Table of Contents Overview Introduction Purpose... x Description... x What s New?... x Data Collection... x Response Rate... x How to Use This Report Report Organization... xi Appendices... xi Additional Information... xi Statistical Interpretation A User s Guide Introduction... xii Interpreting the Data... xii Using the Survey Report... xii Demographics Section One Demographics Not Hospital or IDS Owned 1: Responses Received... 2 2: Geographic Section... 2 3: HHS Region... 2 4: Demographic Classification... 2 5: Legal Organization... 2 6: Organization Ownership... 2 7: State... 3 8: Single-Specialty Group Type... 3 9: Federally Qualified Health Center... 3 10: Rural Health Center... 4 11: MSO or PPMC Provided Services... 4 12: Square Footage of All Facilities... 4 13: Number of Branch Clinics... 4 14: Practice Derived Revenue from Capitation Contracts... 4 15: Total Medical Revenue... 4 16: Net Capitation Revenue Percentage of Total Medical Revenue... 4 17: Tax Reporting Accounting Method... 5 18: Internal Management Accounting Method... 5 19: Re-Age Accounts Receivable... 5 20: FTE Physicians... 5 21: FTE Nonphysician Providers... 5 22: FTE Providers... 5 23: Nonphysician Providers per FTE Physician... 5 24: FTE Support Staff Category... 6 25: Number of Exam/Treatment Rooms... 6 26: Number of Exam/Treatment Rooms per Physician... 6 27: Number of Exam/Treatment Rooms per Nonphysician Provider... 6 28: Dedicated Staff Model... 7 29: Upper Age Limit Allowed... 7 30: Practice Used Immunization Registry... 7 31: Charged Processing Fee for Services... 7 32: Processing Fee Amount Charged for Services... 7 33: Staff Completing Medical Forms... 7 2011 Medical Group Management Association. All rights reserved. page vii
34: Nonphysician Provider Staffing... 8 35: Practice Panel Size... 8 36: Number of Referrals... 8 37: Hours to Complete Survey Questionnaire... 8 Demographics Hospital or IDS Owned 1: Responses Received... 9 2: Geographic Section... 9 3: HHS Region... 9 4: Demographic Classification... 9 5: Legal Organization... 9 6: Organization Ownership... 9 7: State... 10 8: Single-Specialty Group Type... 10 9: Federally Qualified Health Center... 10 10: Rural Health Center... 10 11: MSO or PPMC Provided Services... 11 12: Square Footage of All Facilities... 11 13: Number of Branch Clinics... 11 14: Practice Derived Revenue from Capitation Contracts... 11 15: Total Medical Revenue... 11 16: Net Capitation Revenue Percentage of Total Medical Revenue... 11 17: Tax Reporting Accounting Method... 12 18: Internal Management Accounting Method... 12 19: Re-Age Accounts Receivable... 12 20: FTE Physicians... 12 21: FTE Nonphysician Providers... 12 22: FTE Providers... 12 23: Nonphysician Providers per FTE Physician... 12 24: FTE Support Staff Category... 13 25: Number of Exam/Treatment Rooms... 13 26: Number of Exam/Treatment Rooms per Physician... 13 27: Number of Exam/Treatment Rooms per Nonphysician Provider... 13 28: Dedicated Staff Model... 14 29: Upper Age Limit Allowed... 14 30: Practice Used Immunization Registry... 14 31: Charged Processing Fee for Services... 14 32: Processing Fee Amount Charged for Services... 14 33: Staff Completing Medical Forms... 14 34: Nonphysician Provider Staffing... 15 35: Practice Panel Size... 15 36: Number of Referrals... 15 37: Hours to Complete Survey Questionnaire... 15 All Primary Care Practices Section Two Primary Care, Cost by Hospital Ownership (per FTE Physician)... 18 Coding Profiles: All Primary Care Practices, Not Hospital or IDS Owned... 19 Coding Profiles: All Primary Care Practices, Hospital or IDS Owned... 21 Table 1: All Primary Care Practices, Not Hospital or IDS Owned... 23 Table 2: All Primary Care Practices, Hospital or IDS Owned... 35 Family Practices Section Three Family Practice Revenue and Cost by Nonphysician Provider to Physician Ratio (per FTE Physician)... 48 Coding Profiles: Family Practice, Not Hospital or IDS Owned... 49 Coding Profiles: Family Practice, Hospital or IDS Owned... 53 Table 3: Family Practice, Not Hospital or IDS Owned... 57 Table 4: Family Practice, Hospital or IDS Owned... 69 page viii 2011 Medical Group Management Association. All rights reserved.
