confidential europe • asia • americas · confidential europe • asia • americas section...
TRANSCRIPT
Europe • Asia • Americas Confidential
Slide: 1
Europe • Asia • Americas Confidential
2009 Rheumatology Economic
Survey
Final Report
May 18, 2010
2
Europe • Asia • Americas Confidential
Section Table of Contents Slide
1 Background, purpose, methodology and demographics 4
2 Private practice only 10
Geographic Breakouts 70
Age Breakouts 89
3 Academia only 108
Geographic Breakouts 132
Age Breakouts 140
4 Shared findings between academia and private practice 148
5 Comparisons with1999 ACR National Economic Survey 158
6 Comparisons with 2006 Workforce Study 182
3
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Section 1
Background, objectives, methodology and demographics
4
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Background
The ACR Committee on Rheumatologic Care (CORC), which is
composed of practicing physicians, expressed the desire to conduct a
benchmark study to update previous benchmark survey information
from 1999 and 2003.
While some of the demographic and academic questions were carried
forward from the 2003 administration, a large number of questions
were added to the 2009 administration.
dmrkynetec was selected to conduct the survey, which was fielded in
mid 2009.
5
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Purpose of this Study
The ACR’s primary purpose for this project is to ensure an adequate
rheumatology workforce in an era of increased numbers of uninsured
and underinsured in the general population; increased chronic and
musculoskeletal diseases; and an expanding population of aging
citizens.
The goals were to collect nationwide information regarding practice
situations, including productivity, compensation, types of contracted
arrangements, practice costs, and perceived work force requirements.
Data was collected and comparisons were made for rheumatologists in
academic settings and those in private practice.
6
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Methodology
A high rate of survey participation by the rheumatology membership was
desired. It was estimated that approximately 60% of the 6,800 current members
of the ACR would qualify as potential respondents for the third Rheumatology
Economic Survey (n = 4,200).
The primary qualification was that the respondent was currently a full-time,
actively practicing rheumatologist, either in academia or in private practice.
In order to make the survey as convenient to complete as possible, dmrkynetec
recommended that an on-line, web based survey be conducted. This allowed
the physicians to complete the survey at a time that was convenient for them.
In addition, the on-line questionnaire was programmed in such a manner that
participating rheumatologists who needed to temporarily suspend their surveys,
would be able to do so without losing the information they had already entered.
7
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Methodology (cont.)
Each potential respondent in the sample of eligible rheumatologists received a
cover letter from the ACR explaining the importance of the survey.
Email letters with unique login information were sent to the majority of
respondents. Those rheumatologists who did not have a current email address
on file were given login information via postal mail. All email and phone
contacts were conducted by the ACR. Mailed information was conducted by
dmrkynetec.
An eight page worksheet, designed to help the rheumatologists to collect
information needed to complete the on-line survey, accurately and completely,
was sent to each potential respondent via email or postal mail.
The online survey was hosted by dmrkynetec and was open from June 26 to
November 30, 2009.
Reminder email and mail letters were sent on a periodic basis to each physician
who had not yet completed the on-line survey. Follow-up phone calls to
encourage participation were made by the staff at ACR.
8
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Demographics
23
2
5
2
2
4
319 rheumatologists from across
the US and Puerto Rico participated
in the 2009 Economic Survey.
7
7
4
1
1
3
4
9
4
3 3
28
9 14
4
15 1
5
19
10
10
2
30
9
2
10
3
6
20
6 2
2
8 2
4
Puerto Rico = 2
3 1
DC = 3
1
11
2
2009 Benchmark Survey
Europe • Asia • Americas Confidential
Section 2
Private Practice Findings
10
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Predominant Source of Payment [Physicians answering “private practice” and “other” in Q3.]
Q31. Which of the following is your predominant source of payment? What is the number of rheumatologists/physicians?
(n=176)
11
Mean # of
Physicians
3.7 Rheum
54.0 All Phys
*Note: The single practice
administrator has been added into
the multi-specialty group for all
subsequent questions.
5.2 Rheum
(n=64)
(n=52)
(n=59)
(n=1)
There is a fairly even split between solo private practice (36%), single specialty group (30%) and multi-
specialty group practices (34%). There is an average of five rheumatologists within the single specialty
group and four within the multi-specialty group.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percent of Practice - Adult, Primary Care and Pediatric
Q32. What percentage of visits makes up your clinical practice in each of the following areas?
