2004 MGMA OF GREATER ST. LOUIS SALARY SURVEY

Curt Mayse & Sharon Cardwell

LarsonAllen Health Care Group

August 17th, 2004

Learning Objectives

• Purpose for the survey

• What were some of the “pearls” of the process

Why is this information important?

• Offer competitive salaries and benefits to attract and retain quality employees

• Comparability to other groups

• Specific job/position break down

Background of Process

• Survey distributed to all members – 105 groups

• Survey was conducted on-line for the first time

• It took about an hour or less to complete

• 69% response rate

• 72 surveys considered valid

Background of Process (continued)

• 654 physicians were represented

• Nearly 2,500 employees were represented

• 82% from independent groups

Respondents by Type of Affiliation

Primary Affiliation Indiv idual

hospital affiliated

4%

Other medical

1%

System affiliated

6%

University

affiliated

6%

Independent

82%

Insurance

affiliated

1%

Respondents by Practice Size

Practice Size

13.89%

9.72%

4.17%

37.50%

34.72%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

< 3 3 - 5 6 - 10 11 - 20 20 +

Respondents by Practice Type

Practice Type Specialty (with

primary care)

10%Multi-specialty

(but

predominantly

primary care)

7%

Multi-specialty

(predominantly

specialty care)

4%Multi-specialty

only

4%

Single

specialty only

35%

Single

specialty

(without

primary care)

40%

National Salary Trends

• The average clinical and clerical workers’ pay rose modestly in 2003 nationwide

• Managers’ pay rose only slightly--the smallest gains seen in several years

• Managers in the Northeast make more than those in other areas of the country

• Managers in the Midwest make a little more than the national average ($51,991 vs. $51,707)

According to PAHCOM (Professional Association of Health Care Office Management)

Local Trends

• Average salaries rose by 3% overall from 2003

• Biggest increases:– Lab Technicians - Certified 14.4%– RNs Specialty - Certified 10.5%– Nurse Practitioners - 10.2%– Referral / Managed Care Coordinators - 8.7%– X-Ray Technicians - 7.8%– Receptionists - 6.8%– Patient Accounts Rep. / Collections - 5.2%

Local Trends (continued)

• Biggest decreases:– Office Manager - 16.2% *– Information Systems Technician - 12%– Surgical Technician - 8.7%

NOTE - New category of Administrator most likely affected the Office Manager difference from last year

How Salary Increases are Determined?

Salary Increases

Other 2.86%

General 8.57%

Cost of Living 18.57%

Merit 70.00%

When are Salary Increases Given?

Salary Increase Timing

Calendar Year

25.00%

Fiscal Year

12.50%

Other 15.28%

Employee's

Anniversary

Date 47.22%

How Often is Salary Reviewed?

How Often is Salary Reviewed?

Semi-Annually 1.39%

Other 4.17%

Quarterly 2.78%

Annually 91.67%

Average Salary Increases 2003-2004

Average Salary Increase

0.00%

6.45%

17.74%

53.23%

22.58%18.46%

3.08%

9.23%

43.08%

26.15%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

< 1.99% 2.00 -2.99%

3.00 -3.99%

4.00 -4.99%

5.00%+

2003

2004

Reviews at Time of Salary Increase

Reviews at Same Time of Salary Increase

Yes

75.00%

No

25.00%

Bonuses

• Annual bonuses – 66% provided some sort of staffing bonuses

• Criteria for bonuses based on:– work performance– longevity– profitability of practice– physician’s discretion

Bonuses by Practice Size

Employers Offering Bonuses by Practice Size

80.00%

68.75%

87.50%

57.14% 60.00%

50.00%

37.50%

71.43%

61.54%56.25%

50.00%53.85%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

$1 MM-$2 MM $2 MM-$3.5 MM $3.5 MM-$5 MM $5 MM-$10 MM <$1 MM >$10 MM

Administrator Staff

Bonus Determination

How Are Bonuses Determined?

