October 27, 2009 2:15 p.m. EST
ACHIEVING MORE COVERAGE
& BETTER QUALITY
FOR LESS COST
Demystifying the Anesthesia Stipend
October 27, 2009 2:15 p.m. EST
The Problem
October 27, 2009 2:15 p.m. EST
75%75% 66%66%75% of hospitals are experiencing an increase in surgery wait times
66% of hospitals are limiting access to operating rooms
Effects of the Rising Subsidy
2º anesthesia staffing issues--American Society of Anesthesiologists
October 27, 2009 2:15 p.m. EST
Effects of the Rising Subsidy
47% of hospital administrators are reducing or re-directing operating room procedures due to anesthesia staffing issues.
- ASA Hospital Study
October 27, 2009 2:15 p.m. EST
Why? Cost of Current Staffing Model
October 27, 2009 2:15 p.m. EST
Why? Salaries Above FMV
October 27, 2009 2:15 p.m. EST
Why Are Salaries Rising? Supply & Demand
October 27, 2009 2:15 p.m. EST
Why Are Salaries Rising? Supply & Demand
October 27, 2009 2:15 p.m. EST
The Anesthesia Supply/Demand Gap
Retirees Outnumber Graduates
Residents entering anesthesiology practice between 1990 and 2002 declined by 15%. – AMA
Practicing anesthesiologists AMA study of 30,000 Anesthesiologists:
Approx. 60% are age 45 or olderMore than 25% are 55 or olderOnly 12% are residents
Practicing CRNA Shortage is more than 5000 – US Dept. of Health
October 27, 2009 2:15 p.m. EST
Common Stipend Solutions
Scenario 1 – Pay more for same coveragePay doctors more
Provide more robust perquisites
Scenario 2 – Cut-back on coverageSacrifice efficiency, surgeon, nurse and patient satisfaction
Reducing or re-directing operating room procedures due to anesthesia staffing issues
Scenario 3 – Demand Anesthesia Cover its CostsAttract less qualified anesthetists
Sacrifice efficiency, surgeon, nurse and patient satisfaction
Scenario 4 – Make your problem someone else's problem Anesthesia is #1 outsourced service – Waller Landsen
October 27, 2009 2:15 p.m. EST
de-mys-ti-fy :-(verb) to rid of mystery or obscurity; clarify
www.somniainc.com
Anesthesia Subsidy TrendsExpected to Continue Growing
Resulting In:
Decreasing OR Coverage
Decreasing OR Revenue
Increasing Stipend
Dissatisfied:
Surgeons
Patients
Hospital Leaders
October 27, 2009 2:15 p.m. EST
de-mys-ti-fy :-(verb) to rid of mystery or obscurity; clarify
www.somniainc.com
Anesthesia Subsidy Solutions
Today’s Agenda:Lower Anesthesia ExpensesIncrease Anesthesia RevenueIncrease OR CoverageIncrease Surgeons, Patient & Leadership SatisfactionText Questions to be Answered at End of Presentation
October 27, 2009 2:15 p.m. EST
Dr. Marc E. KochDr. Marc E. Koch Dr. Larry SchecterDr. Larry Schecter
Co-Founder & CEO Somnia AnesthesiaNational Provider of Anesthesia Services Including Leadership, Recruiting, Revenue Cycle Mgmt., Payor Contracting & QAYale University School of Medicine: AnesthesiaFordham University: MBA
CMO Providence Regional Medical Center EverettMedical Degree from Hahnemann Medical College in Philadelphia and surgical training at UCLA and West Los Angeles Veterans HospitalFormer Medical Director of Santa Monica-UCLA Medical Center 30 year career as a General Surgeon in Santa Monica, CA
Presenters
October 27, 2009 2:15 p.m. EST
Dr. Marc E. KochDr. Marc E. Koch Dr. Larry SchecterDr. Larry Schecter
Strategies to
Reduce Your Subsidy & Increase Coverage
Managing the
Subsidy/Service
Balance
Presenters
October 27, 2009 2:15 p.m. EST
Presented By:
Dr. Larry Schecter
CMO
Providence Regional Medical Center Everett, WA
www.providence.org
Managing the Anesthesia Subsidy & Service Balance
Achieving Quality, Cost
& Satisfaction
October 27, 2009 2:15 p.m. EST
Background
#1 in Washington for cardiac and critical care, stroke, and general surgery.
www.providence.org
Providence Regional Medical Center Everett
Everett, Washington
372 Bed Acute Care Hospital
14 ORs
Approx 12,000 surgical cases/yr.
