transplant hepatology: finanacial program organization
DESCRIPTION
Transplant Hepatology: Finanacial Program OrganizationTRANSCRIPT
Last revised 10/26/2013
Transplant hepatology:
finanacial program organization
James Trotter, MDBaylor University Medical Center
Dallas, Texas
Background
“Pick the set of problems you want to deal with.” Daniel Foster, MD, circa 1992
“In hepatology, there are no great jobs; only good jobs.” Thomas Boyer, MD, circa 1997
institutional support
MDproductivity
MD/institutional equinimity
Hepatology program support
1) It is impossible to earn salary + overhead evaluating and managing (E/M) complex patients.
Hepatology is a financially insolvent enterprise.
Hepatology program support
2) To remain solvent, hepatology requires supplementation by liver transplantation profits.
3) Most transplant programs don’t provide sufficient support for hepatology.
Lack of adequate hepatology support
A) Most programs don’t understand hepatology value (benefit/cost).
B) Hospitals will pay MD’s as little as possible to retain their services.
Overview
4) The most common reason for hepatologist discontentment is the perception of
inadequate salary and support.
MD productivity
institutional support
MD discontentment
institutional support
MD productivity
Institutional discontentment
MD/institutional equinimity
5) Hepatology funding/support is one of the
most important means of building and
stabilizing a liver transplant program.
institutional support
MDproductivity
MD/institutional equinimity
Hepatology program support
• How much of the following is fair/required:
• hepatology salary?• hepatology support staff FTE’s? • hepatology workload/RVU’s?
GENERALHEPATOLOGY
POST-TRANSPLANTHEPATOLOGY
PRE-TRANSPLANTHEPATOLOGY
Program background
• liver transplantation since 1984• approximately 4000 total liver transplants • yearly activity • –450 liver transplant evaluations • –442 active listed patients • –135 liver transplants • –co-manage 2500 liver recipients
Program background
• hospital-based, 12-MD (11 FTE) practice • two hospitals – Dallas and Fort Worth • IM, GI and transpl hep training programs • HealthTexas –400+ MD, multi-specialty –subsidiary of Baylor Health System –employs transplant hepatologists/surgeons
Clinical outreach sites
Frisco 25 Garland 10 Grand Prairie 15 Waxahachie 25 McKinney 20 Midlothian 25 Longview 125 Austin 200 Lubbock 350 Odessa 360
site miles from DFW
Service distribution11 hepatology MD FTE
general hepatology
service
pre-transplanthepatology
clinic
post-transplanthepatology
clinic
clinical and administrative staff19 clinical 6 clinical 6 clinical24 admin 6 admin 6 admin
Cost – administrative and clinical
$9.1 million per year
Cost – administrative and clinical
overhead (31 %)
MD salary (49 %)
staff salary (20 %)
$9.1 million per year
Support staff – total
administrative clinical
Support staff – per hepatologist
administrative clinical
3.5 staff per hepatologist
Hepatology - salarystarting salary $2X0,000
RVU > 3000/year + $42.65/RVU
RVU salary $2X0,000 + 3000 $2X0,0004000 $2X0,000 + $42,6505000 $2X0,000 + $83,3006000 $2X0,000 +
$127,9507000 $2X0,000 +
$170,600
Cost – administrative and clinical
overhead (31 %)
MD salary (49 %)
staff salary (20 %)
cost of practice = $9.1 M
Revenue
$9.1 million per year
$3.1 million hepatology revenue
Funding – yearly revenuetotal per hepatologist 44,725 total work RVU’s 4066
22,623 encounters 2057 9508 office (42 %)13,115 hospital (58 %)
$5.36 M gross charges $487k
$3.06 M cash collections (57 %) $278k
Total revenue is $3.1 M
Revenue - supplement
$6.1 million per year deficit22,643 encounters per year
$269.40 extra per encounter
=
Revenue - supplement
$9.1 million per year
$3.1 M hepatology revenue
$6.0 M hospital supplement
Funding - revenue
$3.1 M revenue - $9.1 M cost = $6.0 M loss
$6.14M = $511k support per MD 12 hepatologists
Contribution margin
contribution margin = hospital revenue – direct costs,
where direct cost are
hepatology MD/staff salary benefit, supplies
indirect costs computers, hospital administration, etc.
Contribution margin
contribution margin = hospital revenue – direct costs,
For hepatology $XX.2 M
$XX.2 M contribution margin - $X.1 M cost = $X.1 M margin
institutional support
MDproductivity
MD/institutional equinimity
Summary – support per hepatologist
• 2.0 administrative + 1.5 clinical FTE
• $2xx,000 + $42.65 per RVU > 3000
• cost approximately $500,000 per MD
Summary – yearly revenue per MD
• 4066 RVU
• 2057 encounters
• $487k gross charges
• $278k collections
Funding - revenuetotal per hepatologist 44,725 RVU’s 4066
22,623 encounters 2057
RVU/encounter 1.98
RVU/encounter range 1.6 for non-procedural
2.0 procedural (poor biller)
2.4 procedural (good biller)