7.69% 6.15%

49.23%

21.54%

0.00%1.54%

13.85%

66.67%

0.00%

22.22%

0.00%0.00%0.00%

11.11%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Discretionary % of

productiv ity

and/or

physician

income

Percentage of

organization's

net profit

Other formula

bonus

Deferred

compensation

Combination

of all factors

Other

Administrator Other Staff

Impact to Groups of Various Sizes

• Physicians who have higher profitability, pay more (i.e. surgeons and invasive specialists)

• Type and range of benefits offered is typically determined by group size

Salary vs. Benefits (what’s expected)

• Office Managers in the Midwest have received more-generous benefits packages than those in other sections of the country

• Many practices switching to PTO (paid time off) for increased flexibility for workers

• PTO Days– National Average 24 Days– St. Louis (2003) 23 Days– St. Louis (2004) 25 Days

PTO Days by Years Employed

Average PTO Days by Years of Employment

20.40

25.2428.08 29.37 30.01 30.04

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

<5 Years 5-10 years 10-15years

15-20years

20-25years

>25 years

What is Considered Full Time?

Determination of Hours for Full-Time Employee

35 - 40 Hours

86%30 - 34 Hours

13%

25 - 29 Hours

1%

Positions Surveyed

• Switchboard/Telephone Operator• Receptionist• Medical Secretary• Transcriptionist• Medical Records Clerk• Medical Records Supervisor• File Clerk • Medical Assistant (Certified) • Medical Assistant (Not Certified) • Lab Technician (Certified)• Lab Technician (Not Certified)• Phlebotomist Lead/Chief X-Ray Technician• X-Ray Technician• Ultrasound Technician• Surgical Technician• Licensed Practical Nurse• Registered Nurse• Registered Nurse (Specialty Certified)

• Nurse Practitioner• Clinical Supervisor• Physician Assistant• Physical Therapist• Information Systems Technician • Office Manager• Administrator• Assistant Administrator (Assistant Office

Manager) • Business Office Manager• Accounts Payable• Administrative Assistant• Referral/Managed Care Coordinator• Billing Clerk• Coder/Analyst (Certified)• Coder/Analyst (Not Certified)• Patient Accounts Rep/Collections

Sample Salary Page

CategoryLow

SalaryAverage

SalaryHigh

SalaryFTE's

Average Years of Service

Average Years of Education

All Practices $20,821 $25,064 $29,494

$10.01 $12.05 $14.18

Under $1MM $19,822 $23,504 $28,954

$9.53 $11.30 $13.92

$1MM to $2MM $21,570 $24,648 $30,950

$10.37 $11.85 $14.88

$2MM to $3.5MM $21,154 $25,709 $28,246

$10.17 $12.36 $13.58

$3.5MM to $5MM $20,301 $25,002 $28,933

$9.76 $12.02 $13.91

$5MM to $10MM $33,280 $40,560 $36,920

$16.00 $19.50 $17.75

Over $10MM $18,179 $23,650 $29,141

$8.74 $11.37 $14.01

1.20

*

2.00

1.65

4.00

1.50

1.75

3.47

2.00

14.27

5.20

5.86

7.47

4.64

3.86

1.00

2.75

6.83

1.35

3.45

14.49

Medical Assistant (certified)Assists physicians and nursing personnel in care of patients; may put patients in

exam rooms, chart vital signs and prepare for examinations; also may stock and clean exam rooms and instruments.