Approx 4000 OB deliveries
Cardiac, Thoracic, Vascular, Neurology, Ortho, Urology, General, ENT
Top 100 Hospital (Thomson/Reuters)
Distinguished Hospital for Clinical Excellence (4 yrs. Running)
October 27, 2009 2:15 p.m. EST
Achieving the Right Balance
October 27, 2009 2:15 p.m. EST
Achieving the Right Balance
Subsidy ExpectationsIn Synch with Hospital Goals
Formal QA Program to Prove Results
Professional Behavior
Active Citizens of Larger Organization
Service ExpectationsCoverage at or Near 100%
On-Time Starts
Quick Turnover
Avoidance of Pre & Post-Op Bottlenecks
Thorough Pre-Op Evaluation
October 27, 2009 2:15 p.m. EST
The Balanced Scorecard
October 27, 2009 2:15 p.m. EST
The Balanced Scorecard
QualityImportance of Quality Management Data
Anesthesia Company Should ProvideAlso Do it Yourself (the Anesthesia Scorecard)
CompatibilityFocused on Same Goals as HospitalCitizens of Larger Hospital CommunitySame Professionalism as Hospital Leadership
OtherCollective data for groupIndividual data by providerShould drive process improvement
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The Balanced Scorecard
Cost (Stipend)Compensation Competitive with Region based on FMV
Based on Performance Objectives
Not Based on Physician Salaries
October 27, 2009 2:15 p.m. EST
The Balanced Scorecard
Satisfaction100% Coverage
On-Time Starts
Pre-Op Interviews
Post-Op Examinations
Avoidance of Post-Op PONV
Meeting Attendance
Patient and Surgeon perception
October 27, 2009 2:15 p.m. EST
ADVICE: GET IT RIGHT THE FIRST TIME – YOU DON’T
WANT TO DO THIS TWICE.
The Challenge: Replace the Incumbent Group
October 27, 2009 2:15 p.m. EST
The Challenge:
Replace the Incumbent Anesthesia Group
The NeedsMore Robust Level of Service
Ability to Demonstrate Superior Quality Outcomes
Group Compatibility with Hospital
Work Collaboratively to Reduce the Subsidy
October 27, 2009 2:15 p.m. EST
The Challenge:
Replace the Incumbent Anesthesia Group
Timeline & TasksLess than 90 days to get a new solution in place
Understand & Define our Needs
Solicit RFPs
Interview Top Prospects
Negotiate Contract
Attract 30 clinicians in 30 days!!
October 27, 2009 2:15 p.m. EST
The Challenge:
Replace the Incumbent Anesthesia Group
The Early ResultsClinicians Successfully Recruited
Starting to See Competencies of Each Provider
Noticeable Dedication, Attitude, Behavior
Anesthesia Leadership both Local & National are Major Components of Successful Transition
Implementing MD/CRNA Mix Challenging but Rewarding
October 27, 2009 2:15 p.m. EST
The Challenge:
Prove Anesthesia Results
PRMCE’s Anesthesia Scorecard:OR Efficiency
Available ORs
Turn-Around Time
On-Time Starts
Obstetrics
C-Section Delays
Epidural Timeliness
Epidural Success
Quality & Citizenship
SCIP Standards
Meeting Attendance
Med Staff Participation
And Many More…
October 27, 2009 2:15 p.m. EST
Lessons Learned
Get as much information as possible prior to transition-Don’t hesitate to visit the OR!
Do It Right the First Time – Transitions are Tough on the Facility and Tough on Staff
Anticipate credentialing challenges
Expect attrition and turnover
Be Totally Honest With Your Customers
There is No Substitute for Being in the Trenches
“Hard Times Flush Out the Chumps”
October 27, 2009 2:15 p.m. EST
Strategies to Reduce Your Subsidy &
Increase Coverage
Presented by :
Dr. Marc E. Koch
Co-Founder and CEO of Somnia Anesthesia
www.somniainc.com
October 27, 2009 2:15 p.m. EST
Before Reducing Your Subsidy You Must First Understand It
October 27, 2009 2:15 p.m. EST
October 27, 2009 2:15 p.m. EST
Intervention possible but goals must be realistic. Deriving maximal value is
realistic. Low cost and high quality is magical.
