4/30/2015
1
NERVES
Summary of Survey Trends
April 4, 2014
Michael N. Heaton, CPA/ABV/PFS, CFP, CHBC, CVA
May 1, 2015
2
▪ Survey questionnaires in Excel format were distributed
electronically to the entire membership (300 practices) and
additional non-member practices in September 2014.
▪ Participants and responses are confidential, i.e. only KSM has
access to the specific data.
▪ KSM now screens for certain “critical data questions.” If those
questions are not answered, a survey is rejected or additional
information is requested.
Overview
3
For each statistic reported by individual neurosurgeon, we have
presented the data by practice ownership. Therefore, for each
statistic, there are the following detail pages:
Overall
Physician-Owned
Academic
Hospital-Owned
Overview
4/30/2015
2
4
For each statistic reported by individual neurosurgeon, we have
presented the number of neurosurgeons and practices that
responded.
If eight or more physicians responded, and three or more
practices responded, the data was reported.
Overview
5
The question regarding physician’s primary focus of practice, Clinical vs. Academic, was removed.
The Hybrid category for ownership type was removed.
Malpractice insurance data was collected and reported at the neurosurgeon and practice level.
On the Academic tab, FTE data for mid-level providers was reported.
New in 2014
6
• For the 2014 report, we developed an additional editing process for the practice data. We used the editing process to identify reporting errors and potential outliers in the data. Data determined to be outliers were either reviewed with the survey preparer for correction or excluded from the survey. In regards to the editing process, we used the following additional guidelines:
Overall
All neurosurgeon compensation and statistics were normalized to report compensation on a 1.0 clinical full-\time equivalent (FTE) imputed basis as described below.
▪
New in 2014-Data Editing
4/30/2015
3
7
Academic Physicians
▪ Any neurosurgeon with a clinical FTE that was reported to be equal to or greater than .5 clinical FTE was considered to be a 1.0 clinical FTE for calculation and presentation purposes.
▪ Any neurosurgeon which was reported to be less than a .5 clinical FTE was analyzed as follows:
▫ If the imputed compensation per clinical FTE was greater than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the Academic ownership category, the data was excluded from the survey.
▫ If the imputed compensation per clinical FTE was less than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the Academic ownership category, the data was included in the survey.
▪
New in 2014-Data Editing
8
Physician-Owned/Hospital-Owned Physicians
▪ Any neurosurgeon with a clinical FTE that was reported to be equal to or greater than .5 clinical FTE was normalized as described in the “Overall” section above.
▪ Any neurosurgeon which was reported to be less than a .5 clinical FTE was analyzed as follows:
▫ If the imputed compensation per clinical FTE was greater than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the ownership category, the data was excluded from the survey.
▫ If the imputed compensation per clinical FTE was less than the mean of all imputed compensation for neurosurgeons who reported a .5 or greater clinical FTE in the ownership category, the data was included in the survey.
New in 2014-Data Editing
9
▪ MGMA does not standardize any of the data but instead
categorizes providers into full-time and part-time
categories based on the following FTEs:
▫ Full-time: .08 – 1.0
▫ Part-time: .40 – .60
▫ Excluded: .61 – .79
▪ The actual survey only reports the full time physician data.
▪ The part time physician data is provided in the data mining
resources.
Data Editing – MGMA Physician
Compensation and Production Survey
4/30/2015
4
10
▪ The Academic MGMA Survey requests both the FTE and the
Clinical FTE.
▪ The academic survey only reports 1.0 FTE.
▪ Statistics are reported using the following methodologies:
▫ Percentage of Billable Clinical Activity (0%-33%, 34%-66%,
and 67%-100%)
▫ Standardized to equal 100% Billable Clinical Activity
Data Editing – MGMA Academic Practice Compensation
and Production Survey for Faculty and Management
11
▪ Sullivan Cotter:
▫ All compensation and productivity data is standardized to
reflect 1.0 FTE.
▪ AMGA – Compensation and Financial Survey:
▫ All compensation and productivity data is standardized to
reflect 1.0 FTE.
Data Editing – Sullivan Cotter & AMGA
Compensation and Financial Survey
12
2010 2011 2012 2013 2014
Distributed(NERVES Members) 335 331 331 322 300
Responses(NERVES Members) 72 71 73 63 81
Response Rate(NERVES
Members) 21% 21% 22% 20% 27%
Neurosurgeons 390 464 432 415 580
Non-Physician Providers 111 123 117 131 560
Practices Reporting NPP 42 31 48 46 57
MGMA: Overall Response
Rate* 19% 23% 8% 35% 28%
MGMA: Reporting
Neurosurgeons* 256 261 312 344 355
Demographics – Practice
*SOURCE: Medical Group Management Association’s Annual Physician Compensation and Production Survey
4/30/2015
5
13
Geographic Region 2010 2011 2012 2013 2014
East 10% 8% 7% 13% 11%
South 35% 43% 52% 43% 45%
Midwest 32% 24% 21% 29% 23%
West 23% 25% 21% 14% 21%
Demographics - Practice
14
Ownership 2010 2011 2012 2013 2014
Private 69% 64% 64% 60% 60%
Hospital 7% 10% 16% 16% 15%
Academic 24% 21% 15% 21% 25%
Hybrid N/A 5% 4% 3% N/A
Composition
Single Specialty 39% 43% 67% 54% 55%
Multi-Specialty 29% 37% 33% 46% 45%
Academic 32% 20% N/A* N/A* N/A*
Demographics - Practice
*For 2012 - 2014, the academic category was removed from practice type since it was reported in practice ownership.