(n=186)
12
Fifty-three percent of rheumatologists in private practice report all of their practice is adult rheumatology,
while 44% report that 50% or more of their practice is adult rheumatology. A large majority report no
primary care (80%) or pediatric rheumatology (70%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percent of Practice - Adult, Primary Care and Pediatric
13
% of Income Total n=186
Solo Private
Practice n=64
Single Specialty
Group n=52
Multi-Specialty
Group n=60
Adult
Rheumatology
Practice
Under 50% 2.7% 1.6% 1.9% 5.0%
50-99% 44.1% 42.2% 38.5% 53.3%
100% 53.2% 56.2% 59.6% 41.7%
Primary Care
0% 80.1% 73.4% 96.2% 73.3%
Under 50% 17.2% 21.9% 3.8% 23.3%
50-99% 2.7% 4.7% - 3.3%
Pediatric
Rheumatology
Practice
0% 69.9% 79.7% 63.5% 61.7%
Under 50% 29.0% 20.3% 34.6% 36.7%
50-99% 1.1% - 1.9% 1.7%
Q32. What percentage of visits makes up your clinical practice in each of the following areas?
Over half of the rheumatologists in private practice report that their practice is made up of 100% adult
visits. Eighty percent report no primary care visits and 70% report no pediatric visits.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percentage of Desire to be Dedicated to Rheumatology [Physicians answering “primary care” in Q32.]
Q32a. What percentage of your practice do you desire to be dedicated to rheumatology?
(n = 37)
14
Rheumatologists in small to medium private practice settings tend to have a greater desire to be solely
dedicated to rheumatology than rheumatologists in the largest settings.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Type of Compensation
Q33. What type of compensation method does your practice have? Q33a. What type of incentive bonus does your practice have?
(n=186)
15
(n=34)
Type of Incentive Bonus
[Other responses <2% of total mentions]
[Those answering “salary plus incentive bonus” in Q33]
The majority of rheumatologists in private practice are compensated by their fee for services rendered. This is
particularly true for single physician clinics. Those practices that offer salary plus incentive bonus drive their bonus
mainly off productivity.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Personal Sources of Compensation (see next slides for breakout by % of income)
Q35. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from each of
the following.
(n=186)
16
Rheumatologists practicing in private practice indicate nearly three-fourths of all personal sources of
compensation come from direct patient care.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Personal Sources of Compensation – Direct Patient Care
17
% of Income Total n=186
Solo Private
Practice n=64
Single Specialty
Group n=52
Multi-Specialty
Group n=60
0% 3.8% - 1.9% -
1-50% 17.2% 10.9% 38.5% 8.3%
51-75% 30.1% 32.8% 30.8% 30.0%
76-99% 31.7% 37.5% 23.1% 38.8%
100% 17.2% 18.8% 5.8% 23.3%
Mean 72.0% 78.4% 62.2% 79.7%
Q35. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from each of
the following.
Seventy-two percent of rheumatologists practicing in private practice state that all personal sources of
compensation come from direct patient care, with multi-specialty averaging the highest at almost 80%,
followed by solo private practice at 78% and single specialty at 62%.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Personal Sources of Compensation – Infusion Therapies
18
% of Income
Total n=186
Solo Private
Practice n=64
Single Specialty
Group n=52
Multi-Specialty
Group n=60
0% 45.7% 45.3% 25.0% 55.0%
1-50% 51.6% 53.1% 71.2% 41.7%
51-75% 2.7% 1.6% 3.8% 3.3%
Mean 9.1% 8.7% 11.2% 9.0%
Q35. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from each of
the following.
Private practice rheumatologists report that infusion therapies for personal sources of compensation
averaged only 9%.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percent of Revenue Obtained From Insurance – Fee Based
19
% of Income Total n=186
Solo Private
Practice n=64
Single Specialty
Group n=52
Multi-Specialty
Group n=60
Medicare 37.9% 40.9% 42.2% 35.7%
PPO/HMO 33.4% 34.7% 33.2% 34.3%
Classic indemnity 14.8% 20.3% 16.7% 5.6%
Medicaid/Chronic
children’s programs 4.8% 4.1% 4.7% 6.2%
Self-Pay 4.2% 4.8% 2.2% 2.5%
Uninsured 3.0% 1.6% 0.9% 2.4%
Discounted fee for
service 2.2% 2.1% 2.0% 2.3%
Q36a. Indicate below the percentage of revenue that is obtained from each of the following types of insurance.
Rheumatologists practicing in private practice receive the greatest portion of their revenue from Medicare
and PPO/HMO insurance programs, regardless of the type of practice they are in.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Type of Insurance Patients Carry
20
% of Income Total n=186
Solo Private
Practice n=64
Single Specialty
Group n=52
Multi-Specialty
Group n=60
PPO 24.7% 26.3% 29.0% 25.2%
HMO 20.6% 20.0% 18.4% 22.3%
Classic indemnity 19.9% 17.9% 18.5% 18.9%
Medicare risk 13.7% 13.0% 7.9% 15.0%
Traditional Medicare 13.7% 13.0% 7.9% 15.0%
Discounted indemnity 12.4% 8.3% 10.8% 12.9%
Medicaid 8.2% 8.6% 6.8% 9.3%
Uninsured 7.6% 4.8% 2.5% 6.7%
Q65. On average, what type of insurance do your patients have?