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Define Quality Nexus
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Patient
• Unrushed /thorough Pre-Op• Attentive Post-Op • Avoidance of PONV • Limited Pain
• Physical• Financial
October 27, 2009 2:15 p.m. EST
Surgical Leadership
Surgeon-Centric Schedule ≠ “Efficient” Schedule
On-time Starts = Abundance of anesthesia staff
Quick Turnover = Abundance of anesthesia staff
Good working chemistry/trust
Additional Anesthesia Services
October 27, 2009 2:15 p.m. EST
Nursing Leadership
Surgeon-Centric Schedule
Support and assistance with challenging issues
Solve more headaches than they create
On-time Starts = Abundance of anesthesia staff
Quick Turnover = Abundance of anesthesia staff
Good working chemistry/trust
Additional Anesthesia Services
October 27, 2009 2:15 p.m. EST
Administrative Leadership
“Efficient” Schedule (Note: ≠ Surgeon-Centric Schedule)
Exploration of cost efficient staffing models
No Subsidy or Subsidy supports
FMV Compensation
FMV Benefits
Savvy contracting with payors, to a point
Stellar revenue management
Pro-growth mindset
October 27, 2009 2:15 p.m. EST
“Revenue”= Funds to Support Anesthesia Department
There are only 3 Sources of Funds
1. Patients
2. Insurance Companies
3. Facility (Stipends)
October 27, 2009 2:15 p.m. EST
Anesthesia “Revenue” from Patients
1. Patient mindset makes it a difficult line to walk
2. Surgeon alienation limits utility
3. Hard to count on
October 27, 2009 2:15 p.m. EST
Anesthesia “Revenue” from Payors
1. Out-of-network, a pyrrhic victory, since it interferes withHospital contractSurgeon Surgeon referral sources
2. In-network, battles can be wonMindful of co-insurance/deductible = from Patient Guile of payors: holdbacks, abrupt policy shiftsOptimal rates requires out-of-network intermediate step Stomach of hospital CFO predicates success
October 27, 2009 2:15 p.m. EST
Indigenous Anesthesia “Revenue”
Nuts and Bolts• Compliantly obtain unit rates • Define sources of revenue (OP, IP, OB, GI, Lines, Etc.)
• Define units by revenue source
• Define reimbursement by unit
• Calculate revenue by payor
• Calculate net collections from gross revenue
October 27, 2009 2:15 p.m. EST
INPATIENT CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR ACUTE PAIN REVENUE CASES % PATIENTS UNITS CASE RATE REV/PAYORAETNA 18 0.83% 229 $89.21 $20,428BLUE CROSS 297 13.67% 4,746 $65.30 $309,910 AETNA 6 0.94% $357.67 $2,146CDPHP 552 25.40% 8,392 $36.32 $304,760 BLUE CROSS 91 14.33% $145.47 $13,238CIGNA 9 0.41% 142 $89.67 $12,733 CDPHP 164 25.83% $100.15 $16,425COMMERCIAL 65 2.99% 1,032 $54.84 $56,599 CIGNA 6 0.94% $326.83 $1,961MEDICARE 756 34.79% 11,580 $19.00 $105,746 COMMERCIAL 21 3.31% $279.19 $5,863MEDICAID 129 5.94% 1,606 $14.13 $22,685 MEDICARE 264 41.57% $32.59 $8,603MVP 102 4.69% 1,668 $73.12 $121,962 MEDICAID 8 1.26% $35.38 $283SELF PAY 9 0.41% 162 $32.53 $5,270 MVP 22 3.46% $330.32 $7,267UH 101 4.65% 1,597 $96.96 $154,850 UH 27 4.25% $220.85 $5,963WC/NF 135 6.21% 2,499 $25.07 $62,647 WC/NF 26 4.09% $127.77 $3,322
TOTAL 2,173 100.00% 33,653 $34.99 $1,177,590 TOTAL 635 100.00% $102.47 $65,071