15
Practice Accounts Receivable Data
4/30/2015
6
16
Accounts Receivable
$347,908
$240,822
$309,614
$567,376
$505,551 $532,456
$446,629 $446,235 $442,867 $452,152
$566,723
$537,410 $526,870
$542,556
$594,875
$200,000
$300,000
$400,000
$500,000
$600,000
2010 2011 2012 2013 2014
A/R per FTE Provider
A/R per FTE Physician
A/R per FTE Neurosurgeon
N= 56 68 70 60 90
17
A/R Aging
52% 50% 48%50% 49%
14% 15%16%
16%16%
9% 8%8%
8% 9%
5% 6%5%
6% 6%7% 7%
6%
7% 8%
10% 10%15%
6% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014
180+ Days
121 to 180 Days
91 to 120 Days
61 to 90 Days
31 to 60 Days
Current to 30 Days
N= 62 69 69 59 87
*Please note that the total will not equal 100% due to the response are the plot of the medians.
18
Median Days in A/R
49.0848.65
47.95
45.5
50.44
43
44
45
46
47
48
49
50
51
2010 2011 2012 2013 2014
N= 57 72 66 56 91
4/30/2015
7
19
Median Gross Coll. %
25.00%
27.00%
29.00%
31.00%
33.00%
35.00%
2010 2011 2012 2013 2014
Overall
Academic
Hospital-Owned
Physician-Owned
32.23%
29.19%
32.96%
32.03%
28.57%
26.60%
28.50%
30.37%
N= 63 72 67 58 95
*Please note that the median gross collection percentage was not calculated by ownership prior to 2014.
20
Practice Income
21
Avg % Practice Revenue
30.17% 29.83%
21.29%21.38%
30.57%
7.78%10.11%
6.67%
7.69%
9.15%
46.37%
41.52%
54.30%
36.29%
37.85%
12.84%
19.13%23.94% 15.23%
6.33%
3.89%7.43% 8.26%
4.37% 2.91%
1.74% 3.16% 2.12%1.90% 0.57%
5.50% 6.90% 9.65%10.54% 12.62%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014
Other
Workers Comp FFS - % Chgs.
Workers Comp FFS - Sched.
Commercial FFS - % Chgs.
Commercial FFS - Sched.
Medicaid
Medicare
4/30/2015
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22
Other Relevant Practice Issues
23
New Data in 2014
Questions N 2014 % Yes
Does your practice utilize Work Relative Value
Units(WRVUs) for compensation purposes?
Does your practice utilize Work Relative Value
Units(WRVUs) for practice management?
94
93
37.23%
40.86%
How you undergone a Government HIPPA audit in the last
twelve months?
91 3.30%
24
Relevant Issues in 2013 and 2014Questions N 2013 % Yes N 2014 % Yes
Allocation of General Overhead in Determining Physician
Compensation:
• Equal• Variable based on a measure of productivity
• Blend of Equal and Variable
• If Blended
• Percentage allocated equally
• Percentage allocated variably• Other
4133
31
19
1714
42.59%25.93%
31.48%
57.00%
47.00%35.71%
3229
20
16
167
36.36%32.95%
22.73%
54.12%
45.88%7.95%
Time to Complete Survey?
• 1 – 2 Hours
• 3 – 4 Hours• 4+ Hours
63
6363
8.47%
38.98%52.54%
87
8787
12.64%
20.69%66.67%
Are you currently participating in an ACO?
• Have you participated greater than 1 year?
Are you participating in a shared savings ACO?
• Have you received any savings?
62
21
57
13
27.42%
42.86%
19.30%
7.69%
90
22
78
17
24.44%
59.09%
21.79%
29.41%
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25
Relevant Issues in 2013 and 2014
Question N 2013 % Yes or # N 2014 % Yes or #
Are you participating in National
Neurosurgery Quality and
Outcomes Database (N2QOD) or an alternative spine registry?
What type of registry?
• N2QOD• Other
59
9
15.25%
77.78%22.22%
88
2
23.86%
87.5%12.5%
How many FTEs are assigned to
N2QOD or an alternate spine
registry?
9 1.11 2 *
26
Relevant Issues in 2013 and 2014Question N 2013 % Yes or # N 2014 % Yes or #
Does your practice receive additional revenue for
Medical Directorship?
