Medical University of South Carolina Department of Medicine. The Mount School of Medicine The Samuel Bronfman Department of Medicine.

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1 AIM WEBINAR Staffing Ratios January 13 th, 2010 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

2 Background: Why staffing ratios? AIM Membership: Listserve (3/09) Primary Care staffing benchmarks? Lack of existing data and formal surveys with certain domains Space Limitations MUSC: Clinical Trial Management Sinai: Cost Reduction Initiatives

3 4 Areas of Analysis Education residency and fellowship ratios General/Core Admin faculty/staff ratios; pay-band weighted avg; staff by function Research (MUSC) pay-band weighted avg & expenditures/fte Clinical (Sinai) faculty practice rightsizing using MGMA benchmarks

4 Sinai Who We Are 11 DIVISIONS People Many Backgrounds Clinical Immunology Cardiology Clinicians 287 Faculty Members Clinician-Investigators Investigators Gastroenterology Endocrinology Hepatology General Internal Medicine Hematology/Oncology Infectious Diseases Nephrology Pulmonary & Critical Care Rheumatology 350 Contributed Service Faculty Members 84 Fellows 137 Residents 763 Staff Members Provide 10 hours of voluntary services for the DOM 14 Programs Matched from 49 Schools Includes both MSSM and MSSM FPA employees

5 MUSC Who We Are 11 DIVISIONS 700+ People Many Backgrounds Biostatistics/Epidemiology Cardiology 294 Faculty Members Clinicians Clinician-Investigators Investigators Emergency Medicine Endocrinology 76 Fellows 8 Fellowship Programs GI and Hepatology General Internal Medicine Hematology/Oncology Infectious Diseases Nephrology 98 Residents Matched from 18 Schools 28 Post-docs and In 8 Divisions Graduate students Pulmonary & Critical Care Rheumatology 242 Staff University and UMA employees

6 Education Staffing Residents and Staff Residents 49:1 ratio 33:1 ratio n=98 n=137 Fellows and Staff Fellows 20:1 ratio 21:1 ratio n=80 n=84

7 Education Summary Qs What FTE support does ACGME require? Answer: not-defined What are your Education ratios?

8 General Administration Core administration staff Departmental and Divisional Administration, fiscal techs, HR, A&P, IT, admin support excludes direct practice and research staff

9 General Administration - MUSC Faculty to Staff Ratios for Selected Divisions i i faculty and staff Com mbined # of 2 to 1 n=34 faculty 2.6 to 1 n=17 faculty to t to 1 n=23 faculty 3.1 to 1 n=14 faculty n=23 faculty Overall, 3.4 faculty to 1 staff ratio in Divisions

10 General Administration: 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)

11 Payband Analysis Results MUSC (DOM avg = 1.57) DOM Weighted Average Card Pulm Neph Endo Rheum

12 General Admin: Questions to consider What do the faculty/staff ratios tell us? What confounds the analysis (e.g., transcription outsourcing)? What do weighted avgs tell us?

13 General Admin Functional Staff Analysis - Sinai Divisional Central Administration

14 Administrative Staffing Ratios and Analysis (Function) Sinai 220* Faculty Function Admin Ratios Count Overall Faculty : 1 Admin FTE Management Faculty : 1 Management FTE -Administrator Faculty : 1 Administrator FTE Analyst 5 44 Faculty : 1 Analyst FTE Admin Asst./Coord Faculty : 1 Admin Asst./Coord. FTE *Excludes Cardiology and Hem/Onc faculty

15 Clinical Trials Staffing Analysis 5 Divisions Cardiology, Pulmonary, Nephrology, Endocrine, Rheumatology Metrics: 1. Pay band analysis (Trial Coords) 2. Productivity it analysis (Expenditures per FTE)

16 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

17 Productivity of Clinical Trial FTE- MUSC Clinical Trial Expenditures per FTE DOM Average $82.88

18 $/FTE What does $/FTE tell us? What confounds comparing Divisions using expenditures (e.g., study complexity intervention, intervention, internal costs, sponsor type, budget negotiations)?

19 Clinical Faculty Practice Plan - Sinai Staffing Rightsizing Analysis: Central Billing Office and Clinical Practice Operations

20 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

21 Central Billing Office Functions Insurance Verification Charge Entry Accounts Receivable Payment Posting Refunds

22 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. (28k 1 per month = (28k/~21 21 working days = 1.3k accounts per day)

23 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.

24 Clinical Practice Functions Scheduling Front Desk Registration Medical Secretaries Clinical i l Support Staff

25 Scheduling (DOM Call Center) Functions: scheduling appointments with full registration i 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

26 Front Desk Registration Functions: includes check-in, scheduling and cashiering. Benchmark used: according to MGMA publications a front desk registrar should be able to process patients per day. Actual Production: the daily average of arrived patients t 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 Monday Tuesday Wednesday Thursday Friday th Floor Monday Tuesday Wednesday Thursday Friday

27 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

28 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

29 Results of Analysis Actual FTEs FTEs required based on Benchmark FRONT DESK MAs MEDICAL RN/NPs FRONT DESK MAs MEDICAL RN/NPs A/R PAYMENT SCHEDULING SECR. SECR. POSTING 11th fl Practices 8th fl Practices BILLING OFFICE CALL CENTER

30 Summary & Conclusion What do these ratios mean to you? Nothing, until we have larger sample size Variables to consider when comparing ratios: org. structure, processes, technology, etc.. Clinical l MGMA and UHC FPSC Education, General Admin, and Research all have greatest potential for development AIM (Data Survey)

31 Staffing Ratios Q&A Thank You