The Samuel Bronfman Department of Medicine. Carolina Department of Medicine. Luis Rivera, MBA Director of Finance

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1 Staffing Ratios The Mount School of Medicine The Samuel Bronfman Department of Medicine Medical University of South Carolina Department of Medicine Luis Rivera, MBA Director of Finance Joe Gough, MA Operations Manager Steve Vinciguerra, MBA Cardiology Division Administrator Overview Background and Descriptive Data 4 areas of focus: Education Academic/Core Administration Research (MUSC) Clinical i l (Sinai) i) Conclusion: Q&A 1

2 Background: Why staffing ratios? AIM Listserve (3/09) Primary Care staffing benchmarks? Clinical Trial Management sharing divisional FTE Cost Reduction Initiatives Space Limitations i i Lack of data AIM Data Committee Audience Questions Who is in a centralized vs. decentralized structure? Inter-Divisional staff consolidation (e.g., sharing trial coordinators)? Quantified staff benchmarks/ratios (i.e., volume of work/fte)? 2

3 MUSC Who We Are 11 DIVISIONS 700+ People Many Backgrounds Biostatistics/Epidemiology Cardiology ogy Emergency Medicine Endocrinology GI and Hepatology General Internal Medicine Hematology/Oncology Infectious Diseases Nephrology Pulmonary & Critical Care Rheumatology 294 Faculty Members 76 Fellows 116 Residents 28 Post-docs and Graduate students 242 Staff Clinicians Clinician-Investigators Investigators 8 Fellowship Programs Matched from 18 Schools In 8 Divisions University and UMA employees MUSC Clinical and Research Enterprise 12% increase from FY08 to FY09 17% increase from FY08 to FY09 3

4 MUSC FY09 Budget Annual Budget = $80M Sinai Who We Are 11 DIVISIONS People Many Backgrounds Clinical Immunology Cardiology ogy Gastroenterology Endocrinology Hepatology General Internal Medicine Hematology/Oncology Infectious Diseases Nephrology Pulmonary & Critical Care Rheumatology 294 Faculty Members 350 Contributed Service Faculty Members 80 Fellows 133 Residents 763 Staff Members Clinicians Clinician-Investigators Investigators Provide 10 hours of voluntary services for the DOM 14 Programs Matched from 49 Schools Includes both MSSM and MSSM FPA employees 4

5 Sinai - Organizational Structure (Matrix) Sinai FY09 Budget 5

6 4 Areas of Analysis Education residency and fellowship ratios Divisional & Chairman s Office admin faculty/staff ratios; pay-band weighted avg; staff by function Research (MUSC) trials management ratios and pay-band weighted avg Clinical (Sinai) faculty practice rightsizing using MGMA benchmarks Area 1 - Education Staffing Analysis Sum of all fellows and residents within all programs FTE count of functional time, not bodies 6

7 Residents and Staff Education Staffing Ratio Results Residents 49:1 ratio 33:1 ratio n=98 n=137 Fellows and Staff Fellows 20:1 ratio 20:1 ratio n=80 n=84 Overall 29:1 ratio 27:1 ratio n=178 n=221 Education Staffing Analysis Summary Qs What FTE support does ACGME require? Answer: not-defined What do the ratios tell you? (note - if MUSC added 1 FTE = 33:1) What are your Education staff ratios? * AIM Data Survey collect Education ratios 7

8 Area 2 - Academic Administration Analysis Core administration staff functional staff only (Division Administrators, Finance, HR, A&P, IT, Communications, Analysts, and Managers, admin support, secretaries/coordinators) No mission-based staff excludes direct practice and research staff Academic Administration Analysis - MUSC Faculty to Staff Ratios for Selected Divisions Combin ned # of faculty and staff 2 to 1 n=34 faculty 2.6 to 1 n=17 faculty 4.6 to 1 n=23 faculty 3.1 to 1 n=14 faculty 4.8 to 1 n=23 faculty Overall, 3.4 faculty to 1 staff ratio in Divisions 8

9 Academic Administration MUSC (PhDs prorated by 75%) Faculty to Staff Ratios for Selected Divisions Combin ned # of faculty and staff 1.5 to 1 n=26 faculty 2.6 to 1 n=17* faculty 3.1 to to to 1 n=15 faculty n=9 faculty n=13 faculty Overall, 2.4 faculty to 1 staff ratio in Divisions Area 2 - Academic Administration Analysis (Payband Analysis) What is the makeup of staffing levels in each Division? A payband analysis with weighted averages is needed: Band 3 = 1 wt ($ $37.8K) Band 4 = 2 wt ($ $46.0K) Band 5 = 3 wt ($ $56.0K ) Band 6 = 4 wt ($ $68.1K) Band 7 = 5 wt ($ $82.9K) 9

10 Method - Weighted Avg DEF: Applies weights in calculating average EX: homework 10%, quizzes 20%, tests 70% (.10 x 40)+(.20 x 50)+(.70 x 95) = = 81.5 (passed a B!!!) Payband Analysis Results - MUSC DOM Weighted Average

11 Area 2 - MUSC Analysis Summary What do the faculty/staff ratios tell us? What confounds the analysis (e.g., transcription outsourcing)? What do weighted avgs tell us? Area 2 Staff Function Analysis - Sinai Divisional Central Administration 11

12 Administrative Staffing Ratios and Analysis (Function) Sinai 220* Faculty Function Admin Ratio Count Overall w/o Faculty HS Management Faculty Administrator Faculty Analyst 5 44 Faculty Admin 31 7 Faculty Asst./Coord. *Excludes Cardiology and Hem/Onc faculty Area 3 Clinical Trials Staffing Analysis 5 Divisions Cardiology, Pulmonary, Nephrology, Endocrine, Rheumatology Metrics: 1. Pay band analysis (Clinical Trial FTEs) 2. Productivity analysis (Expenditures per FTE) 12

