eardon onsulting, Inc. An Affiliate of The Reardon Group Healthcare, Financial & Management Consulting The Practice Financial Performance Report A Practice Performance Report benchmarks a medical practice against MGMA norms for revenue and costs, balance sheets, staffing (FTE and costs), A/R and ratios. We can benchmark a medical practice using any of the more than 700 variables in the Cost Survey report. Benchmarking operations represents more than establishing targets for expenditures. The report results should be developed through a process in which all providers including the Medical Group s Executive Management Director team (hereinafter MGMD) participate. Cost and productivity issues between providers come into clear view during this process, underscoring the need for administrative and physician leadership. For instance, the process will expose opportunities for integrating systems, facilitate dialogue among the stakeholders in the practice, and ultimately serve as a catalyst for changes in the operation. The process of benchmarking will surface issues related to physician production, expectations for changes to the case mix and/or insurance mix and opportunities to maximize revenue through fee schedule changes. Reporting The reporting and analysis of operating results through financial statements must be done according to a consistent methodology. Medical practices historically report performance on the cash basis of accounting differing from the accrual methods utilized by larger businesses including hospitals. The differences in the two accounting systems are significant. For example, accrual accounting reports income when services are rendered, whereas cash basis accounting recognizes the income when the payment is received. Because physician practices are not endowed with substantial working capital, the overriding financial issue is whether there is enough cash on hand to pay expenses. In this regard, accrual accounting can provide misleading information. Furthermore, recognizing the income when services are rendered will have tax implications for the physician practice as a cash basis taxpayer, an issue that does not concern commercial enterprises and bigger businesses. Main Office Telecommunications: Internet 27 Regency Plaza Main Phone: 610 459-9300 E-Mail: trg@thereardongroup.com 871 Baltimore Pike DE Phone: 302 656-5530 Web Site: www.thereardongroup.com Glen Mills, PA 19342 Fax: 610-459-5122
Performance Measures and Benchmarking Actual performance should be compared with benchmarked performance to monitor the financial health of the practice. External data can also be extremely useful for comparing practice performance against national and other norms. Just as the physician monitors medical vital signs such as heart rate, blood pressure and respiration in determining the health and well being of the patient, the Medical Group s Executive Management team must monitor their practice s financial vital signs in determining the financial health and well being of the medical practice in order to identify opportunities for practice performance enhancement. Expenses The financial health and well being of the physician practice is not determined solely by the flow of money into the practice; however, the practice s ability to manage its finances prudently is critical. Although the physician leadership should monitor all expenses, three expense categories provide them with a strong indication of practice performance: Total non-provider operating expenses, Staff salaries, and Provider compensation. Non-provider operating expenses (excluding provider compensation and costs of provider benefits) are expenses incurred to operate the practice and should be compared to the benchmark. Staff and physician salaries represent the wages each group receives. Since human resource expenses are the largest costs incurred by medical practices, these expenses should be closely monitored. In summary, the Practice Performance Report provides the physician leadership with the key elements that indicate the financial health and well being of their medical practice. Sample Practice Data In the following Tables we depict the practice operating results of a 3 Full Time Equivalent (FTE) physician medical practice specializing in Anesthesiology. Page 2 of 11