What type of medical directors?• Cranial/Brain Tumors Neurosurgery
• Spinal Neurosurgery
• Pediatric Neurosurgery
• Endovascular/ Vascular Neurosurgery
• OtherWhat is the hourly rate?
• Cranial/Brain Tumors Neurosurgery
• Spinal Neurosurgery
• Pediatric Neurosurgery
• Endovascular/ Vascular Neurosurgery• Other
What is the average hours per year required?
• Cranial/Brain Tumors Neurosurgery
• Spinal Neurosurgery
• Pediatric Neurosurgery• Endovascular/ Vascular Neurosurgery
• Other
62
15
14
14
14
14
7
3
3
512
8
4
36
11
41.94%
66.67%
50.00%
50.00%
50.00%
90.00%
*
*
*
*$283
243
*
**
183
86
33
33
33
33
33
8
11
5
812
8
10
59
12
38.37%
39.39%
48.48%
33.33%
45.45%
66.67%
$348
$204
*
$405$244
305
270
*195
200
27
Relevant Issues in 2013 and 2014
Questions N 2013 % Yes or # N 2014 % Yes or #
Do you have a set time period for Partner Buy-In?
What is the time period?
59
20
35.59%
1.95 years
85
3
34.12%
*
Does a physician have to be board certified to
become a partner?
54 68.52% 80 57.50%
What is your Partner Buy-In method?
• Net Book Value
• Fair Market Value• Other
40
30.00%
20.00%50.00%
52
15%
12%73%
Have you attested to Year 1 Medicare Meaningful
Use standards?
What percentage of neurosurgeons have attested
to Year 1 standards?
58
38
70.69%
95.53%
81
63
76.54%
93.16%
4/30/2015
10
28
Other Relevant Practice Issues - Productivity
2010 2011 2012 2013 2014
Utilize Total RVUs for Comp. 32% 31% 29% 38% 13%
Utilize Total RVUs for Mgmt. 51% 50% 42% 52% 20%
Planning to Recruit 72% 70% 67% 62% 60%
29
Other Relevant Practice Issues - Technology
2010 2011 2012 2013 2014
Utilize Remote Imaging 89% 91% 93% 92% 92%
Utilize EMR 70% 78% 90% 90% 90%
Planning to Implement EMR 54% 50% 23% 31% 32%
30
Other Relevant Practice Issues - Payers
2010 2011 2012 2013 2014
Imposed Limits on Medicare
Patients 19% 17% 26% 21% 20%
Imposed Limits on Medicaid
Patients 40% 29% 44% 39% 40%
Cancelled Payer Contracts 18% 21% 26% 25% 7%
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31
Neurosurgeon Data
(per FTE)
32
% of Practice
28%34%
17%19% 19%
57%53%
78%55% 53%
7% 6% 5%
11% 13%
0% 0% 5% 5% 6%8% 7% 5% 5% 5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014
Other
Endovascular
Pediatric
Spine
Cranial
N= 372 417 432 408 543
33
Neurosurgeon Subspecialty Data
• For the 2014 survey, gross
charges, collections,
compensation and WRVU
data was presented for the
following subspecialties:o Cranial
o Pediatric
o Pediatric, Subspecialty Cranial
o Spine
o Endovascular
o Functional
o Other
• The data was presented for
each subspecialties as
follows:o Greater than 25%
o Greater than 50%
o Greater than 75%
o Greater than 90%
o 100%
4/30/2015
12
34
Comparative Data: Annual Compensation per FTE Neurosurgeon
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp. 156 62 32 20 11
Cranial $646,162 $890,884 $999,747 $1,034,375 $573,297
# of Resp. 366 330 228 120 34
Spine $756,650 $787,844 $911,440 $1,030,523 $1,336,015
# of Resp. 74 69 60 57 49
Pediatric $561,802 $573,250 $593,501 $592,002 $592,002
# of Resp. 46 37 25 9 8
Pediatric – Cranial $500,143 $450,000 $403,000 $450,000 $462,350
# of Resp. 43 29 16 11 8
Endovascular $670,199 $684,473 $753,755 $684,473 $617,300
# of Resp. 28 21 15 11 5
Functional $482,326 $450,000 $450,000 $416,000 *
# of Resp. 30 17 14 12 12
Other $468,492 $461,268 $482,423 $507,155 $507,155
2014Overall $670,100 # of Resp. 580
2013Overall $743,243# of Resp. 415
35
Comparative Data: Annual Charges per FTE Neurosurgeon
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp. 148 54 24 12 11
Cranial $2,855,835 $4,875;435 $5,821,014 $8,560,357 $2,733,016
# of Resp. 345 309 207 99 13
Spine $3,268,679 $3,435,251 $4,356,215 $5,681,159 $9,197,713
# of Resp. 70 65 56 53 45
Pediatric $1,506,812 $1,572,874 $1,807,519 $1,852,823 $2,018,130