By Revenue Type

Sample Salary Page (continued)

CategoryLow

SalaryAverage

SalaryHigh

SalaryFTE's

Average Years of Service

Average Years of Education

All Practices $20,821 $25,064 $29,494$10.01 $12.05 $14.18

Multi Specialty $21,112 $26,083 $30,950(but predominantly primary care) $10.15 $12.54 $14.88Multi Specialty $18,574 $23,837 $29,037(predominantly specialty care) $8.93 $11.46 $13.96Multi Specialty Only $17,888 $22,235 $27,664

$8.60 $10.69 $13.30Single specialty $21,216 $24,586 $28,829(with primary care) $10.20 $11.82 $13.86Single Specialty $20,842 $25,106 $29,099(without primary care) $10.02 $12.07 $13.99Specialty $22,485 $26,915 $32,344(with primary care) $10.81 $12.94 $15.55

1.96 4.75 *

3.40 4.50 1.50

3.78 6.14 1.86

3.50 2.25 1.50

3.00 2.33 1.50

6.83 5.20 1.65

36.28 15.00 1.50

* Insufficient ResponsesNOTE: Low, average and high salary amounts are compiled from survey responses and each category is then averaged. If a respondent did not respond to all data elements, no adjustment was made and data may appear to be inconsistent in some instances (e.g., average salaries may be lower than low salaries).

Sample Average Salaries

• Receptionist $11.48/hr.• Medical Records Clerk $10.29/hr.• Medical Assistant (Non Certified) $12.07/hr.• Registered Nurse $19.70/hr.

• Billing Clerk $13.04/hr.• Office Manager $21.52/hr.• Assistant Administrator $31.41/hr.

Staffing Ratio

• MGMA’s Better Performing Practices annual guide states that in some cases a higher staffing ratio can create higher profitability

Staffing Ratio per FTE Physician

Staffing Ratio Per FTE Physician

14.08%

28.17%

25.35%

15.49%

16.90%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

< 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5+

Current Staffing Needs

Current Staffing Needs for Your Practice

28

4 4

17

3

7

17

34

11

1

11

6

0

5

10

15

20

25

30

Simple Truths

• If you begin with the “who”, rather than the “what”, you can more easily adapt to a changing world.

• If you have the right people “on the bus”, the problem of how to motivate and manage people largely goes away.

• If you have the wrong people, it doesn’t matter whether you discover the right direction—you still won’t have a great company (practice).

Key Components to Staffing

• Offering Competitive Salaries

• Recruiting the best people

• Orientation and training

• Reducing turnover

• Knowing what functions can be outsourced

Keys to Recruiting the Best People

• Make sure they fit the culture of workplace

• Check references and previous work experience

• Check for skill set matches

• Use an outside firm to do background checks

Keys for New Employees

• Use mentors• Orientation should include mission & values• Keep training materials updated• Use performance reviews• Ongoing training

Keys to Reduce Turnover

• Salary important only to a point

• People will stay in a job when – they feel valued – a part of the team– they get the training they need – that their opinions count – when they feel they are making a difference

• Laugh and celebrate small successes

• Use rewards

Rewards

• Can be formal or informal

• Best when tied to performance

• Do not have to be expensive

• Can involve cash, non-cash, or both

• Be creative with rewards – flexible time off (handled equally between employees)– Gift certificates to favorite restaurants– House cleaning services for person’s home

Rewards (continued)

• Should be matched to the person’s personal preferences

• Should be matched to the achievement

• Should reflect your values and business strategy

• Should be timely and specific

What Services can be Contracted

Contracted Services

27%

15%19%

15%

8% 8% 8%

0%

5%

10%

15%

20%

25%

30%

Group

Purchasing

Billing Collections Accounting Admin.

Serv ices

Third-Party

Payors

Non-

Medical

Staffing

Links to Powerful Information on Staffing

• www.mgma.com

• www.memag.com

• www.physicianpractice.com

• www.medscape.com

Steps for Next Year

• Be able to print each section as you go

• Be able to start and come back to the survey

• Better clarify Office Manager vs. Administrator

• Will include category for Aestheticians

• Will do on-line AGAIN….

Summary

A combination of competitive salaries and good benefits along with an environment of mutual respect, fun, and positive work relationships can result in productive and happy employees.

Thank You

LarsonAllen Health Care Group

(314) 336-3726

www.larsonallen.com