Rheumatologists in private practice state that one-quarter of their patients carry PPOs, followed by HMOs
and classic indemnity.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percent of Revenue Obtained From Insurance – Capitated
21
% of Income Total n=186
Solo Private
Practice n=64
Single Specialty
Group n=52
Multi-Specialty
Group n=60
HMO 16.7% 14.1% 11.5% 25.0%
Medicare risk 12.9% 12.5% 13.5% 15.0%
Subcap for
rheumatology 4.8% 4.7% 3.8% 6.7%
Cap for primary care 4.8% 3.1% 1.9% 10.0%
None of the above 73.1% 81.2% 71.2% 66.7%
Q36b. Indicate below the percentage of revenue that is obtained from each of the following types of insurance. [Multiple mentions accepted]
Nearly three out of four private practice rheumatologists state that none of their revenue obtained from
capitated insurance was obtained from the four types of insurance listed in the survey.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Restriction of Insurance Carriers
Q37. Do you restrict any insurance carriers?
(n=186)
22
Fifty-five percent of rheumatologists practicing in private practice restrict certain insurance carriers in their
practice. Fewer physicians in the smaller practice size (2-5) restrict insurance carriers.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Restricted Insurance Carriers [Physicians answering “yes” in Q37]
Q37. Do you restrict any insurance carriers? Which ones?
23
% of Income Total n=102
Solo Private
Practice n=44
Single Specialty
Group n=29
Multi-Specialty
Group n=27
Medicaid 37.3% 45.5% 41.4% 22.2%
HMOs 13.7% 15.9% 13.8% 11.1%
Aetna 10.8% 15.9% 10.3% 3.7%
Medicare 9.8% 13.61% 6.9% 7.4%
United Healthcare 6.9% 6.8% 10.3% 3.7%
Humana 6.9% 6.8% 3.4% 11.1%
Don’t know/refused 9.8% 2.3% 10.3% 18.5%
One in three rheumatologists practicing in private practice who restrict insurance carriers report they do
not accept Medicaid. However, multi-specialty groups do not restrict Medicaid at the same level as solo
private practices or single specialty groups.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percent of Booked Charges Collected
Percentage of Rheumatologists
Q38. Of your total booked charges, what percentage is collected?
24
(n=186)
(n=64)
(n=52)
About
(n=60)
69.7
Mean
Percent
74.5
69.5
69.3
Rheumatologists practicing in private practice report, on average, that 70% of their total booked charges
are collected. Solo private practices collect slightly higher total booked charges than the average.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percent of Total Collections to Physician Compensation
Percentage of Rheumatologists
Q39. What percentage of your total collections goes directly to physician compensation and benefits, insurance and professional liability?
25
(n=186)
(n=64)
(n=52)
About
(n=60)
43.6
Mean
Percent
46.4
39.3
47.9
Rheumatologists practicing in private practice report that an average of 44% of total collections go
directly to their compensation and benefits, insurance and professional liability. The average is slightly
lower in single specialty group clinics, at 39%.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Overhead Percentages
26
Number of Rheumatologists
Overhead Categories Total
(n=186)
Solo (n=74)
2-5 (n=62)
5-9 (n=27)
>10
(n=23)
Clerical labor 36.1% 35.7% 39.9% 35.4% 28.6%
Expenses to maintain an
office 31.2% 31.4% 27.7% 35.2% 34.9%
Supplies 20.7% 21.6% 19.4% 18.6% 23.4%
Procedure-specific equip. 6.8% 6.2% 8.2% 7.2% 4.6%
Overhead equip. 5.2% 5.0% 4.8% 3.5% 8.5%
Don’t know / Refused 10.2% 4.1% 14.5% 14.8% 13.0%
Q40. The remaining revenue not applied to physician compensation and benefits, insurance and professional liability (Q.39) is generally referred to as
overhead. Overhead may be direct or indirect. What are your overhead percentages for the following types of costs?