# of Resp. 42 33 21 9 8
Pediatric – Cranial $1,500,801 $1,758,308 $2,040,584 $2,552,883 $2,560,303
# of Resp. 39 26 14 11 8
Endovascular $2,930,390 $3,023,838 $4,687,820 $4,708,971 $5,619,982
# of Resp. 23 19 13 10 4
Functional $1,822,391 $2,107,235 $1,276,374 $863,812 *
# of Resp. 28 16 14 12 12
Other $1,944,804 $1,752,772 $1,643,354 $1,870,822 $1,870,822
2014Overall $2,855,871 # of Resp. 540
2013Overall $2,807,955# of Resp. 410
36
Comparative Data: Annual Collections per FTE Neurosurgeon
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp. 151 58 28 16 11
Cranial $839,677 $1,292,901 $1,830,141 $2,133,263 $1,066,890
# of Resp. 342 309 207 99 13
Spine $972,420 $1,047,091 $1,228,374 $1,516,212 $1,890,646
# of Resp. 70 65 56 53 45
Pediatric $572,780 $594,111 $621,752 $634,757 $634,757
# of Resp. 42 33 21 9 8
Pediatric – Cranial $520,633 $569,026 $634,757 $722,788 $725,526
# of Resp. 41 27 14 11 8
Endovascular $745,272 $745,272 $862,518 $865,854 $921,116
# of Resp. 23 19 13 10 4
Functional $622,097 $622,097 $548,019 $331,542 *
# of Resp. 28 16 14 12 12
Other $690,568 $631,963 $631,963 $690,568 $690,568
2014Overall $858,597# of Resp. 535
2013Overall $942,399# of Resp. 410
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37
Comparative Data: Annual Work Relative Units (WRVUS) per
FTE Neurosurgeon
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp. 117 59 32 20 11
Cranial 9,216 10,306 10,570 10,740 10,506
# of Resp. 238 207 148 85 32
Spine 11,398 11,548 11,535 12,144 12,398
# of Resp. 63 58 49 46 40
Pediatric 5,763 5,689 5,617 5,365 5,365
# of Resp. 36 29 22 6 6
Pediatric – Cranial 6,133 6,619 7,161 * *
# of Resp. 41 29 16 11 8
Endovascular 10,202 10,134 12,715 12,725 12,540
# of Resp. 27 21 15 11 5
Functional 6,392 6,262 5,907 4,892 *
# of Resp. 25 16 13 11 11
Other 6,771 6,598 6,912 8,376 8,376
2014Overall 9,618# of Resp. 429
2013Overall 10,366# of Resp. 298
38
Comparative Data: Neurosurgeon Annual Compensation
per WRVU
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp.117 59 32 20 11
Cranial$65 $65 $62 $60 $62
# of Resp.238 207 148 85 32
Spine$65 $63 $62 $60 $59
# of Resp. 63 58 49 46 40
Pediatric$92 $98 $101 $102 $103
# of Resp.36 29 16 6 6
Pediatric – Cranial$89 $81 $76 * *
# of Resp.41 29 16 11 8
Endovascular$68 $68 $67 $64 $64
# of Resp.27 21 15 11 5
Functional$79 $85 $94 $97 *
# of Resp.25 16 13 11 11
Other$80 $75 $66 $64 $64
2014Overall $67# of Resp. 429
2013Overall $74# of Resp. 298
39
Comparative Data: Neurosurgeon Annual Gross Charges
per WRVU
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp.117 59 32 20 11
Cranial$302 $299 $287 $277 $348
# of Resp.238 207 148 85 32
Spine$293 $293 $295 $304 $329
# of Resp. 63 58 49 46 40
Pediatric$235 $230 $216 $221 $209
# of Resp.36 29 16 6 6
Pediatric – Cranial$242 $277 $291 * *
# of Resp.41 29 16 11 8
Endovascular$321 $335 $424 $439 $515
# of Resp.27 21 15 11 5
Functional$306 $347 347 $352 *
# of Resp.25 16 13 11 11
Other$263 $246 $243 $243 $243
2014Overall $286# of Resp. 396
2013Overall $262# of Resp. 298
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14
40
Comparative Data: Neurosurgeon Annual Collections per WRVU
Median Data by Subspecialty
Time Allocated to Specialty >25% >50% >75% >90% 100%
# of Resp.117 59 32 20 11
Cranial$80 $84 $81 $83 $97
# of Resp.238 207 148 85 32
Spine$81 $81 $81 $81 $77
# of Resp. 63 58 49 46 40
Pediatric$82 $80 $81 $82 $82
# of Resp.36 29 16 6 6
Pediatric – Cranial$84 $74 $96 * *
# of Resp.41 29 16 11 8
Endovascular$73 $74 $74 $74 $78
# of Resp.27 21 15 11 5
Functional$79 $87 $75 $75 *
# of Resp.25 16 13 11 11
Other$104 $96 $90 $96 $96
2014Overall $80# of Resp. 394
2013Overall $82# of Resp. 298
41
▪ Neurosurgeon compensation represents total W-2
compensation and/or K-1 ordinary income, i.e. likely includes
ancillary profits that flow through the practice.