OUTPATIENT CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR Lines CASES % OF PATIENTS UNITS CASE RATE REV/PAYORAETNA 34 1.03% 342 $87.35 $29,875BLUE CROSS 694 21.09% 6,980 $54.38 $379,589 AETNA 1 1.19% $106.00 $106CDPHP 1,001 30.43% 9,761 $36.56 $356,854 BLUE CROSS 11 13.10% $96.36 $1,060CIGNA 15 0.46% 159 $97.31 $15,473 CDPHP 34 40.48% $76.85 $2,613COMMERCIAL 141 4.29% 1,396 $49.73 $69,420 CIGNA - 0.00% $0MEDICARE 694 21.09% 7,446 $19.00 $68,221 COMMERCIAL 3 3.57% $56.33 $169MEDICAID 182 5.53% 1,681 $30.20 $50,768 MEDICARE 24 28.57% $29.04 $697MVP 193 5.87% 1,916 $104.78 $200,759 MEDICAID 4 4.76% $25.00 $100SELF PAY 29 0.88% 232 $47.62 $11,047 MVP 3 3.57% $241.67 $725UH 226 6.87% 2,236 $84.62 $189,217 UH 2 2.38% $61.00 $122WC/NF 81 2.46% 904 $23.61 $21,340 WC/NF 2 2.38% $54.00 $108
TOTAL 3,290 100.00% 33,053 $42.13 $1,392,563 TOTAL 84 100.00% $67.86 $5,70010.0
OB REVENUE CASES % OF PATIENTS UNITS UNIT RATE REV/PAYOR GASTRO REVENUE CASES % OF PATIENTS UNITS UNIT RATE REV/PAYORAETNA 5 1.12% 136 $99.40 $13,518BLUE CROSS 92 20.67% 2,060 $62.43 $128,598 AETNA 1 1.12% 7 $102.86 $720CDPHP 209 46.97% 4,717 $42.88 $202,281 BLUE CROSS 16 17.98% 124 $65.00 $6,383CIGNA 2 0.45% 44 $74.80 $3,291 CDPHP 26 29.21% 208 $32.98 $6,860COMMERCIAL 20 4.49% 406 $72.65 $29,495 CIGNA 1 1.12% 8 $18.25 $146MEDICARE 6 1.35% 221 $19.00 $4,199 COMMERCIAL 2 2.25% 16 $28.88 $462MEDICAID 69 15.51% 1,229 $16.70 $20,528 MEDICARE 31 34.83% 258 $19.00 $4,602MVP 24 5.39% 463 $71.75 $33,219 MEDICAID 3 3.37% 23 $10.00 $230UH 18 4.04% 401 $78.29 $31,393 MVP 4 4.49% 38 $59.74 $2,270WC/NF - 0.00% - $0.00 $0 UH 5 5.62% 40 $87.63 $3,505
TOTAL 445 100.00% 9,677 $48.21 $466,522 TOTAL 89 100.00% 722 $25,178
$3,132,624$2,975,993
Total projected revenue Net Collections (95% of gross)
Identification and Quantification of Revenue SourcesInpatient assumes 13-15 Units per Case Outpatient assumes 9-11 Units per CaseGI Endo assumes 7-9 Units per Case
OB assumes 15-20 Units per CaseAcute Pain and Lines are $ per case
October 27, 2009 2:15 p.m. EST
Revenue Augmentation Intervention
1. Sources of RevenueConversion of local cases to sedationCover GICover pediatric radiology
2. Calculate net collections from gross revenueConfirm historical figures benchmark to MGMA
Days AR0-30 Days AR Bucket30-60 Days AR Bucket60-90 Days AR Bucket90-120 Days AR Bucket>120 Days AR Bucket
Ensure actual verses contracted payments syncScanning, rapid charge entry, rapid coding, e-submissions, robust billing system, audits
October 27, 2009 2:15 p.m. EST
“Expenses”= Costs to Run an Anesthesia Department
There are 2 Buckets of Expenses1. Direct Expenses
Clinical Staff, Equipment, Supplies 2. Indirect Expenses = Management Costs
Technology: Telephony, computers, servers, software (i.e. Billing System)
Credentialing with Payors and Hospital Payroll & Benefits Administration Scheduling Revenue Management and Collections Quality Assurance ProgramRisk Management LegalAccounting
October 27, 2009 2:15 p.m. EST
Anesthesia Staffing (Direct) Expense: Nuts and Bolts
Management Fee 25% 1,316,214$ Total Direct & Indirect Expense 10,090,973$ Revenue 6,612,163$ Shortfall/Surplus (3,478,809)$ Shortfall per month (289,901)$
Coverage by hoursOR 1 OR 2 OR 3 OR 4 Float MD OB