[Mean percents]
The three biggest overhead categories for rheumatologists in their practice are clerical labor, followed by
expenses to maintain an office, and supplies.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Support Personnel in Practice
27
Number of Rheumatologists
Support Personnel Total
(n=186)
Solo (n=74)
2-5 (n=62)
5-9 (n=27)
>10
(n=23)
Secretarial / front desk 4.6 2.7 4.1 7.0 9.7
Medical assistants 3.5 1.1 4.2 4.6 8.1
Lab, x-ray and bone
density technicians 1.7 0.8 1.2 3.4 3.6
RNs 1.2 0.5 1.2 1.8 3.2
LPNs / LVNs 1.1 0.4 0.9 1.1 3.4
Research support 0.6 0.4 0.8 0.9 0.8
Mid-level providers 0.5 0.3 0.6 0.9 0.7
Q41. How many support personnel are employed in your practice? [INDICATE THE FULL TIME EQUIVALENCY (FTE) PER MD].
Secretarial staff and medical assistants make up the greatest portion of support personnel.
[Mean number of personnel]
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Utilization of Nurse Practitioners and Physician Assistants
28
Number of Rheumatologists
Utilization of Personnel Total
(n=186)
Solo (n=74)
2-5 (n=62)
5-9 (n=27)
>10
(n=23)
Do not utilize 62.9% 81.1% 54.8% 40.7% 52.2%
Follow-up routine patients 36.0% 18.9% 45.2% 55.6% 43.5%
Work-ins 25.8% 10.8% 32.3% 44.4% 34.8%
Patient education 19.4% 6.8% 22.6% 29.6% 39.1%
Screening new patients 14.5% 9.5% 24.2% 14.8% 4.3%
Q42. How does your practice utilize nurse practitioners and physician assistants? [Multiple answers accepted]
Overall, sixty-three percent of participating rheumatologists do not utilize nurse practitioners and physician
assistants. When utilized, they are used primarily to follow-up with routine patients (36%) and as work-ins
(36%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Hiring Additional Rheumatologists Within the Next Five Years
Q44. Does your practice plan to hire additional rheumatologists within the next five years? If yes, how many do you plan to rehire?
(n=186)
Number of Hires Hiring Plan
29
(n=69)
Nearly 40% of rheumatologists report that they plan to hire additional rheumatologists within the next five
years. Among practices intending to hire, 68% plan to add one additional rheumatologist.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Physician Associates in the Practice
Q43. Number of physician associates in your practice (excluding yourself)?
(n=186)
30
Forty percent of private practice rheumatologists are in solo practice, followed by one-third in practices of
five to nine rheumatologists.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Replacement of Retiring Rheumatologists
Q45. Does your practice plan to replace retiring rheumatologists within the next five years? If yes, how many do you plan to replace?
(n=186)
Number of Replacements Replacing Retiring Rheumatologists
31
(n=42)
Slightly over half of rheumatologists state their practice does not plan to replace retiring rheumatologists
within the next five years. Of the 23% of practices intending to replace a retiring rheumatologist, nearly
70% plan to replace one.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Hiring Additional Nurse Practitioners or Physician Assistants
Q46. Does your practice plan to hire additional nurse practitioners or physician assistants within the next five years? If yes, how many do you plan to
hire?
(n=186)
Number of Hires Hiring Plan
32
(n=44)
Twenty-four percent of rheumatologists reported that their practice plans to hire additional nurse
practitioners or physician assistants within the next five years. Seventy-three percent of practices plan to
hire one employee.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Waiting Time (in weeks) to Next Consultation With a Physician
Q47. What is the waiting time (in weeks) to next consultation with a physician?
(n=186)
33
Mean number of weeks = 5.0
The average waiting time in weeks to the next consultation with a rheumatologists is five weeks.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Waiting Time (in weeks) to Next Return Visit With a Physician
Q48. What is the waiting time (in weeks) to the next return office visit with a physician?
(n=186)
34
Mean number of weeks = 3.8
The average waiting time in weeks to the next return visit with a rheumatologists is four weeks. Nearly half
of rheumatologists report a one to two week waiting time and a quarter report three to four weeks.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Waiting Time (in weeks) to Next Consultation With a PA or NP
Q47. What is the waiting time (in weeks) to next consultation with a PA or NP?
(n=186)
35
Mean number of weeks = 1.2
The average waiting time in weeks to the next consultation with a PA or NP is one week.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Waiting Time (in weeks) to Next Return Visit With a PA or NP
Q50. What is the waiting time (in weeks) to next return office visit with a PA or NP?
(n=186)
36
Mean number of weeks = 1.2
The average waiting time in weeks to the next return visit with a PA or NP is one week. However, 71% of
rheumatologists report this situation does not apply to their practice.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Time (in hours) Spent Filling Out Prior Authorizations
Q51. How much time in a typical day do you or your staff spend filling out prior authorizations (include phone calls)? [Hours per day]
(n=186)
37
Mean number of hours = 3.1
Single specialty group = 4.2
Solo private practice = 3.1
Multi-specialty group = 2.5
Rheumatologists or their staff spend an average of 3.1 hours per day filling out prior authorizations
(including phone calls). This average is consistent across practice sizes but does vary somewhat by
payment source.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Summary of Productivity / Scheduled Hours Per Week (See slides 72-78 for breakouts)
38
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
Based on the number of scheduled hours of office time per week Means
Time interval, in minutes, for
New patients 48 Min.