Table 5: Family Practice, Hospital or IDS Owned by NPP to FTE Physician Ratio... 81 Table 6: Family Practice, Not Hospital or IDS Owned by Geographic Section... 87 Table 7: Family Practice, Hospital or IDS Owned by Geographic Section... 93 Table 8: Family Practice, Not Hospital or IDS Owned by FTE Physician... 99 Table 9: Family Practice, Hospital or IDS Owned by FTE Physician... 105 Internal Medicine Practices Section Four Internal Medicine Revenue and Costs, Hospital or IDS Owned (per FTE Physician)... 112 Table 10: Internal Medicine, Hospital or IDS Owned... 113 Obstetrics and Gynecology Practices Section Five OB/GYN Total Medical Revenue after Operating Costs by NPP to FTE Physician Ratio (per FTE Physician)... 126 Coding Profiles: OB/GYN... 127 Additional OB/GYN Demographics... 136 Table 11: Obstetrics and Gynecology, Not Hospital or IDS Owned... 137 Table 12: Obstetrics and Gynecology by NPP to FTE Physician Ratio... 151 Table 13: Obstetrics and Gynecology by Geographic Section... 157 Table 14: Obstetrics and Gynecology by FTE Physician... 163 Pediatric Practices Section Six Pediatrics Revenue and Costs, Not Hospital or IDS Owned (per FTE Physician)... 170 Coding Profiles: Pediatrics, Not Hospital or IDS Owned... 171 Table 15: Pediatrics, Not Hospital or IDS Owned... 175 Table 16: Pediatrics, Hospital or IDS Owned... 187 Table 17: Pediatrics, All Practices by NPP to FTE Physician Ratio... 199 Table 18: Pediatrics, All Practices by Geographic Section... 205 Table 19: Pediatrics, Not Hospital or IDS Owned by FTE Physician... 211 Table 20: Pediatrics, Hospital or IDS Owned by FTE Physician... 217 Multispecialty with Primary Care Only Practices Section Seven Multispecialty, Primary Care Only Support Staffing by Hospital Ownership (per FTE Physician)... 224 Coding Profiles: Multispecialty, Primary Care Only, Not Hospital or IDS Owned... 225 Table 21: Multispecialty with Primary Care Only, Not Hospital or IDS Owned... 229 Table 22: Multispecialty with Primary Care Only, Hospital or IDS Owned... 241 Appendices Appendix A: Abbreviations, Acronyms, and Geographic Sections... 254 Appendix B: Terms Used in the Report... 256 Appendix C: Formulas and Methodology... 264 Appendix D: MGMA Survey Products... 267 Appendix E: Cost Survey for Primary Care Practices: 2011 Questionnaire Based on 2010 Data... 269 Appendix F: Cost Survey for Primary Care Practices: 2011 Guide to the Questionnaire Based on 2010 Data... 287 2011 Medical Group Management Association. All rights reserved. page ix
Overview Introduction Purpose In an effort to keep up with changing times, MGMA surveyed its members and nonmembers to obtain the most recent primary care cost data. MGMA s Cost Survey for Primary Care Practices Report is an essential benchmarking tool for primary care practices that allows medical group executives to compare their performance to similar practices. You can also use the report to identify and evaluate the factors affecting productivity and costs. Description In this report you will find Complete data from 932 primary care practices, including staffing ratios, staff costs, medical revenue, total operating costs, revenue after operating costs, provider cost, and net practice income or loss; Data on accounts receivable, payer mix, collection percentages, and financial ratios; Procedure and revenue collections on current procedural terminology (CPT) codes, including the most reported evaluation and management (E&M) codes, including total office/outpatient visits for new patients and total new and previous visits for established patients; Unique tables by NPP to FTE physician ratio; Tables categorized by hospital- and not hospital-owned practices; and Demographic data broken down by primary care specialty, geographic section, and number of FTE physicians. What s New? New format to include all specialty-specific information in one place: graphs, coding, and tables; Revenue from hospital subsidies; Months adjusted fee-for-service charges in AR; and Days adjusted fee-for-service charges in AR. Data Collection Invitations were mailed in February 2011 to both MGMA member and nonmember organizations that include both medical group practices and other types of organizations involved in physician practice management. Printed invitations were mailed to selected organizations that were or were presumed to be affiliated with medical practices. Invitations to participate were also e-mailed to medical practices. Response Rate The table illustrates the response rate. Medical Practices Count Percent Questionnaires mailed 399 100.00% Undeliverable 13 3.26% Questionnaires reaching recipients 386 96.74% Responses 937 242.75% Electronic versions 937 100.00% Paper surveys 0 0.00% *Ineligible or incomplete surveys 5 0.53% Completed surveys included in the report 786 **Gross response rate 242.75% ***Net response rate 241.45% *Missing required answers; not a full year of data; academic practices or ambulatory surgery centers. **(Number of responses divided by the number of questionnaires reaching recipients) 100. ***((Responses minus ineligible or incomplete surveys) divided by questionnaires reaching recipients) 100. page x 2011 Medical Group Management Association. All rights reserved.
