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© 2020 AMGA Consulting, LLC. All rights reserved. 2020 AMGA Medical Group Operations and Finance Survey Overview October 28, 2020

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Page 1: 2020 AMGA Medical Group

©2020 AMGA Consulting, LLC. All rights reserved.

2020 AMGA Medical Group Operations and Finance Survey Overview

October 28, 2020

Page 2: 2020 AMGA Medical Group

2©2020 AMGA Consulting, LLC. All rights reserved.

Speaker Introduction

Kelsi O’Brien is a Director with AMGA Consulting. Her areas of expertise includecompensation plan design, operations optimization and improvement, changemanagement and provider utilization. Mrs. O’Brien has been in health careconsulting for over 6 years. Prior to consulting she held a Director level position witha major academic medical center for 4 years. [email protected]

Rose Wagner is Chief Operating Officer with AMGA Consulting. Rose possessesstrategic and tactical expertise that results in successful financial, operational andclinical outcomes. She is a collaborative leader and applies this style working withcomplex teams of internal and external stakeholders. With more than 25 years ofexperience working inside both private practice and integrated delivery systems,Rose has honed keen analytic skills to assess, develop and implement plans to meetan organization’s desired outcomes. [email protected]

Page 3: 2020 AMGA Medical Group

3©2020 AMGA Consulting, LLC. All rights reserved.

Objectives

• Discuss market insights

• Share the evolution of the survey

• Provide an overview of the participants and survey content

• Highlight key examples from the report

Page 4: 2020 AMGA Medical Group

4

AMGA Consulting

©2020 AMGA Consulting, LLC. All rights reserved.

Market Insights

Page 5: 2020 AMGA Medical Group

5©2020 AMGA Consulting, LLC. All rights reserved.

COVID-19

COMPENSATION

NET REVENUE

REGULATORY

• Unknown long-term implications

• Continues to rise

• Continues to decline

• Potential change in E/M Codes

Industry Pressures

Page 6: 2020 AMGA Medical Group

6©2020 AMGA Consulting, LLC. All rights reserved.

Medical Group Cost Structure

Page 7: 2020 AMGA Medical Group

7©2020 AMGA Consulting, LLC. All rights reserved.

Survey Areas of Focus

01

06 03

02

0405

Patient Access

Provider Staffing

Complement

Revenue and

Expenses

Clinic Staffing

Operational Overhead

Revenue Cycle

Page 8: 2020 AMGA Medical Group

8

AMGA Consulting

©2020 AMGA Consulting, LLC. All rights reserved.

Survey Evolution

Page 9: 2020 AMGA Medical Group

9©2020 AMGA Consulting, LLC. All rights reserved.

1

2

3

4

5 2020

2008-2012• Embedded in the AMGA Compensation and Productivity Survey

• Data included revenue, provider salary, support department staffing and

operational expenses

2013• Greater granularity in operational support staff department

• Increase in the overall financial indicators at the

organization level

2016• First year produced as a stand-alone book.

• Added clinic hours, scheduling capacity and scribe usage

• Financial portion of the survey report streamlined to

mirror a standard P&L statement

2019• Data reported at the per provider level due to

increased utilization of APPs

• Additional revenue cycle and access metrics

provided

• Expanded operational support departments, clinic

staffing roles and financial information

• Transition to online platform

• Addition of telehealth prevalence questions

• Added patients visits as an additional volume measure

An Evolving Resource

Page 10: 2020 AMGA Medical Group

10©2020 AMGA Consulting, LLC. All rights reserved.

2020 Key Survey Changes

• Clarifications to medical group/organization structure

• Enhanced revenue cycle metrics

• Expanded call center benchmarks

• Updated operational support department data

• Consolidated clinic level staffing and expense data

• Largest survey response to date

• Online reporting platform

Page 11: 2020 AMGA Medical Group

11

AMGA Consulting

©2020 AMGA Consulting, LLC. All rights reserved.

Survey Details

Page 12: 2020 AMGA Medical Group

12©2020 AMGA Consulting, LLC. All rights reserved.

Total

providers

represented:

XX,XXX

Custom data reports may be requested (sample size dependent):

-Regional -Academic -Group-size -Additional percentiles

3,371

Clinic Sites

Represented

2020 Overview

Survey data can be purchased online at http://www.amga.org/

+20,000

Providers

Represented

608

Median FTE

Providers –

System

Affiliated

65

Specialties

8

Roll-up

Specialties

177

Median FTE

Providers –

Independent

Page 13: 2020 AMGA Medical Group

13©2020 AMGA Consulting, LLC. All rights reserved.