Return patients 22 Min.
Number of patients seen per week
New patients 12
Return patients 79
Number of
Hospital visits 3
Hospital consultations 2
Arthrocentesis, joint, tendon or bursa injections performed per week 15
Office no-show rate (a percentage) 7 %
RVU work components per week (if known) 53
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Scheduled Hours Per Week – Time Interval for New Patients
39
Number of Rheumatologists
Time Interval in Min. Total
(n=186)
Solo (n=74)
2-5 (n=62)
5-9 (n=27)
>10
(n=23)
0 1.6% 1.4% 3.2% - -
1 – 15 Min. 2.7% 1.4% 3.2% 3.7% 4.3%
16 – 30 Min. 21.0% 21.6% 19.4% 18.5% 26.1%
31 – 45 Min. 32.3% 35.1% 35.5% 33.3% 13.0%
46 – 60 Min. 38.7% 36.5% 37.1% 37.0% 52.2%
More than 60 Min. 3.8% 4.1% 1.6% 7.4% 4.3%
Mean # of Minutes 48 47 46 56 49
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
Forty-eight minutes is the average time reported for a new patient visit.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Scheduled Hours Per Week – Return Patients
40
Number of Rheumatologists
Time Interval in Min. Total
(n=186)
Solo (n=74)
2-5 (n=62)
5-9 (n=27)
>10
(n=23)
0 1.6% 1.4% 3.2% - -
1 – 15 Min. 56.9% 55.4% 48.4% 66.7% 73.9%
16 – 30 Min. 38.7% 40.5% 46.8% 25.9% 26.1%
31 – 45 Min. 1.1% 2.7% - - -
46 – 60 Min. - - - - -
More than 60 Min. 1.6% - 1.6% 7.4% -
Mean # of Minutes 22 19 23 35 17
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
The average time reported for a return patient visit is 22 minutes.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Hospital Visits
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
(n=186)
41
Mean number of visits = 3.0
Rheumatologists report an average of three hospital visits in a fully scheduled week.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Hospital Consultations
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
(n=186)
42
Mean number of visits = 2.0
Rheumatologists report an average of two hospital consultations in a fully scheduled week.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Arthrocentesis, Joint, Tendon or Bursa Injections
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
(n=186)
43
Mean number of visits = 15
Rheumatologists report an average of 15 arthrocentesis, joint, tendon or bursa injections in a fully
scheduled week. Nearly 20% of rheumatologists report more than 20 injects per week.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Office No-Show Rate
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
(n=186)
44
Mean percentage = 7%
On average, the reported office no-show rate is seven percent. One-quarter of rheumatologists surveyed
report a no-show rate of three percent or less.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of RVU Work Components Per Week
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
(n=186)
45
Mean # of RVUs = 53
Nearly 90% of rheumatologists surveyed did not know the number of RVU work components per week.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Hours Charged to Specific Visit Codes in the Last
Fully Scheduled Week
46
Payment Source
Visit Codes Total
(n=186)
Solo (n=64)
Single Specialty (n=52)
Multi-Specialty (n=60)
New patient /office
99203 2 1 0 2
99204 2 2 1 3
99205 1 1 1 2
Total new 5 4 3 7
Established patient/office
99213 25 28 23 24
99214 30 32 36 26
99215 4 4 3 4
Total established 58 65 62 54
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
Data in this table show mean hours for each code by payment source.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Number of Hours Charged to Specific Visit Codes in the Last
Fully Scheduled Week (cont.)
47
Payment Source
Visit Codes Total
(n=186)
Solo (n=64)
Single Specialty (n=52)
Multi-Specialty (n=60)
Consult/office
99243 2 2 1 3
99244 6 5 5 7
99245 3 2 5 3
Total consult 11 10 11 12
Consult/inpatient
99253 1 0 0 1
99254 1 1 1 2
99255 1 0 0 1
Total established 3 2 1 4
Mean weeks worked per year 46 47 46 47
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Collection of Measures of Function and Disease Activity
Q54. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc?
48
(n=186)
(n=64)
(n=52)
(n=60)
Approximately 50% of rheumatologists report they routinely collect measures of function and disease
activity from their patients,(e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc). Sixty-seven
percent of single specialty groups routinely collection these measures.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Reporting of Data for Pay-for-Performance/Other Quality
Measures Encouraged/Required By Payers
Q55. Are you encouraged / required by payers to report data for pay for performance or other quality measures?