Table 1 depicts the practice data as reported on the cash basis for one full tax accounting year which has been recast into the same categories of Revenues and Expenses utilized in the MGMA Annual Cost Survey datasets. TABLE #1: Income Statement (% of Total Medical Revenue) 12/06 Revenue (% of Total Medical Revenue) $ Percent Table 5a Net fee-for-service collections/revenue $1,418,068 90.78% Net capitation revenue $120,436 7.71% Net other medical revenue $23,616 1.51% Total medical revenue $1,562,120 100.00% Net nonmedical revenue $0 0.00% Total revenue $1,562,120 100.00% %NMR Cost (% of Total Medical Revenue) 12/06 Table 5b Operating Cost $ Percent Total business operating staff $84,987 5.44% Total front office support staff $102,939 6.59% Total clinical support staff cost $130,931 8.38% Total ancillary support staff cost $45,010 2.88% Total employed support staff benefits $86,483 5.54% Total contracted support staff cost $5,117 0.33% Total support staff cost $455,468 29.16% Information technology $19,098 1.22% Drug Supply $37,825 2.42% Medical and surgical supply $21,086 1.35% Building and occupancy $101,952 6.53% Furniture and equipment $10,407 0.67% Admin supplies and services $29,913 1.91% Professional liability insurance $25,768 1.65% Other insurance premiums $2,981 0.19% Outside professional fees $8,015 0.51% Promotion and marketing $3,305 0.21% Clinical laboratory $33,639 2.15% Radiology and imaging $6,747 0.43% Other ancillary services $5,192 0.33% Billing purchased services $31,441 2.01% Management fees paid to MSO $68,438 4.38% Misc operating cost $16,994 1.09% Cost allocated to practice from parent $145,512 9.32% Total general operating cost $568,312 36.38% Total operating cost $1,023,779 65.54% Page 3 of 11
Table 5c Provider Cost Physician Providers Total physician compensation $490,050 31.37% Total physician benefit cost $78,208 5.01% Total physician cost $568,258 36.38% Nonphysician Providers Nonphysician provider compensation $62,214 3.98% Nonphysician provider benefit cost $12,977 0.83% Total nonphysician cost $75,191 4.81% Provider Consultants Provider Consultant Cost $0 0.00% Total Provider Cost $643,449 41.19% Total Cost $1,667,229 106.73% Page 4 of 11
Table 2 depicts what is commonly referred to as a Common Size table comparison. Here the respective percentages that each dollar category of expense represents in Table 1 is compared converted to a percentage of each dollar of fee collections and the percentage of each dollar of collections that goes toward covering an item of practice expense is then compared to the National (or sometimes regional) benchmark data for your specific practice specialty. From this comparison, the percentage spread for each line item is then noted for the percentage deviance from the suggested normative data for comparison. It is here that the major categories of expense begin to reveal themselves for items such as: Total support staff cost Total general operating cost Total operating cost Total physician cost Total nonphysician cost Total provider cost Total cost From this data it begins to become evident where the major cost overruns (if any) begin to reveal themselves. TABLE #2: Revenues & Cost (% of Total Medical Revenue) MGMA percentile 50 is the benchmark. 12/06 MGMA 12/06 Revenue (% of Total Medical Revenue) Percent Percent % Difference Net fee-for-service collections/revenue 90.78% 97.83% -7.21% Net capitation revenue 7.71% 6.65% 15.92% Net other medical revenue 1.51% 2.16% -30.11% Total medical revenue 100.00% 100.00% Net nonmedical revenue 0.81% Total revenue 100.00% Cost (% of Total Medical Revenue) 12/06 MGMA 12/06 Operating Cost Percent Percent % Difference Total business operating staff 5.44% 6.66% -18.36% Total front office support staff 6.59% 5.76% 14.38% Total clinical support staff cost 8.38% 7.61% 10.14% Total ancillary support staff cost 2.88% 3.62% -20.49% Total employed support staff benefits 5.54% 5.97% -7.25% Total contracted support staff cost 0.33% 0.38% -13.33% Total support staff cost 29.16% 30.23% -3.53% Information technology 1.22% 1.49% -17.84% Page 5 of 11
Drug Supply 2.42% 4.28% -43.46% Medical and surgical supply 1.35% 1.50% -10.01% Building and occupancy 6.53% 6.40% 1.93% Furniture and equipment 0.67% 1.10% -39.49% Admin supplies and services 1.91% 1.55% 23.78% Professional liability insurance 1.65% 2.16% -23.74% Other insurance premiums 0.19% 0.19% 3.14% Outside professional fees 0.51% 0.47% 8.24% Promotion and marketing 0.21% 0.34% -37.59% Clinical laboratory 2.15% 1.86% 15.96% Radiology and imaging 0.43% 0.94% -54.10% Other ancillary services 0.33% 0.55% -39.79% Billing purchased services 2.01% 0.42% 384.99% Management fees paid to MSO 4.38% 3.04% 43.97% Misc operating cost 1.09% 1.37% -20.65% Cost allocated to practice from parent 9.32% 3.98% 134.10% Total general operating cost 36.38% 30.77% 18.24% Total operating cost 65.54% 61.55% 6.48% Provider Cost Physician Providers Total physician compensation 31.37% 33.42% -6.14% Total physician benefit cost 5.01% 5.17% -3.24% Total physician cost 36.38% 39.07% -6.90% Nonphysician Providers Nonphysician provider compensation 3.98% 2.51% 58.61% Nonphysician provider benefit cost 0.83% 0.59% 40.57% Total nonphysician cost 4.81% 3.13% 53.83% Provider Consultants Provider Consultant Cost 0.98% Total Provider Cost 41.19% 42.07% -2.09% Total Cost 106.73% 100.89% 5.79% Footnotes: 1. MGMA benchmark table and selection criteria is: All Multispecialty. 2. Due to rounding "Total" may not equal the sum of the detail numbers. 3. All MGMA data in MGMA columns is from the 2006 report based on 2005 data. Page 6 of 11