▪ Per the NERVES Survey Instructions for Neurosurgeon
Compensation: “Indicate each neurosurgeon’s total gross
compensation from the professional practice for the most
recently completed fiscal year. This amount can be gross W-2
compensation and/or Schedule K-1 ordinary income from the
professional practice only.”
Neurosurgeon Compensation
42
$730,530
$715,764
$784,519
$743,243
$670,100
600,000
620,000
640,000
660,000
680,000
700,000
720,000
740,000
760,000
780,000
800,000
2010 2011 2012 2013 2014
Neurosurgeon Compensation - Overall
N= 291 464 432 415 580
4/30/2015
15
43
Overall
Phys. Owned
Private Practice
Health System
Owned
Academic
Owned
Median
Neurosurgeon Compensation
• 2014
• 2013
$670,100
$743,243
$759,662
$785,182
$826,708
$900,000
$569,529
$664,208
Portion
Attributable to Professional
Neurosurgery
Services
• 2014• 2013
79%
73%
68%
69%
79%
94%
91%
75%
Composition of Neurosurgeon
Compensation – By Ownership
2014 N= 580 277 48% 65 11% 238 41%
2013 N= 415 178 43% 54 13% 136 33%
*Please note that the Hybrid accounted for 11% of the total N in 2013.
44
$-
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
2010 2011 2012 2013 2014
Physicians
Health Systems
Academic
Note:
1. In 2010 there were
not enough
responses to report
Health Systems.
Composition of Neurosurgeon
Compensation - Ownership
N= 291 464 432 415 580
45
$1,033,796$1,007,872 $988,011
$942,399$858,597
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
2010 2011 2012 2013 2014
Collections per FTE Neurosurgeon -
Overall
N= 333 441 426 410 535
4/30/2015
16
46
10,662 10,776
10,460
10,366
9,618
12,211
11,835
10,463
11,645 11,316 11,393
11,509
11,936
11,706
10,132 9,996
10,469
9,174
7,791 7,500
8,000
8,500
9,000
9,500
10,000
10,500
11,000
11,500
12,000
12,500
2010 2011 2012 2013 2014
Overall
Physician-Owned
Hospital-Owned
Academic
WRVUs per FTE Neurosurgeon
N= 199 301 238 298 429
Note: In 2010
there were not
enough responses
to report Health
Systems.
47
-
2,000.00
4,000.00
6,000.00
8,000.00
10,000.00
12,000.00
14,000.00
2010 2011 2012 2013 2014
Physicians
Health Systems
Academic
Note: In 2010
there were not
enough responses
to report Health
Systems.
WRVUs per FTE Neurosurgeon –
Ownership
N= 199 194 238 298 429
48
$266
$264 $249
$262
$286
$95 $83 $84 $82 $80
$60 $68 $69 $74 $67
$-
$50
$100
$150
$200
$250
$300
$350
2010 2011 2012 2013 2014
Gross Charges
Collections
Compensation
Neurosurgeon $ per WRVU – Overall
4/30/2015
17
49
Summary of Neurosurgeon Collections Data
2010 2011 2012 2013 2014
Collections
per FTE $1,033,796 $1,007,872 $988,011 $942,399 $858,597
WRVUs per
FTE 10,662 10,776 10,460 10,366 9,618
Collections
per WRVU $95 $83 $84 $82 $80
50
385 393 400370
332
262276 280 279
259
0
50
100
150
200
250
300
350
400
450
2010 2011 2012 2013 2014
New Patients
Primary Surgeries
New Patients and Primary Surgeries per
FTE Neurosurgeon – Overall
NP= 292 419 286 391 426
PS= 294 414 409 394 496
51
2010 2011 2012 2013 2014
Physicians238 282 281 282 279
Health
Systems * 258 285 264 279
Academic251 287 293 292 217
Median Primary Surgeries by Ownership –
Overall
4/30/2015
18
52
0.600.65 0.64
0.750.75
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
2010 2011 2012 2013 2014
Implied Surgical Conversion Rate per FTE
Neurosurgeon – Overall
SURGICAL CONVERSION RATE = PRIMARY SURGERIES/NEW PATIENTS
2009-2014 DATA: PRIMARY SURGERIES/NEW PATIENTS CALCULATED BY NEUROSURGEON
53
Neurosurgery Reports: Call Pay
54
Neurosurgery Reports –
Median Daily Call Pay Per Contract
N-# of
Contracts 2014
Overall Trauma Pay 61 $2,450
Primary Call Pay 102 $1,612
Spine 14 $858
Endovascular 15 $1,500
Cranial 8 $830
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55
Neurosurgery Reports – Overall Median
Daily Call Pay Per Contract
Geographic Region N 2014
East 8 $1,194
South 66 $1,800
Midwest 34 $1,500
West 22 $1,562
Ownership
Private 96 $1,695
Hospital 12 $1,300
Academic 22 $1,826
56
Neurosurgery Reports – Overall Median
Daily Call Pay Per Contract