49
(n=186)
(n=64)
(n=52)
(n=60)
One-quarter of rheumatologists surveyed are encouraged or required by payers to report data for pay for
performance or other quality measures.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
New Patient Requirement to Have a Physician Referral
Q56. Do you require new patients to have a physician referral?
50
(n=186)
(n=64)
(n=52)
(n=60)
Just over half (55%) of the participating rheumatologists require patients to have a physician referral.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Participation in the 2007 Physician Quality Reporting
Initiative Program
Q57. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program?
51
(n=186)
(n=64)
(n=52)
(n=60)
Overall, twenty percent of rheumatologists participated in the 2007 Physician Quality Reporting Initiative
Program. Single specialty group rheumatologists had the highest participation in the program at 35% and
solo private practice the lowest at 11%.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Receipt of 2007 PQRI Program Bonus
Q57a. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program? If yes, did you receive your bonus?
52
(n=37)
(n=7)
(n=18)
(n=12)
One hundred percent of the seven solo rheumatologists who participated in the 2007 program received
their bonus, whereas, 50% of rheumatologists overall received their bonus.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Participation in the 2008 PQRI Program
Q58. Did you or your practice participate in the 2008 PQRI program?
53
(n=186)
(n=64)
(n=52)
(n=60)
Participation in the 2008 PQRI program (21% of rheumatologists surveyed) was very similar to 2007
(20%). Slightly fewer single specialty group physicians and more from multi-specialty participated in
2008 than 2007.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Receipt of 2008 PQRI Program Bonus
Q58a. Did you or your practice participate in the 2008 PQRI program?
54
(n=39)
(n=6)
(n=16)
(n=17)
Receipt of bonuses for the 2008 PQRI program (44% of rheumatologists) was also very similar to 2007
(46%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Use of E-Prescribe on Eligible Prescriptions
Q59. Do you currently e-prescribe all eligible prescriptions using a qualified system?
(n=186)
55
Nearly half (47%) of rheumatologists practicing in private practice report they currently use e-prescribe,
with 24% planning to begin within the next year. Smaller clinics report less usage of e-prescribe, while the
majority of large clinics are using e-prescribe at the present time.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
EHR Use in Your Practice
Q60. Do you use an EHR in your practice? (n=186)
56
About 50% of rheumatologists practicing in private practice report they use EHR in their practice, with one in ten using
EHR along with paper charts. Fifteen percent do not use EHR in their practice and have no intention of implementing any
EHR system within the next three years. Solo clinics have not adopted EHR use as much as the larger clinics and will be
slower to adopt EHR use in the near future.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
EHR Systems [Physicians answering “Yes” at Q60]
Q61. s your EHR CCHIT certified? Q62. Which EHR system do you currently have in your office?
(n=96)
Current EHR System Is your EHR system certified?
57
(n=96)
[Other mentions <4.0% of total]
Among the rheumatologists practicing in private practice who report using an EHR system, five in ten indicate their EHR
system is CCHIT certified. One third do not know whether their EHR system is CCHIT certified. The top mentioned EHR
systems currently being used are Allscripts, eClinical works, EPIC, Centricity, CPRS (VA) and LastWord.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Year EHR Was Implemented
Q63. In what year did you implement EHR in your practice? (n=96)
58
Seventy-three percent of rheumatologists in private practice report they implemented EHR in their
practice within the last seven years.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Various Functions Performed By EHR
Q64. I use my EHR to perform the following functions:
Enter and review lab orders
Basic functions (i.e., review chart info., create visit notes)
Update and review medication lists
Scan and store paper reports
Enter and review radiology orders
Print prescriptions
Update and review problem lists
Electronically place radiology orders
Electronically transmit prescriptions
Electronically place lab orders
Disease-based registries (built or fed into your EHR)
Rheumatologists report that their EHR is used primarily to update and review medication lists (95%), for
basic functions like reviewing chart information (95%) and updating and reviewing problem lists (92%).
2009 Benchmark Survey – Private Practice Findings
59
Europe • Asia • Americas Confidential
Contracts with Organizations
60
Payment Source
Organizations Total
(n=186)
Solo (n=64)
Single Specialty (n=52)
Multi-Specialty (n=60)
HMO (Yes) 30.1% 35.9% 30.8% 28.3%
Don’t know 34.9% 21.9% 28.8% 51.7%
Mean # of sub-
capitation contracts 19 45 1 2
Mean # of fee-based
contracts 4 4 5 3
PHO (Yes) 22.6% 37.5% 21.2% 11.7%
Don’t know 44.6% 31.2% 42.3% 60.0%
Mean # of contracts 4 4 6 4
Q66. Do you have contracts with the following? Do any of these alliances involve equity?
