nerves summary of survey trends - th mgmt., inc...

4/30/2015

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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

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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

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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.

▪


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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.


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▪ 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

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▪ 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

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▪ 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

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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

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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

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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.

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Practice Accounts Receivable Data

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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

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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.

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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

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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.

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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

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Other Relevant Practice Issues

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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%

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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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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

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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 *

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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


• Pediatric Neurosurgery

• Endovascular/ Vascular Neurosurgery• Other

What is the average hours per year required?

• Cranial/Brain Tumors Neurosurgery


• Pediatric Neurosurgery• Endovascular/ Vascular Neurosurgery

• Other

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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

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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

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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%

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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%

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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%

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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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Neurosurgeon Data

(per FTE)

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% 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

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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%

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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

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Comparative Data: Annual Charges per FTE Neurosurgeon



# 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

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Comparative Data: Annual Collections per FTE Neurosurgeon



# 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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Comparative Data: Annual Work Relative Units (WRVUS) per

FTE Neurosurgeon



# 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

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Comparative Data: Neurosurgeon Annual Compensation

per WRVU



# 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


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Comparative Data: Neurosurgeon Annual Gross Charges

per WRVU



# 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


# 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



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Comparative Data: Neurosurgeon Annual Collections per WRVU



# 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


# 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



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▪ 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

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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

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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

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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

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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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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

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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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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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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)

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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


(Calculated) – Hospital Owned


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


(Calculated) – Academic


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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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


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


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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.


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.


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

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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.

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