Table 3 depicts the staffing averages evidenced by our sample practice to those of the statistical benchmarks evidenced by those comparable competitors in the median staffing range. The far column to the right entitled Ranking suggests in what percentile your practice ranks compared to the benchmark. For instance, total front office support staff at 2.26 FTE for each 1.0 FTE physician in our sample practice is higher than the benchmark of 1.53 FTE for each 1.0 FTE physician and ranks in the 89 th percentile of the benchmark data. Here for example, this higher staffing ratio should be supported by better and higher collections or it may cause the physician owners to question why their practice requires such a heavier staffing complement to that of their peers and perhaps to question what, if anything that they might do to reduce that ratio to a more manageable number (and implied cost). Keep in mind that we always break down the analysis to the most common denominator---1.0 full time equivalent (1.0 FTE). This allows us to properly benchmark our subject practice to the normative data. Thus, where the practice suggests that it has total front office support staff at 2.26 FTE for each 1.0 FTE physician, given that we have 3.0 FTE physicians in our subject practice, then in actuality we have 6.8 FTE front desk personnel involved is servicing the needs of these 3 physicians and their CRNAs (hence, 6.8 FTE divided by 3 FTE practice physicians gives us the comparison of 2.26 FTE front office support staff, per 1.0 FTE physician). A review of this data can serve to reveal opportunities for potential cost reduction or process improvements. Table 3: Staffing Comparison (Per FTE Physician) MGMA percentile 50 is the benchmark. 12/06 1/05-12/05 MGMA 12/06 12/06 Per FTE Per FTE Per FTE % Difference Ranking Support Staff FTE Physician Physician Physician General administrative 0.25 0.00 0.28 9.75% 43% Patient accounting 0.67 0.00 0.64-4.71% 56% General accounting 0.13 0.00 0.08-65.38% 77% Managed care administrative 0.06 0.00 0.07 17.39% 40% Information technology 0.05 0.00 0.11 58.72% 15% Housekeeping, maintenance, security 0.00 0.00 0.08 100.00% Total business oper staff 1.15 0.00 1.16 1.37% 49% Medical receptionists 1.27 0.00 0.97-31.09% 82% Medical secretaries, transcribers 0.28 0.00 0.19-49.46% 65% Medical records 0.44 0.00 0.36-22.35% 65% Other administrative support 0.28 0.00 0.13-125.60% 74% Total front office support staff 2.26 0.00 1.53-48.39% 89% Registered Nurses 0.31 0.00 0.39 19.17% 42% Licensed Practical Nurses 0.67 0.00 0.39-71.03% 69% Medical assistants, nurse aides 0.98 0.00 0.82-18.71% 60% Total clinical support staff 1.96 0.00 1.60-22.10% 76% Page 7 of 11
Clinical laboratory 0.35 0.00 0.30-17.79% 59% Radiology and imaging 0.25 0.00 0.26 3.05% 48% Other medical support services 0.14 0.00 0.27 49.08% 32% Total ancillary support staff 0.74 0.00 0.65-14.31% 59% Total contracted support staff 0.16 0.00 0.08-89.02% 67% Total support staff 6.27 0.00 4.91-27.70% 82% Total Nonphysician Provider FTE 0.33 0.00 0.23-44.93% 70% Total Physician FTE 3.00 0.00 Total Provider FTE 1.33 0.00 1.23-8.40% 69% Footnote: 1. MGMA benchmark table and selection criteria is: All Multispecialty. 2. Due to rounding "Total" may not equal the sum of the detail numbers. 3. All MGMA data in MGMA columns is from the 2006 report based on 2005 data. Page 8 of 11
Table 4 depicts a few key operating characteristics of our Sample practice to the benchmark data and calculates both the percentage difference by our sample practice to those of the statistical benchmarks evidenced by those comparable competitors in the median cost range. The far column to the right entitled Ranking suggests in what percentile your practice ranks compared to the benchmark. For instance, the data suggests that Nonphysician provider compensation as a % of total medical revenue is higher than the median data reported by this Sample practice s peers and that their (the Sample practice s) costs are actually falling into the 74th percentile of those reported in the benchmark data. This might cause the owner physicians in the Sample practice to review their staffing structure to see what, if anything, might be done to improve their competitive advantage. Clearly at 31.37% (or put yet another way, 37 1/3 cents) out of every dollar collected is what is left for them at the end of the day to reward them for their time and efforts. This suggests that at they are being paid only in the 40 th percentile of their peers. Hence 60% of their peers are doing better than they are. Clearly, this is one area that the data suggests warrants a deeper analysis to see how it might be improved. Table 4: Ratio Analysis % Difference MGMA percentile 50 is the benchmark. Ranking 12/06 MGMA 12/06 12/06 Total gross charges (Input) $1,843,488 Total medical revenue as a % of total gross charges 84.74% Nonphysician provider compensation as % of total medical revenue 3.98% 2.51% -58.61% 74% Total nonphysician provider cost as % of total medical revenue 4.81% 3.13% -53.83% 72% Total physician compensation as % total gross charges 26.58% Total physician cost as % total medical revenue 36.38% 39.07% 6.90% 40% Total physician compensation as % total medical revenue 31.37% 33.42% 6.14% 40% Page 9 of 11