Monday ‐MD 8 24Monday ‐ CRNA 12 12 10 8 24Tuesday ‐MD 8 24Tuesday ‐ CRNA 12 12 10 8 24Wednesday ‐MD 8 24Wednesday ‐ CRNA 12 12 10 8 24Thursday ‐MD 8 24Thursday ‐ CRNA 12 12 10 8 24Friday ‐MD 8 24Friday ‐ CRNA 12 12 10 8 24Saturday ‐MD 24Sunday ‐MD 24Total Hours ‐MD 40 168Total Hours ‐ CRNA 60 60 50 40 120Number of MD hours per week 376Number of MD hours per year 19,552Number of CRNA hours per week 330Number of OB hours per year 17,160
MD CRNAOR, Endo & OB CoverageTotal Hours (week) 526 630Total Hours (year) 27,352 32,760Per FTE Hours/Week 54 40Per FTE Hours/Year 2808 2080Required to cover OR 9.7 15.8Required to cover vacations 2.0 2.0Chief MD (incl as float)Site Director (incl as float) Total MD and CRNA on Staff 12 18Compensation 421,801$ 190,000$
Cost of OR Coverage 4,952,259$ 3,372,500$ Subspecialty Stipend ‐$ Chief of Anesthesia Stipend 100,000$ Vice Chief 50,000$ OB/Cardiac/Peds Stipends 50,000$ Administrative Costs 250,000$ Coverage Cost 5,402,259$ 3,372,500$ Total staffing expenses
24
General Hospital‐ In Patients and OB
Total Coverage Cost
24
2424
8,774,759$
24
24
24
Model with Expenses
168
2. Define staffing model & MD‐CRNAincluding ratios, break folks, etc
1. Define rooms & hours of coverage
3. Sum hours of work for MD and CRNA
4. Based on # of hours work per FTE calculate headcount
6. Add‐in premiums (Chief, directors, subspecialists, beeper call, etc.)
5. Calculate compensation per clinician
October 27, 2009 2:15 p.m. EST
Survey Title: Midwest (US)Market - Northeast US (NY)Data Effective Date
25%ile 50%ile 75%ile Age Data Geograph Total 50% Median 25% 50% 75%Base $ Base $ Base $ Jul-09 Adjust. Base Comp. Incentive Total comp Total Comp. Total Comp.
Economic Research Institute Data 07/09 $223,386 $250,447 $285,571 100.00% 100.00% $250,447 $17,426 $248,785 $267,873 $415,421Anesthesiologist: DesMoines
Sullivan Cotter Physician Survey Data 03/08 $220,000 $259,000 $302,306 106.67% 101.00% $279,029 $65,357 $262,412 $344,386 $455,534Anesthesiology Staff Physician MidWest US
Sullivan Cotter Physician Survey 03/08 $234,662 $296,341 $349,100 106.67% 103.00% $325,580 $61,990 $284,691 $387,570 $501,545Anesthesiology Staff MD US Group Practice
Medical Group Mgt Assoc (MGMA) 01/08 $295,912 $364,758 $436,505 107.50% 103.00% $403,878 $327,649 $403,878 $483,320Anesthesiology: All Orgsm US Group Practice
Hospital & Healthcare Comp Svc (HHCS) Data 04/08 $269,000 $306,407 $390,000 106.25% 103.00% $335,324 $294,387 $335,324 $426,806Physician Survey: Anesthesiologist : Group Practice
Hospital & Healthcare Comp Svc (HHCS) Data 04/08 $237,844 $265,160 $313,425 104.58% 101.00% $280,086 $251,233 $280,086 $331,068Physician Survey: Anesthesiologist : All Groups
AAMC Data 06/07 $250,000 $296,250 $341,250 110.42% 103.00% $336,923 $284,323 $336,923 $388,101Clinical Science: Anesthesiology All Orgs
Averaged Results $247,258 $291,195 $345,451 106% 102% $315,895 $48,258 $315,623 $364,153 $421,801
INCENTIVE COMPENSATION Surveyed Data Adjustments
BASE SALARY
“Direct Expense” = Mostly Science …
October 27, 2009 2:15 p.m. EST
“Direct Expense” = Some Art…
Aging DataLarge escalations
Local supply and demand idiosyncrasies
Regional COL variations run counter to compensation
Accounting for job stress, case volume, call stress, etc.