2020 AMGA Finance and Operations Metrics

Survey Data

• Access information• Revenue cycle metrics• Operational support

staffing• Clinic staffing• Clinic expenses

Data Cuts

• Per physician• Per provider• Per 10,000 wRVUs• Per 5,000 visits

Data Groups

• Median percentiles• Independent practices

and system affiliated

Page 14: 2020 AMGA Medical Group

14©2020 AMGA Consulting, LLC. All rights reserved.

Survey Participants

Page 15: 2020 AMGA Medical Group

15

AMGA Consulting

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Access

Page 16: 2020 AMGA Medical Group

16©2020 AMGA Consulting, LLC. All rights reserved.

SCHEDULING

VISIT MIX

PANEL SIZE

EMERGING TRENDS

• Patient Contact Hours

• No-Show Rate

• Fill Rate

• Established vs. New

• Physician and APP

• Primary Care and Specialty Care

• APP

• Physician

• Methodology

• Scribe Utilization

• Virtual / Telehealth Visits

Access Metrics

Page 17: 2020 AMGA Medical Group

17©2020 AMGA Consulting, LLC. All rights reserved.

Scheduling

Schedule Fill Rate by Organization Type and Specialty Type

All GroupsSystem

Affiliated Independent

Specialty Type Median Median Median

Primary Care 85.1% 85.1% 82.0%

Medical Specialties 86.9% 82.6% 86.9%

Surgical Specialties 84.1% 83.5% 75.0%

No Show Rate by Organization Type and Specialty Type

All GroupsSystem

Affiliated Independent

Specialty Type Median Median Median

Primary Care 5.0% 5.5% 5.0%

Medical Specialties 6.5% 7.0% 5.0%

Surgical Specialties 5.9% 6.2% 3.0%

Page 18: 2020 AMGA Medical Group

18©2020 AMGA Consulting, LLC. All rights reserved.

Contact Hours and ShiftsPatient Contact Hours per Week

Specialty Type Median

Primary Care 36.0

Medical Specialties 36.0

Surgical Specialties 36.0

Hours per Shift

Specialty Type Median

Urgent Care 12.0

Hospitalists 12.0

Emergency Medicine 12.0

Shifts per Month

Specialty Type Median

Urgent Care 14.0

Hospitalists 15.0

Emergency Medicine 13.0

Page 19: 2020 AMGA Medical Group

19©2020 AMGA Consulting, LLC. All rights reserved.

Visit Mix

Primary Care: Physicians Primary Care: APPsOther Specialties:

PhysiciansOther Specialties: APPs

Established Patient Visits 90.5% 92.2% 75.4% 78.2%

New Patient Visits 5.8% 7.5% 13.4% 10.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Patient Visit Mix - Median

Page 20: 2020 AMGA Medical Group

20©2020 AMGA Consulting, LLC. All rights reserved.

Panel InformationPrimary Care Panel Size

Median Average

Physicians 1,600 1,586

APPs 756 832

Yes61%

No39%

APP Independent Panel

Yes36%

No64%

Panel Size Risk Adjusted

Page 21: 2020 AMGA Medical Group

21©2020 AMGA Consulting, LLC. All rights reserved.

Scribe Utilization

Scribe Utilization by Specialty Type

Specialty Type

Median Percent of Providers Using

Scribes

Primary Care 9%

Medical Specialties 10%

Surgical Specialties 13%

72%

28%

Yes

No

0% 50% 100%

Percent of Groups Utilizing Scribes

74%

4%

22%

Scribe Location

Onsite

Virtual

Both

Page 22: 2020 AMGA Medical Group

22©2020 AMGA Consulting, LLC. All rights reserved.

APP to Physician Ratios

0.56

0.65 0.660.63

0.71

0.57

Primary Care Medical Specialties Surgical Specialties

APP to Physician - Specialty Type

2018 2019

Page 23: 2020 AMGA Medical Group

23

AMGA Consulting

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Revenue Cycle

Page 24: 2020 AMGA Medical Group

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Revenue Cycle Metrics

CLAIMS

CBO RESOURCES

BAD DEBT

• Lag Time: Date of Service to Submittal

• Coding Lag

• Staff Types

• Per Provider FTE

• All Groups, Integrated and Independent

• Organization Type

• % of Gross and Net Revenue

DAYS IN A/R • 30, 60, 90 and 120 Day Metrics

Page 25: 2020 AMGA Medical Group

25©2020 AMGA Consulting, LLC. All rights reserved.