HMO was mentioned by 30% of rheumatologists surveyed, followed by PHO (23%) and IPA (21%). PHO
appears to be more common in solo practices and less common in multi-specialty practices.
Ninety-seven percent of the rheumatologists report that these alliances do not involve equity (Q66a).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Contracts with Organizations (cont.)
61
Payment Source
Organizations Total
(n=186)
Solo (n=64)
Single Specialty (n=52)
Multi-Specialty (n=60)
IPA (Yes) 21.0% 31.2% 25.0% 10.0%
Don’t know 41.9% 23.4% 46.2% 56.7%
Mean # of Contracts 3 3 2 4
Hospital networks 7.5% 6.2% 5.8% 11.7%
Don’t know 36.0% 25.0% 34.6% 46.7%
Mean # of Contracts 1 1 2 1
PPMs 1.1% 1.6% - 1.7%
Don’t know 52.7% 48.4% 46.2% 63.3%
Mean # of Contracts 1 1 - 1
Q66. Do you have contracts with the following? If yes, how many?
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Have You Sold Equity In Your practice?
Q67. Have you sold equity in your practice? To whom have you sold equity in your practice?
62
(n=186)
(n=64)
(n=52)
(n=60)
Two percent of the participating rheumatologists report their practice has sold equity.
Of the three rheumatologists who report their practice has sold equity, two reported the practice sold equity
to a hospital and one stated a foundation.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Merger With Another Practice in the Last Five Years
Q68. Have you merged your practice with another in the last five years?
63
(n=186)
(n=64)
(n=52)
(n=60)
Overall, 5% of rheumatologists report their practice has merged with another practice in the last five years.
Multi-specialty groups are more likely to merge (10%) compared to single specialty (4%) and solo
practices (2%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Reduced or Denied Charges During the Last Year
Q69. Have you had your charges reduced or denied during the last year?
64
(n=186)
(n=64)
(n=52)
(n=60)
Fifty-four percent of the rheumatologists, overall, have had charges reduced or denied during the last year.
Charges have been reduced or denied for three-quarters of single specialty rheumatologists, followed by
53% of solo practices and 42% for multi-specialty groups.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percentage of Reduced or Denied Charges [Physicians answering “yes” in Q69.]
Q69a . What percentage of the charges have been reduced or denied during the last year?
65
(n=100)
Mean % = 15.2
Of the 100 rheumatologists who had charges reduced or denied, nearly 50% of the charges were reduced
by one to five percent. Another 20% had charges reduced or denied by more than 20%.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Most Frequent Problem for Having Charges Reduced or Denied
[Physicians answering “yes” in Q69]
66
Total n=100
Solo Private
Practice n=34
Single Specialty
Group n=39
Multi-Specialty
Group n=25
Payment schedule by third-party
payer is inadequate 48.0% 47.1% 46.2% 48.0%
Denial of E/M visit and injection on
same day 32.0% 41.2% 23.1% 32.0%
Reduction of E/M code level 24.0% 26.5% 23.1% 20.0%
Denial of Dual Energy X-ray
Absorptiometry (DEXA) 16.0% 20.6% 15.4% 12.0%
Denial of infusion therapy service 16.0% 23.5% 12.8% 12.0%
Denial of interpretative charges for
imaging procedure 5.0% 5.9% 2.6% 8.0%
Denial of an in office MRI 5.0% 5.9% 5.1% 4.0%
Denial of an in office ultrasound 3.0% 5.9% - 4.0%
Bundle lab and x-ray 3.0% - 7.7% -
Other 11.0% 14.7% 5.1% 16.0%
Q69b. What was your most frequent problem for having your charges reduced or denied during the last year?
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Formal Audit by Medicare in the Last Year
Q70. Have you had a formal audit by Medicare in the last year? 70a. As a result of the formal audit by Medicare in the last year, how much, if any, did
you have to pay back to Medicare?
(n=186)
67
Ninety-five percent of rheumatologists surveyed report they have not had a formal audit by
Medicare in the last year. None of the rheumatologists who had an audit were able to provide an
estimate on how much the practice may have had to pay back to Medicare.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Does Your Practice Have a Web site?
Q71. Does your practice have a Web site?
68
(n=186)
(n=64)
(n=52)
(n=60)
The majority of rheumatologists in a multi-specialty group (80%) report that their practice has a
Web site, followed by single specialty groups (64%) and solo private practice (16%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Does your practice advertise its services?
Q72. Does your practice advertise its services?