2010 2011 2012 2013 2014
Trauma $1,750 $2,000 $2,000 $2,000 $2,450
Level 1 Trauma Pay $2,000 $2,200 $2,200 $2,175 $2,448
Level 2 Trauma Pay $1,790 $2,000 $1,900 $1,800 $2,000
Emergency Department $875 $1,265 $1,425 $1,531 $1,300
N= 58 83 94 88 130
57
Neurosurgery Reports –
Overall Daily Call Pay per Contract
$1,750 $2,000 $2,000 $2,000
$2,450
0
500
1000
1500
2000
2500
3000
2010 2011 2012 2013 2014
Average Trauma Pay
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58
Additional On-Call Relevant DataQuestion 2014 % Yes
Trauma vs. Emergency Department
• Trauma
• Emergency Department
Trauma Center Level
• Level 1
• Level 2
N=130
46.32%
53.68%
N=71
46.48%
53.52%
Restricted vs. Unrestricted Call
• Restricted Call
• Unrestricted Call
N=127
14.96%
85.04%
Reimbursement for under funded patients
• Yes
• No
N=130
8.21%
91.79%
Which method
• Medicare
• Medicaid• Other
N=11
54.55%
18.18%27.27%
Separately bill for services rendered in addition to receiving call pay
• Yes
• No
N=130
94.74%
5.26%
59
Neurosurgery Costs and Staffing
60
Median Operating Costs per FTE
Neurosurgeon
$219,455 $229,552
$224,531
$147,543
$215,932
$318,080
$273,849
$169,153
$168,952
$234,445
$543,862
$519,404 $505,817
$363,982
$451,964
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
2010 2011 2012 2013 2014
Total Support Staff
Other (IncludingMalpractice)
Total
N= 45 69 72 63 96
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61
Mean FTE Support Staff per FTE
Neurosurgeon
4.54 4.454.95
5.646.13
0
1
2
3
4
5
6
7
2010 2011 2012 2013 2014
N= 61 69 72 63 96
62
Mean FTE Support Staff per FTE
Neurosurgeon and Provider
4.45
2.2
4.95
2.58
5.64
3.76
0
1
2
3
4
5
6
7
Neurosurgeon Provider
2011
2012
2013
2014
6.13
2.51
N=
69
72
63
96
63
Non-Neurosurgeon Providers
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22
64
Non-Neurosurgeon Provider Comp.
Pain Management
$350,000
$428,098
$515,656 $519,798
$395,701
$-
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
2010 2011 2012 2013 2014
N= 11 16 12 12 17
65
Non-Neurosurgeon Provider Comp.
Physiatry
$549,242
$275,000
$350,189
$334,244 $288,895
0
100,000
200,000
300,000
400,000
500,000
600,000
2010 2011 2012 2013 2014
N= 8 11 8 12 14
66
Non-Physician Provider Comp.
$93,000
$95,157 $94,378
$98,847
$105,117
$100,857 $101,401
$107,000 $106,667
$101,889
80,000
85,000
90,000
95,000
100,000
105,000
110,000
2010 2011 2012 2013 2014
Nurse Practitioner
Physician Assistant
NP= 23 31 30 30 50
PA= 32 45 39 37 57
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67
Administrative Leadership
68
Administrator/CEO
2010 2011 2012 2013 2014
% Employ
Administrator/CEO 89% 85% 78% 82% 86%
Median Annual Base
Salary $120,000 $125,668 $123,000 $138,333 $130,915
% Eligible for Bonus 76% 76% 87% 67% 67%
Median Annual
Bonus $16,500 $15,000 $15,500 $15,500 $10,608
% Employment
Contract 35% 32% 28% 31% 28%
% Severance
Package 17% 19% 23% 15% 17%
69
Office Manager
2010 2011 2012 2013 2014
% Employ Office Mgr. 62% 59% 64% 57% 66%
Median Annual Salary $58,500 $60,000 $61,200 $63,810 $62,000
% Eligible for Bonus 45% 50% 56% 45% 46%
Median Annual Bonus $5,000 $2,666 $4,758 $5,000 $5,711
% Employment Contract 3% 8% 7% 15% 9%
% Severance Package 3% 3% 10% 6% 5%
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70
Academic Practice Information
71
N 2014
Medical Director 16 $255,901
Mid-Level Practitioners 22 $457,000
Mid-Level FTE 18 4
Research 7 *
Faculty Member Start-Up 8 $212,500
General Administrative Staff 13 $244,418
General Support 11 $1,282,508
Uncompensated Care 5 *
Other 12 $486,208
Total Support Area 28 $1,375,409
Profit Contribution Dollars 10 $16,010,770
Profit Contribution Margin 8 30.00%
Academic Practice – Median Financial
Support Received from Teaching Hospital
72
N 2014
Medical Director 2 *
Mid-Level Practitioners 3 *
Mid-Level FTE 2 *
Research 8 169,000
Faculty Member Start-Up 7 *
General Administrative Staff 4 *
General Support 11 $524,000
Uncompensated Care 1 *