Outsourced Revenue Cycle

0%

8%

10%

12%

15%

20%

25%

15%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Revenue Cycle Management/Leadership

Professional Coding

Payment Posting/RefundProcessing /Cashier

Accounts Receivable/Account Follow-Up

Customer Service (post-visit)

Collections /Delinquent Accounts

Other business office functions(exclude front-end functions such as scheduling…

All Business Office Functions

Percent of Groups with Outsourced Business Office Functions

Page 26: 2020 AMGA Medical Group

26©2020 AMGA Consulting, LLC. All rights reserved.

Days in A/R

Aged A/R as a Percent of Total Billed A/R – ALL GROUPS

Gross Dollars Net Dollars

ALL Median Median

Current to 30 days 55% 60%

31 to 60 days 13% 13%

61 to 90 days 8% 7%

91 to 120 days 5% 5%

Over 120 days 15% 11%

Page 27: 2020 AMGA Medical Group

27©2020 AMGA Consulting, LLC. All rights reserved.

Revenue Cycle: CBO Staffing Resources

Median Business Office Staffing

Per Physician Per Provider Per 10,000 wRVUs

Revenue Cycle Management/Leadership 0.04 0.03 0.07

Professional Coding 0.11 0.07 0.21

Accounts Receivable/ Account Follow-Up 0.13 0.09 0.22

Payment Posting/Refund Processing /Cashier 0.06 0.05 0.22

Customer Service (post-visit) 0.06 0.04 0.16

Other business Office Functions 0.08 0.06 0.16

Page 28: 2020 AMGA Medical Group

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Operational Support Staffing

Page 29: 2020 AMGA Medical Group

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Operational Support Department Staffing

FTE, Salary and Benefits information was captured for the following operational overhead departments per physician and per provider:

General Accounting/FinanceInformation Technology/ EHRsManaged Care ContractingQuality/Patient Safety/RiskPI/Department of ExcellenceCare CoordinatorsPopulation HealthOperational Leadership/AdministrationHuman Resources

Facilities ManagementPurchasing and MaterialsMarketing and Public RelationsStrategy and PlanningExecutive TeamPhysician LeadershipChairs/Medical DirectorsCBO/Patient Accounting

Page 30: 2020 AMGA Medical Group

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Operational Support Department Staffing:By Department

Total Support Department FTEs per Provider FTE by Group

All Groups

Operational Categories Median

General Accounting / Finance 0.03

Information Technology/Electronic Health Records (EHR) 0.08

Managed Care Contracting 0.02

Quality / Patient Safety /Risk 0.02

Process Improvement / Department of Excellence 0.01

Care Coordinators 0.07

Population Health 0.02

Operational Leadership/Administration 0.12

Central Business Office /Patient Accounting 0.30

Human Resources 0.04

Facilities Management 0.03

Purchasing and Materials Management 0.01

Marketing and Public Relations 0.01

Strategy and Planning 0.01

Page 31: 2020 AMGA Medical Group

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AMGA Consulting

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Clinic Staffing

Page 32: 2020 AMGA Medical Group

32©2020 AMGA Consulting, LLC. All rights reserved.

Clinic Staffing

• Survey report contains multiple iterations of the clinic staffing details:

– Per physician

– Per provider

– Per 10,000 wRVUs

– Per 5,000 visits

• Additional views:

– By organization type

– By specialty type

– By specialty

Clinical Staffing Positions

Registered Nurses

Licensed Practical Nurses

Medical Assistants/Nurses Aides

Radiology/Imaging Staff

Laboratory Staff

Pharmacy Staff

Dietician/Nutritionist

Behavioral Health/Social Work

Referral Coordinator

Medical Receptionist

Clinic Call Center Staff

Page 33: 2020 AMGA Medical Group

33©2020 AMGA Consulting, LLC. All rights reserved.

Clinic Staffing: Per PhysicianAll Groups System Affiliated Independent

Staffing Per Physician by Organization Type Median Median Median

Total Clinical Support/Direct Patient Care Staff 1.95 1.92 2.02

Registered Nurses 0.58 0.57 0.66

Licensed Practical Nurses 0.55 0.53 0.89

Medical Assistants/Nurses Aides 1.29 1.30 1.12

Radiology/Imaging Staff 0.43 0.40 0.61

Page 34: 2020 AMGA Medical Group

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Clinic Staffing: Per PhysicianAll Groups System Affiliated Independent

Staffing Per Physician by Organization Type Median Median Median

Total Clinical Support/Direct Patient Care Staff 1.95 1.92 2.02

Registered Nurses 0.58 0.57 0.66

Licensed Practical Nurses 0.55 0.53 0.89

Medical Assistants/Nurses Aides 1.29 1.30 1.12

Radiology/Imaging Staff 0.43 0.40 0.61

Primary Care Medical Specialties Surgical Specialties

Staffing Per Physician by Specialty Type Median Median Median

Total Clinical Support/Direct Patient Care Staff 2.24 1.83 1.50

Registered Nurses 0.49 0.73 0.62

Licensed Practical Nurses 0.67 0.50 0.49

Medical Assistants/Nurses Aides 1.57 1.16 1.00

Radiology/Imaging Staff 0.35 0.89 0.35

Page 35: 2020 AMGA Medical Group

35©2020 AMGA Consulting, LLC. All rights reserved.

