AOA 2010 Practice Benchmarking Survey (Sample to Guide Data Collection for the Online Instrument)
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1 AOA 2010 Practice Benchmarking Survey (Sample to Guide Data Collection for the Online Instrument) A. Services & Income 1. What services does your practice provide? Aesthetician Allergy - Intradermal testing or skin endpoint titration testing Allergy - RAST Testing Allergy - Sublingual Allergy Testing Assisted Listening Devices CT Scans Clinical Trials Diagnostic Audiology Testing Durable Medical Equipment Sales Other: please specify Facial Plastic and Reconstructive Surgery Hearing Aids Sales Physical Therapy Physician Assistant/Nurse Practitioner Skin Care Products Sleep Services Speech Therapy Thyroid Ultrasounds Transnasal Esophogoscopy If applicable, what is the name of the CT manufacturer? 2. What percentage of your total practice payments are from each of the following? (you can answer to one decimal place if possible) Cash/Self Pay... % Commercial (HMO/PPO/POS)... % Medicaid... % Medicare... % Capitation... % Other payments... % Total 100% 3. For your entire practice, please indicate: Gross # hearing aid units sold:... # of hearing aid units returned:... Net # of hearing aid units sold: Which strategic Initiatives apply to your practice over the next 12 to 24 months? Looking to hire a new doctor Considering purchase of new practice management system Planning on merging with another practice Considering implementing a new EMR system Relocating any of its existing office locations Considering change from existing EMR system to new Opening any additional office locations EMR system Considering addition of new ancillary services Implementing new EMR system Other (specify) B. Practice Characteristics 1. Is your practice managed by a Management Company or Managed Service Organization? Yes No 2. In what type of setting does your practice operate? Academic Practice Private Group Practice-Single Specialty Primary Practice-Solo Practitioner Private Group Practice-Multiple Specialty Hospital-owned Other setting 3. Please indicate the following: Total full time equivalent (FTE) physicians in your practice:... Total full time equivalent (FTE) staff in your practice:... Total full- and part-time office locations (where patients are seen):... Standard charges as an average percentage of Medicare (any value above 100%: i.e. 150%, 200%, 250%, etc.)...
2 4. Please indicate the total FTEs (full time equivalents) working in your practice*: Physicians... Clinical... Nurse Practitioner... Administrative... Physician Assistant... Other... * If an employee has multiple job responsibilities, select the ONE job title that most represents the position. Count each employee only once. 5. Is your practice using an EMR? No Yes: if yes, what is the name of the software you use? C. Financial Performance 1. Provide practice financial data for FY2008 from your Income and/or Production Reports from your billing system: 2009 Gross Charges... $ 2009 Total Adjustments*... $ 2009 Gross Receipts... $ 2009 Refunds (Insurance & Patient)... $ 2009 Net Collected Receipts**... $ * Write Offs to Include Contractual Discounts/Bad Debt/etc ** Total Practice Revenues - Total Practice Refunds Aged Accounts Receivable - FYE 2009 Accounts Receivable 0-30 Days in Dollars... $ Accounts Receivable Days in Dollars... $ Accounts Receivable Days in Dollars... $ Accounts Receivable Days in Dollars... $ Accounts Receivable 120+ Days in Dollars... $ Total Accounts Receivable in Dollars... $ Annual Fiscal Expenses by Type (exclude all Physician Related Expenses) Advertising/Marketing... $ Equipment Leases - Medical Equipment... $ Equipment Leases - Office Equipment... $ Non Physician Employees - Benefits... $ Non Physician Employees - Salaries & Wages... $ Rent... $ Repairs & Maintenance... $ Supplies - Office and Printing... $ Supplies - Hearing Aids... $ Supplies - Hearing Aid Supplies & Batteries... $ Supplies - Medical, Drugs & Laboratory... $ Telephone... $ Utilities... $ Other*... $ Total (non-physician related) Practice Expenses... $ * Please exclude all physician (shareholder and non-shareholder) salary and benefit costs. *Please indicate "other" expenses from Question C2 above.