October 27, 2009 2:15 p.m. EST
“Direct Expense”: Interventions to Lower
• Sophisticated determination of fair market value salary
• Sophisticated determination of fair market value benefits
• Explore alternative staffing models
October 27, 2009 2:15 p.m. EST
Lower Expenses: Staffing Model Options
October 27, 2009 2:15 p.m. EST
Lower Expenses: Staffing Model Options
October 27, 2009 2:15 p.m. EST
Direct Expense Management
Various Models to Cover 4 ORs
Model MD CRNA Rooms Covered Hands on Deck Gross $ Cost/Room
MD Only 4 0 4 4 people 1,600,000 400,000
CRNA Only 0 4 4 4 people 800,000 200,000
MD/CRNA 1 4 4 5 people 1,200,000 300,000
The CRNA Only model provides lowest cost per room. • Liability and Revenue Management Issues
The MD/CRNA model provides second lowest cost per room. • Avoids Liability or Revenue Management Issues
October 27, 2009 2:15 p.m. EST
“Indirect Expenses”= Costs to Run an Anesthesia Department
Technology: Telephony, computers, servers, software (i.e. Billing System)
Credentialing with Payors and Hospital Payroll & Benefits Administration Scheduling Revenue Management and Collections Quality Assurance ProgramRisk Management LegalAccounting Insurances
October 27, 2009 2:15 p.m. EST
Source: American Hospital Association, 2005
Percent of Revenue Allocated to Administration Functions
26.7%
13.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Percen
t of Reven
ue
Physician Groups
Total Administrative Costs Billing and Insurance Related Costs
“Indirect Expenses”=Costs to Run an Anesthesia Department
October 27, 2009 2:15 p.m. EST
The average medical practice spends between 14 and 25% on administrative costs. Working with larger entities permits economies of scale and economies of scope and can drive down costs. Larger entities have access to the most effective technology and highly sophisticated human resources.
Indirect Expense Intervention
October 27, 2009 2:15 p.m. EST
Review: The Anatomy of a Subsidy
Revenue - Expenses = Subsidy
• Patients
• Payors
• Clinicians • Management
• Fixed Amount• Revenue Threshold • Case/Payor Mix Guarantee• Cost Plus
October 27, 2009 2:15 p.m. EST
Subsidy Forms
Fixed AmountHospital defers revenue/expense risk and reward
If sum proves insufficient, is insolvency an option?
Revenue Threshold Hospital on the hook for group’s billing
Due diligence on revenue management and contracting required
Contemplate bonus schedule to align interests
Case/Payor Mix GuaranteeHard to quantify impact of payor mix drift
Case guarantee relatively easy to quantify
Hospital avoids revenue management risk
Cost PlusHospital retains all revenue/expense risk and reward
Bonus schedule critical to align interests
October 27, 2009 2:15 p.m. EST
Review: Interventions to Reduce Subsidy
Revenue - Expenses-Savvy Payor Contracting
-Pristine Revenue Management
-Leveraging technology
-Sophisticated compensation analysis
-Ensuring FMV salary and benefits
-Deploying cost-efficient staffing models
-Leveraging technology
SOUND ADMINISTRATION
October 27, 2009 2:15 p.m. EST
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
# of
Gra
duat
es
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
YoY
% G
row
th
Is There Relief on the Horizon?
Growth in Number of New Anesthesia Graduates
October 27, 2009 2:15 p.m. EST
33% 31% 29% 27% 25%
49% 49% 50% 50% 50%
18% 20% 21% 23% 25%
0%
20%
40%
60%
80%
100%
2001 2002 2003 2004 2005
CRNA's Anesthesiologists Unfilled Demand
The Data is Not Encouraging…Note the unfilled demand
October 27, 2009 2:15 p.m. EST
Closing Remarks: Defining Victory
Deriving the most value per dollar spentClinicians are paid a fair day’s wage for fair day’s work
Fair benefits
Obtaining a robust quality management program
Making sure that all potential revenue is capturedAll revenue streams explored
Contracts with payors are optimized
Revenue management is smooth, efficient and error-free
October 27, 2009 2:15 p.m. EST
Questions
Marc E. Koch, MD MBASomnia President and Chief Executive Officer
877-476-6642 www.somniainc.com
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