Clinic Staffing: Per PhysicianAll Groups System Affiliated Independent

Staffing Per Physician by Organization Type Median Median Median

Total Clinical Support/Direct Patient Care Staff 1.95 1.92 2.02

Registered Nurses 0.58 0.57 0.66

Licensed Practical Nurses 0.55 0.53 0.89

Medical Assistants/Nurses Aides 1.29 1.30 1.12

Radiology/Imaging Staff 0.43 0.40 0.61

Primary Care Medical Specialties Surgical Specialties

Staffing Per Physician by Specialty Type Median Median Median

Total Clinical Support/Direct Patient Care Staff 2.24 1.83 1.50

Registered Nurses 0.49 0.73 0.62

Licensed Practical Nurses 0.67 0.50 0.49

Medical Assistants/Nurses Aides 1.57 1.16 1.00

Radiology/Imaging Staff 0.35 0.89 0.35

Staffing Per Physician by Specialty

Registered NursesLicensed Practical

Nurses

Medical Assistants/Nurses

AidesRadiology/ Imaging

Staff

Primary Care

Family Medicine 0.64 0.69 1.71 0.44

Internal Medicine 0.50 0.67 1.57 0.33

Pediatrics and Adolescent – General 0.62 0.34 1.12 ***

Page 36: 2020 AMGA Medical Group

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Financial Information

Page 37: 2020 AMGA Medical Group

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Financial Information

Gross and Net Revenue

Operating Expenses

Provider Salaries and

Benefits

Staff Salaries and Benefits

Bottom Line Performance

Page 38: 2020 AMGA Medical Group

38©2020 AMGA Consulting, LLC. All rights reserved.

Financial Information: Per 10,000 wRVUsOverall Financial Summary per 10,000 wRVUs: All Groups

Financial Indicator Median

Gross Revenue

Professional Revenue $1,739,420

Ancillary Revenue $309,610

Other Medical Revenue $9,823

Total Gross Revenue $1,750,457

Net Revenue

Professional Revenue $820,152

Ancillary $71,947

Other Medical Revenue $44,352

Total Net Revenue $856,978

Non-Medical Revenue $7,573

Provider Salaries

Physician Salaries $506,922

Locum Expense $29,326

APP Salaries $100,758

Provider Benefits

Physician Benefits Expense $68,396

APP Benefits Expense $21,106

Total Provider Salaries and Benefits $652,074

Page 39: 2020 AMGA Medical Group

39©2020 AMGA Consulting, LLC. All rights reserved.

Financial Information: Per 10,000 wRVUs

Overall Financial Summary per 10,000 wRVUs: All Groups

Financial Indicator Median

Operating Expenses

Drug Supply $43,139

Medical And Surgical Supply $11,490

Radiology/Imaging Expense $635

Laboratory Expense $4,060

Other Ancillary Expense $1,387

Building And Occupancy $61,589

Building Depreciation Expense $7,969

Professional Liability Insurance Expense $10,581

Other Insurance Expense $7,394

Information Technology Services Expense $3,199

Furniture And Equipment Expense $1,690

Furniture And Equipment Depreciation Expense $4,307

Administrative Supplies and Services $3,739

Marketing Expense $559

Purchased Services $21,305

Other Expenses $19,979

Total Operating Expenses $197,856

Non-Medical Expense $9,335

Overall Financial Summary per 10,000 wRVUs: All Groups

Financial Indicator Median

Total Revenue $872,137

Total Expense $1,112,282

Profit/Loss (Before Allocations) -$168,999

Totals With System Overhead Allocations

System Overhead Allocations $166,243

Total Profit/Loss (After Allocations) -$244,381

Page 40: 2020 AMGA Medical Group

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Online Survey Platform

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Online Survey Platform

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AMGA Consulting

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Questions?

Page 43: 2020 AMGA Medical Group

43©2020 AMGA Consulting, LLC. All rights reserved.

AMGA Consulting Services

Page 44: 2020 AMGA Medical Group

44©2020 AMGA Consulting, LLC. All rights reserved.

Rose Wagner, Chief Operating OfficerAMGA Consulting

[email protected](913) 660-8234

William Holets, Director AMGA Consulting

[email protected](651) 402-8958