Other 7 *
Total Support Area 22 $582,042
Tax Percentage 21 6.75%
Other Inst Overhead 22 9.35%
Academic Practice – Median Financial
Support Received from Medical School
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73
Summary
74
2014 N 2013 N 2010 2011 2012 2013 2014
Median
Gross Charges 540 410 $3,256,210 $3,162,856 $2,925,914 $2,807,955 $2,855,871
Median
Collections 535 410 $1,033,796 $1,007,872 $988,011 $942,399 $858,597
Median
Overhead 96 63 $543,862 $519,404 $505,817 $363,982 $451,964
Median
Net Income
from
Professional
Services 551 333 $564,288 $557,701 $593,006 $540,517 $528,200
Ancillary Profits
(Calculated) $166,242 $158,063 $191,513 $202,726 $141,900
Median
Neurosurgeon
Compensation 580 415 $730,530 $715,764 $784,519 $743,243 $670,100
Five-year Comparison per FTE
Neurosurgeon (Calculated)
75
2014 N 2013 N 2010 2011 2012 2013 2014
Median
Gross Charges 262 177 $3,066,770 $3,398,960 $2,946,785 $3,227,814 $3,232,916
Median
Collections 258 177 $1,103,495 $1,087,073 $1,019,497 $1,057,489 $1,043,718
Median
Overhead* 96 63 $543,862 $519,404 $505,817 $363,982 $451,964
Median
Net Income from
Professional
Services 551 333 $616,155 $573,296 $580,597 $540,517 $517,383
Ancillary Profits
(Calculated) $114,918 $193,588 $219,970 $244,665 $242,279
Median
Neurosurgeon
Compensation 227 178 $731,073 $766,884 $800,567 $785,182 $759,662
Five-year Comparison per FTE Neurosurgeon
(Calculated) – Physician Owned
*Please note the median overhead is calculated on a per FTE Neurosurgeon basis only and is not ownership specific.
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76
2014 N 2013 N 2010 2011 2012 2013 2014
Median
Gross Charges 64 54 * $2,517,294 $2,376,070 $2,694,036 $2,316,886
Median
Collections 64 54 * $682,246 $892,760 $771,106 $750,454
Median
Overhead* 96 63 * $519,404 $505,817 $363,982 $451,964
Median
Net Income
from
Professional
Services 551 333 * $568,000 $871,343 $850,000 $649,999
Ancillary Profits
(Calculated) * $82,000 $28,657 $50,000 $176,709
Median
Neurosurgeon
Compensation 65 54 * $650,000 $900,000 $900,000 $826,708
Five-year Comparison per FTE Neurosurgeon
(Calculated) – Hospital Owned
*Please note the median overhead is calculated on a per FTE Neurosurgeon basis only and is not ownership specific.
77
2014 N 2013 N 2010 2011 2012 2013 2014
Median
Gross Charges 214 132 $3,337,489 $3,138,270 $3,179,543 $2,484,447 $2,430,886
Median
Collections 213 132 $935,602 $976,466 $1,007,883 $903,244 $708,817
Median
Overhead* 96 63 $543,862 $519,404 $505,817 $363,982 $451,964
Median
Net Income from
Professional
Services 551 333 $503,975 $593,755 $585,356 $500,649 $519,739
Ancillary Profits
(Calculated) $226,113 $129,674 $135,610 $163,559 $49,790
Median
Neurosurgeon
Compensation 238 136 $730,088 $723,429 $720,966 $664,208 $569,529
Five-year Comparison per FTE Neurosurgeon
(Calculated) – Academic
*Please note the median overhead is calculated on a per FTE Neurosurgeon basis only and is not ownership specific.
78
2014 N 2012 2013 2014
Total Compensation 580 $784,519 $743,243 $670,100
Professional Services 551 $593,006 $540,517 $528,200
Call Pay 256 $149,466 $123,865 $139,958
Ancillary Net Income: ASC 50 $167,844 $178,500 $98,800
Ancillary Net Income: Imaging 112 $80,000 $80,000 $27,336
Ancillary Net Income: PT or OT 12 $11,308 * *
Ancillary Net Income: Other 64 $46,667 $59,055 $60,507
Three-year Comparison per FTE
Neurosurgeon
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79
2014 N 2012 2013 2014
Research 27 $55,938 $55,382 $37,364
Medical Directors 72 $55,136 $80,199 $70,051
Teaching: Dept. Chair 12 $243,222 * *
Teaching: Dept. Professor 27 $51,256 * $67,900
Teaching: Assoc. Professor 12 $80,000 * *
Teaching: Asst. Professor 56 $49,739 $66,667 $42,250
Teaching: Instructor 1 * * *
Other 147 $28,376 $34,915 $51,100
Three-year Comparison per FTE
Neurosurgeon (con’td)
80
▪ Due to new data editing process, it is recommend to use statistics within each ownership type.