How to Use This Report Report Organization Seven sections appear in the report: 1. Demographics provides various respondent demographic tables, such as state, ownership, and number of FTE physicians. 2. All Primary Care Practices provides tables for all respondents, including key performance indicators and specialtyspecific coding, as well as data for accounts receivable, procedures, total medical revenue, gross charges and revenue by payer type, staffing, ancillary services, operating costs and charges, revenue, and net income or loss. 3. Family Practices provides tables for all family practice respondents, including key performance indicators and specialty-specific coding, as well as data for accounts receivable, procedures, total medical revenue, gross charges and revenue by payer type, staffing, ancillary services, operating costs and charges, revenue, and net income or loss. 4. Internal Medicine Practices provides tables for hospital-owned internal medicine respondents, including key performance indicators and specialty-specific coding, as well as data for accounts receivable, procedures, total medical revenue, gross charges and revenue by payer type, staffing, ancillary services, operating costs and charges, revenue, and net income or loss. 5. Obstetrics and Gynecology Practices provides tables for not hospital- or IDS-owned obstetrics and gynecology respondents, including key performance indicators and specialty-specific coding data, as well as data for accounts receivable, procedures, total medical revenue, gross charges and revenue by payer type, staffing, ancillary services, operating costs and charges, revenue, and net income or loss. 6. Pediatric Practices provides tables for all pediatric respondents, including key performance indicators and specialty-specific coding, as well as data for accounts receivable, procedures, total medical revenue, gross charges and revenue by payer type, staffing, ancillary services, operating costs and charges, revenue, and net income or loss. 7. Multispecialty with Primary Care Only Practices provides tables for all multispecialty practices with primary care only respondents, including key performance indicators and specialty-specific coding, as well as data for accounts receivable, procedures, total medical revenue, gross charges and revenue by payer type, staffing, ancillary services, operating costs and charges, revenue, and net income or loss. Appendices More information can be found in the appendices that explain how the information is collected and defined in the survey and report. Appendix A contains a list of abbreviations and acronyms used in the report, as well as the states included in the geographic sections. Appendix B contains a glossary of common survey terms and the term definitions. Appendix C contains formulas and methodology used in the report. Appendix D lists MGMA s survey products. Appendices E and F feature the 2011 Cost Survey for Primary Care Practices Questionnaire and Guide to the Questionnaire as references. Additional Information Visit mgma.com for more information about the surveys and reports and to find future educational Web casts. Any updates to this report can also be found on mgma.com. To order MGMA products, visit the Store on mgma.com or call toll-free 877.ASK.MGMA (275.6462), ext. 1888. 2011 Medical Group Management Association. All rights reserved. page xi
Statistical Interpretation A User s Guide Introduction The following descriptive statistics summarize financial and operational characteristics of the medical groups that participated in the survey. The statistics displayed in tables include Count the number of practices that reported the data used to create the variable; Mean the arithmetic average calculated by summing the data and dividing by the count; Standard deviation an index of the variability of the data values for any given variable; 10th percentile the value where one tenth (10 percent) of the responses are lower; 25th percentile the value where one quarter (25 percent) of the responses are lower; Median the midpoint of all responses when arrayed from lowest to highest; 75th percentile the value where three quarters (75 percent) of the responses are lower; and 90th percentile the value where nine tenths (90 percent) of the responses are lower. Each data section or cut contains multiple tables. Generally, each table of the report contains normalized information, such as per physician or as a percentage of total medical revenue, to normalize the impact of practice size and scope and to readily facilitate comparison. Interpreting the Data An exception to the above directive occurs in Table *.2 and Table *.3, where the Accounts Receivable and Collection Percentages and Percentage Breakout of Total Gross Charges and Total Medical Revenue by Type of Payer information includes related, consecutive variables. In these tables, the respondent answered consecutive questions that sum to a total dollar amount or 100 percent, respectively, and the count statistic is the same for all variables. For these variables, the mean or average is the best value to use, and when summed, they depict the relative relationship of the variables. The median values usually sum close to 100 percent if the distribution approximates a normal curve. However, if the distribution has very high or low values, this does not occur. Also, in the instance of variables that add to 100 percent, the situation exists that a zero value can be reported; for example, in the Percentage Breakout of Total Gross Charges and Total Medical Revenue by Type of Payer table, some respondents reported 0 percent capitation revenue. The mean value for capitation revenue percentage (4.39 percent) represents the average capitation for the respondents in the survey. However, the median is 0 percent, since a significant number of respondents reported no capitation percentage. Standard deviation measures the extent of variability within the data set. A standard deviation similar in value to the mean indicates dispersed data and a weak central tendency. A standard deviation less than a third of the mean indicates data clustered tightly around the mean and a strong central tendency. Using the Survey Report In examining the data presented in the report, medical group management professionals and other report users should consider the following: 1. What is the difference between your facility s data and the report median (or mean, if appropriate)? 2. Does the difference, if any, indicate that your medical group s performance is significantly out of line with the survey statistics? A substantial difference identifies an area that might require managerial attention. 3. Are the differences explainable? For example, the method of data collection, survey definitions, special circumstances, and/or organization objectives can affect the outcome of comparison analysis. 4. By what methods can the cost indicator be internally and/or externally changed or controlled? 5. How should your medical group measure performance for this indicator? Do your systems and processes allow for the appropriate assessment of the cost indicator? page xii 2011 Medical Group Management Association. All rights reserved.