,922
Locum Expense $29,326
APP Salaries $100,758
Provider Benefits
Physician Benefits Expense $68,396
APP Benefits Expense $21,106
Total Provider Salaries and Benefits $652,074
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Financial Information: Per 10,000 wRVUs
Overall Financial Summary per 10,000 wRVUs: All Groups
Financial Indicator Median
Operating Expenses
Drug Supply $43,139
Medical And Surgical Supply $11,490
Radiology/Imaging Expense $635
Laboratory Expense $4,060
Other Ancillary Expense $1,387
Building And Occupancy $61,589
Building Depreciation Expense $7,969
Professional Liability Insurance Expense $10,581
Other Insurance Expense $7,394
Information Technology Services Expense $3,199
Furniture And Equipment Expense $1,690
Furniture And Equipment Depreciation Expense $4,307
Administrative Supplies and Services $3,739
Marketing Expense $559
Purchased Services $21,305
Other Expenses $19,979
Total Operating Expenses $197,856
Non-Medical Expense $9,335
Overall Financial Summary per 10,000 wRVUs: All Groups
Financial Indicator Median
Total Revenue $872,137
Total Expense $1,112,282
Profit/Loss (Before Allocations) -$168,999
Totals With System Overhead Allocations
System Overhead Allocations $166,243
Total Profit/Loss (After Allocations) -$244,381
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Online Survey Platform
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Online Survey Platform
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Questions?
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AMGA Consulting Services
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Rose Wagner, Chief Operating OfficerAMGA Consulting
[email protected](913) 660-8234
William Holets, Director AMGA Consulting
[email protected](651) 402-8958