▪ The mix of respondents changed in 2014
▫ The number of academic respondents increased from 136 in 2013 to 238 in 2014, an increase of 75%.
▫ The number of private practice respondents increased from 178 in 2013 to 277 in 2014, an increase of 55.6%.
▫ The number of hospital owned respondents increased from 54 in 2013 to 65 in 2014, an increase of 20.4%.
▫ The hybrid category in 2013 was 11% of total respondents. This category was eliminated in 2014.
Conclusions
81
▪ Number of practices that have cancelled third party payor contracts decreased from 25.40% in 2013 to 6.74% in 2014.
▪ The average commercial reimburse as a % of Medicare has decreased from 177.02% in 2013 to 163.59% for 2014.
▪ Practices planning on recruiting new physicians and non-physicians continues to decrease from 72.31% in 2010 to 59.57% in 2014.
▪ 90% of practices are using an EMR system.
Conclusions
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82
▪ Of the practices using EMR systems, the number attesting to Year 1 Medicare Meaningful Use Standards increased from 71% in 2013 to 76.54% in 2014.
▪ 24.44% of practices are participating in an ACO. This is a decrease of 2.98% from the 2013 amount.
▪ For those practices participating in an ACO, the percentage that received savings increased from 7.69% in 2013 to 29.41% in 2014.
▪ Staff turnover rate for the past 12 months increased from 16% in 2013 to 21% in 2014.
Conclusions (cont’d)
83
▪ Median collections for professional services per neurosurgeon continues to decrease. Over the last five years, collections have decreased by ownership type:
2010 2014
▫ Overall $1,033,796 $858,597
▫ Physician-Owned $1,103,495 $1,043,718
▫ Hospital-Owned * $750,454
▫ Academic $935,602 $708,817
▪ Median WRVUS per neurosurgeon continues to decrease. Over the last five years, WRVUs have decreased by ownership type:
2010 2014
▫ Overall 10,662 9,618
▫ Physician-Owned 12,211 11,316
▫ Hospital-Owned * 11,706
▫ Academic 10,132 7,791
Conclusions (cont’d)
84
▪ With the exception of Academic, collections per WRVU have decreased over the last four years. Variances by ownership type include:
2011 2014
▫ Overall $83 $80
▫ Physician-Owned $91 $87
▫ Hospital-Owned $75 $69
▫ Academic $81 $81
▪ Compensation per WRVU has decreased over all ownership types, except Academic, since 2011. The variances over the last four years include:
2011 2014
▫ Overall $68 $67
▫ Physician-Owned $79 $64
▫ Hospital-Owned $89 $66
▫ Academic $65 $72
Conclusions (cont’d)
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85
▪ The composition of practice has shifted over the last five years
from cranial and spine to other specialties.
▫ In 2010 cranial and spine together were 85% of practice compared
to 71% in 2014.
- Cranial decreased 10%
- Spine decreased 4%
▫ Other specialties, including pediatric, endovascular and functional,
made up 15% of practice in 2010 compared to 26% in 2014.
Conclusions (cont’d)
86
▪ The compiled data continues to show variance in the median daily call pay rate between geographic regions. The south geographic region has the highest daily call pay amount compared to the other regions.
▪ The median overall daily call pay per contract decreased from $1,775 in 2013 to $1,612 in 2014.
▪ The median overall daily call pay per contract for trauma increased from $2,000 in 2013 to $2,315 in 2014.
▪ The median overall daily call pay per contract for Level 1 Trauma increased from $2,175 in 2013 to $2,389 in 2014, while the daily rate for Level 2 Trauma was consistent between the two years.
Conclusions (cont’d)
87
▪ New Time Line
▫ June 15th-Send questionnaire to NERVES members
▫ August 15th-Deadline for all questionnaires to be submitted to KSM
▫ December 1st-Final surveys are mailed to participating members
▪ Survey will request both FTE and Clinical FTE status
▪ Additional academic reporting
New for 2015 Survey
4/30/2015
30
88
Contact Information
Office: 317.844.4884
Cell: 317.319.3490
E-mail: [email protected]
800 East 96th Street, Suite 500
Indianapolis, IN 46240
ksmpa.com
Michael N. Heaton CPA/ABV/PFS/ CFP,CHBC,CVA – Partner
Michael Heaton is a partner in Katz, Sapper & Miller’s Healthcare Resources Group. He has engaged in the practice of public accounting and healthcare consulting since 1976. Michael has
extensive healthcare consulting experience and provides in-depth consulting in the areas of
practice management, physician compensation, practice startups, practice valuations, third-party
reimbursement, practice mergers and reorganizations, retirement plans, personal financial
planning, managed care contracting, and group practice design. He also has expertise in the taxation of medical practices, dental practices, professional corporations, not-for-profit
organizations, S corporations, and individuals.