13 Clinical Trial FTE Analysis - MUSC Payband Analysis for Clinical Trial FTE (using weighted average) ) DOM Weighted Average 3.34 n=6 n=17 n=2 n=4 n=4 Weighted Avg Qs What does weighted avg tell us (e.g., why is Rheumatology a pay band lower?) What factors determine pay band/type employee needed? Remember Rheumatology now productivity. 13

14 Productivity of Clinical Trial FTE- MUSC Clinical Trial Expenditures per FTE DOM Average $82.8 $/FTE What does $/FTE tell us? What confounds comparing Divisions directly (e.g., study complexity intervention, #/type of Rx & internal costs, sponsor type, budget negotiations)? 14

15 Trial Productivity Qs Why expenditures (not net residual-- profit)? Don t expenditures inversely effect the bottom line? What metrics = productivity (pts. enrolled, net residual, covered PI effort/incentive, success/reputation, ability to share coordinator FTE?) Area 4 - Clinical Faculty Practice Plan - Sinai Using established benchmarks to conduct a rightsizing analysis 15

16 Methodology and Data Sources Methodology: Identify and define the FPA functions across the department (billing office and practices) and quantify total FTE counts and compare to industry staffing benchmarks Data sources: Actual FTE counts MSSM HR employee rosters of the central billing office (div #65), the FPA Practices (div #70), and some specialty divisions (div #35, 37, etc ) Benchmarks MGMA Publication, The Physician Billing Process, Deborah Walker, Sara Larch, and Elizabeth Woodcock; MGMA 2007 Multispecialty Cost Survey, Table 1.6a Central Billing Office Functions Insurance Verification Charge Entry Accounts Receivable Payment Posting Refunds 16

17 Accounts Receivable Reps Functions: perform follow-up calls to insurance carriers and patients for accounts older than 60 days. Benchmark used: according to MGMA publications an A/R FTE should be able to work 110 accounts per day, and each account older than 30 days should be follow- up once per month Actual Production: we took random daily counts of accounts older than 30 days and found the daily average to be 28k. Payment Posters Functions: include manual posting of payments received by all payors except Medicare and Medicaid which is done electronically. Medicare and Medicaid represents about 26% of our payment mix. Benchmark used: according to MGMA publications the range of payments posted per FTE should be between transactions per day with the assumption that payment lag time is same day or within 24 hrs. Actual Production: the daily average of payments posted from Oct thru Dec was 1,538 payment transactions per day. (Min. per day = Max. per day = ) 17

18 Practice Functions Scheduling Front Desk Registration Medical Secretaries Clinical Support Staff Scheduling (DOM Call Center) Functions: scheduling appointments with full registration Benchmark used: according to MGMA publications a scheduler FTE should be able to schedule appointments with full registration per day. Actual Production: Daily average =490 (7/1/08 2/28/09) Monday Tuesday Wednesday Thursday Friday 18

19 Front Desk Registration Functions: includes check-in, scheduling and cashiering. Benchmark used: according to MGMA publications i a front desk registrar should be able to process patients per day. Actual Production: the daily average of arrived patients was 65 (min. = 12 max. = 109) for the 8 th floor multispecialty practice, and 136 (min. = 20 max. = 186) for the 11 th floor multispecialty practice th Floor th Floor Monday Tuesday Wednesday Thursday Friday 0 Monday Tuesday Wednesday Thursday Friday Medical Secretaries Functions: Rx refills, obtaining referrals and authorizations, transcriptions, patient correspondences, and other patient related services. Benchmark used: according to MGMA 2007 Cost Survey for multispecialty practices, the average medical secretary support is.9 FTE for every 1 MD FTE. Actual Production: 8th floor 46.5 MD sessions/10 sessions = 4.65 MD FTEs 11th floor MD sessions/10 sessions = MD FTEs 19

20 Clinical Support: MAs, RNs, and NPs Functions: providing clinical support to providers Benchmark used: according to MGMA 2007 Cost Survey for multispecialty practices, the average clinical support: 1 MA FTE for every 1 MD FTE.49 RN/NP FTE for every 1 MD FTE Actual Production: 8th floor 46.5 MD sessions/10 sessions = 4.65 MD FTEs 11th floor MD sessions/10 sessions = MD FTEs Results of Analysis Actual FTEs FTEs required based on Benchmark FRONT DESK MAs MEDICAL SECR. 1 RN/NPs FRONT DESK MAs MEDICAL SECR RN/NPs A/R PAYMENT POSTING SCHEDULING 11th fl Practices 8th fl Practices BILLING OFFICE CALL CENTER 20

21 Variances and Corrective Actions: Billing Area Variance Corrective Action Accounts Receivable overstaffed by 3.3 FTEs Planning to eliminate these positions through attrition Payment Posting overstaffed by 5 FTEs Further reviewing of payment posting functions needs to be conducted to determine validatity Variances and Corrective Actions: Practice Area Variance Corrective Action 11 th floor MAs Understaffed by 2 MAs Planning to fill 2 empty MA positions 8 th and 11 th fl medical secretaries 8 th floor is overstaffed by 2 FTEs Centralize medical secretary functions for both floors to benefit from flexible resource allocations and cross coverage based on demand. Eliminate 2 positions 21

22 Staffing Ratios Q & A Thank You Summary How do you assess staff FTE efficiency? What other work output metrics should be assessed relative to FTE? 22

23 Issues Feedback Emergency Medicine Fellow Coordinator? Clinical Trial core nucleus? Pro-rated PhD? New Div X core weighted avg? 23