Table 5 puts the whole puzzle together and reflects each and every line item of the financial data of the practice. Again the column to the far right gives the percentile ranking that our Sample practice holds in comparison to those of its peers reported for the most recent year in their specialty, Anesthesiology. This too tells a whole story. Our Sample practice is only performing in the 27 th percentile for collections! On a per FTE basis they appear to be are leaving on the table $133,415 in collections for each one of their 3 FTE physicians. That translates into $400,245 in the aggregate among the 3 physician providers. Clearly this is an area that warrants further analysis. The low performance of the collections is probably one major contributor to the higher than median costs that our physicians are experiencing since the cost is being divided by lower than median collections for our 3 physician providers. Their choice may be to concentrate on what they need to do to improve their collections or, in the event that this is going to prove to be limited, then they may want to try to right-size their operations to get their overhead in line with the benchmark so that they can be better rewarded for their investment of their individual time, talent and treasure in their Anesthesiology practice. Table 5 Revenues & Operating Expenses (Per FTE Physician) MGMA percentile 50 is the benchmark. Physician FTE's 12/06 3.00 12/06 MGMA $/FTE $/FTE Physician Physician 12/06 Ranking % Difference 12/06 Revenue (Per FTE Physician) Net fee-for-service collections/revenue $472,689 $601,912-21.47% 27% Net capitation revenue $40,145 $36,582 9.74% 53% Net other medical revenue $7,872 $16,535-52.39% 36% Total medical revenue $520,707 $654,132-20.40% 27% Net nonmedical revenue Total revenue $520,707 Cost (% of Total Medical Revenue) 12/06 MGMA 12/06 Ranking Operating Cost $/FTE Physician $/FTE Physician % Difference 12/06 Total business operating staff $28,329 $44,711-36.64% 20% Total front office support staff $34,313 $39,158-12.37% 39% Total clinical support staff cost $43,644 $50,893-14.24% 30% Total ancillary support staff cost $15,003 $25,776-41.79% 28% Total employed support staff benefits $28,828 $41,359-30.30% 24% Total contracted support staff cost $1,706 $2,498-31.71% 36% Total support staff cost $151,823 $197,991-23.32% 23% Information technology $6,366 $10,736-40.70% 31% Page 10 of 11
Drug Supply $12,608 $26,455-52.34% 23% Medical and surgical supply $7,029 $10,256-31.47% 27% Building and occupancy $33,984 $43,065-21.09% 33% Furniture and equipment $3,469 $7,987-56.57% 23% Admin supplies and services $9,971 $11,161-10.66% 41% Professional liability insurance $8,589 $14,725-41.67% 20% Other insurance premiums $994 $1,295-23.28% 38% Outside professional fees $2,672 $3,448-22.52% 41% Promotion and marketing $1,102 $2,395-53.99% 21% Clinical laboratory $11,213 $14,486-22.59% 39% Radiology and imaging $2,249 $6,672-66.29% 30% Other ancillary services $1,731 $4,178-58.57% 33% Billing purchased services $10,480 $2,954 254.83% 79% Management fees paid to MSO $22,813 $19,453 17.27% 51% Misc operating cost $5,665 $9,461-40.12% 29% Cost allocated to practice from parent $48,504 $18,603 160.74% 76% Total general operating cost $189,437 $203,563-6.94% 42% Total operating cost $341,260 $406,133-15.97% 31% Provider Cost Physician Providers Total physician compensation $163,350 $219,372-25.54% 20% Total physician benefit cost $26,069 $34,943-25.39% 30% Total physician cost $189,419 $249,593-24.11% 21% Nonphysician Providers Nonphysician provider compensation $20,738 $17,899 15.86% 57% Nonphysician provider benefit cost $4,326 $3,906 10.74% 55% Total nonphysician cost $25,064 $22,260 12.59% 57% Provider Consultants Provider consultant cost $7,052 Total Provider Cost $214,483 $287,649-25.44% 16% Total Cost $555,743 $689,383-19.39% 24% Footnote: 1. MGMA benchmark table and selection criteria is: All Multispecialty. 2. Due to rounding "Total" may not equal the sum of the detail numbers. 3. All MGMA data in MGMA columns is from the 2006 report based on 2005 data. Page 11 of 11