3 FYE 2009 Ancillary Services 3. What percentage of your entire practice's Net Collections come from Ancillary Services? % Please include all net collections from services provided by non-physicians: include Aesthetician, allergy - intradermal testing or skin endpoint titration testing, allergy - RAST testing, allergy - sublingual allergy testing, assisted listening devices, ct scans, clinical trials, diagnostic audiology testing, durable medical equipment sales, hearing aids sales, physical therapy, skin care products, sleep services, speech therapy, thyroid ultrasounds, transnasal esophogoscopy, 4. Do you allocate indirect costs to the departments listed in Question C5 below? Yes: If yes, please answer C5 No: If no, skip to Section D 5. What are your net collected receipts and expenses for: Net Collected Receipts Allergy... $ $ Audiology... $ $ In-office Radiologic Imagery... $ $ Departmental Expenses D. Productivity and Compensation of Physicians and PAs/NPs 1. For your overall practice in FY2009, indicate the following weekly productivity totals by physician in terms of hours worked and patient. Indicate data for all physicians (up to 10 in the online survey, up to 100 through the provided spreadsheet). If physician is the managing partner, list as #1 and check designated box. Managing Partner Total hours providing patient care in office Total hours providing patient care in office For your overall practice in FY2009, indicate the following annual productivity totals by physician in terms of hours worked and patient. New patient Established patient Total patient consultations / Total no charge pre-/post-op patient Please indicate charges, receipts, adjustments, and refunds by physician: Gross Charges Gross Receipts Refunds Net Receipts Adjustments
4 2. For your overall practice in FY2009, indicate the following malpractice expenses and policy data: Malpractice Insurance Expanse Medical Malpractice Policy Limits Main Scope of Practice Compensation Type 3. How many times did each physician charge for the following CPT Codes? In-office Sinus/Temporal Allergy Audiology Office Procedures Bone CT Scans Surgical Case Volume* Allergy: 82785, 86001, 86003, 86005, 87880, 95004, 95010, 95015, 95024, 95027, 95028, 95044, 95115, 95117, 95120, 95125, 95144, Include sublingual codes Audiology: , , , , , , 92571,92573, , 92579, , , , 92620, 92621, , 92630,92633 In-office Sinus/Temporal Bone CT Scans: 70480, Office procedures: 30901,30903,30905,30906,31231,31237,31575,31579,69210,69220,69222,70486,92504,92511 *Indicate the annual number of separate surgical cases completed in the operating room by this provider. As an example, one sinus surgery with 10 procedures (CPT Codes) would count as one surgical case. 4. Tell us the following regarding compensation for each physician in your practice: (please exclude malpractice insurance premiums, cell phones from this total) Direct compensation and bonus income (reported on W-2/K-1) * Refer to Box 5 on W-2 or Part 3 Box 1 on K-1 Total value of benefits received* Total compensation (all sources) Status within practice (drop down box) 5. What benefits are typically included in the compensation of each physician in your practice owner/partners and other? (check all that apply) Owner/Partner Non-Owner/ of practice Associate Health/Dental Insurance Disability Insurance Life Insurance Retirement Plan Contributions CME Travel Costs Professional Dues Professional Licenses Automobile Lease(s) Other benefits (specify)
5 6. For your overall practice in FY2009, indicate annual data by physician assistant/nurse practitioner in terms of hours worked and patient : Total hours providing patient care in office New patient Established patient # patient consultations / # no charge pre- /post-op patient Please indicate charges, receipts, adjustments, and refunds by each PA/NP in your practice: Gross Charges Gross Receipts Refunds Net Receipts Adjustments 6. Tell us the following regarding compensation for each physician assistant or nurse practitioner in your practice: (please exclude malpractice insurance premiums, cell phones from this total) * Refer to Box 5 on W-2. Direct compensation and bonus income (reported on W-2) Total value of benefits received* Total compensation (all sources) Thank you for participating in this study. Association of Otolaryngology Administrators * WM&R * * info@kwhorton.com
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