69
(n=186)
(n=64)
(n=52)
(n=60)
About half of rheumatologists in a multi-specialty group (53%) report that their practice advertises
its services, followed by single specialty groups (27%). Very few solo private practices (8%)
advertise.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Private Practice Findings by Geography
70
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percentage of Desire to be Dedicated to Rheumatology [Physicians answering “primary care” in Q32.]
Q32a. What percentage of your practice do you desire to be dedicated to rheumatology?
(n = 37)
71
Overall, about half of rheumatologists report the desire to be 51% - 99% dedicated to rheumatology. In
the W. Central region, a significantly higher percentage of rheumatologists (75%) have a desire to be
solely dedicated to rheumatology.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Type of Compensation
Q33. What type of compensation method does your practice have? Q33a. What type of incentive bonus does your practice have?
(n=186)
72
(n=34)
Type of Incentive Bonus
[Other responses <2% of total mentions]
[Those answering “salary plus incentive bonus” in Q33]
The majority of rheumatologists in private practice are compensated by their fee for services rendered. This is
particularly true for clinics located in the NE. Those practices that offer salary plus incentive bonus drive their
bonus mainly off productivity.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Restriction of Insurance Carriers
Q37. Do you restrict any insurance carriers?
(n=186)
73
Fifty-five percent of rheumatologists practicing in private practice restrict certain insurance carriers in their
practice. Practices in the SE restrict the most carriers, while clinics in the West restrict fewer insurance
carriers than clinics in other parts of the U.S.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Approximately 50% of rheumatologists reported that they routinely collect measures of function and
disease activity from their patients, (e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc). Three-
quarters of clinics in the W. Central region routinely collect these measures, while only 37% of clinics
collect them in the West.
Collection of Measures of Function and Disease Activity
Q54. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc?
74
(n=186)
(n=37)
(n=26)
(n=30)
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
One-quarter of rheumatologists surveyed are encouraged or required by payers to report data for pay for
performance or other quality measures.
Reporting of Data for Pay-for-Performance/Other Quality
Measures Encouraged/Required By Payers
Q55. Are you encouraged / required by payers to report data for pay for performance or other quality measures?
75
(n=186)
(n=37)
(n=26)
(n=30)
2009 Benchmark Survey – Private Practice Findings
(n=37)
Europe • Asia • Americas Confidential
New Patient Requirement to Have a Physician Referral
Q56. Do you require new patients to have a physician referral?
76
(n=186)
(n=37)
(n=26)
(n=30)
Just over half (55%) of the participating rheumatologists require new patients to have a physician referral.
A slightly higher percentage of physicians in the NE and West regions require these referrals, and a lower
percentage in the Midwest and W. Central regions.
2009 Benchmark Survey – Private Practice Findings
(n=56)
(n=37)
Europe • Asia • Americas Confidential
Participation in the 2007 Physician Quality Reporting
Initiative Program
Q57. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program?
77
(n=186)
(n=37)
(n=26)
(n=30)
Overall, twenty percent of rheumatologists participated in the 2007 Physician Quality Reporting Initiative
Program. The Midwest had the highest participation in the program (50%), and the W. Central and West
had the lowest participation (less than 10% each).
2009 Benchmark Survey – Private Practice Findings
(n=56)
(n=37)
Europe • Asia • Americas Confidential
Receipt of 2007 PQRI Program Bonus
Q57a. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program? If yes, did you receive your bonus?
78
(n=37)
(n=8)
(n=13)
(n=3)
Nearly 70% of rheumatologists from the Midwest and West who participated in the 2007 program
received their bonus, whereas, none of the eight rheumatologists in the SE received their bonus.
2009 Benchmark Survey – Private Practice Findings
(n=10)
(n=3)
Europe • Asia • Americas Confidential
Participation in the 2008 PQRI Program
Q58. Did you or your practice participate in the 2008 PQRI program?
79
(n=186)
(n=37)
(n=26)
(n=30)
Participation in the 2008 PQRI program (21% of rheumatologists surveyed) was very similar to 2007
(20%). There was slightly more participation from physicians in the NE and less participation from
physicians in the SE and Midwest regions in 2008 than 2007.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Receipt of 2008 PQRI Program Bonus
Q58a. Did you or your practice participate in the 2008 PQRI program?
80
(n=39)
(n=5)
(n=11)
(n=4)
Receipt of bonuses for the 2008 PQRI program (44% of rheumatologists) was also very similar to 2007
(46%). All four participating rheumatologists in the West received their bonus; however, no one in the SE
received their bonus.
2009 Benchmark Survey – Private Practice Findings
(n=15)
(n=4)
Europe • Asia • Americas Confidential
Use of E-Prescribe on Eligible Prescriptions
Q59. Do you currently e-prescribe all eligible prescriptions using a qualified system? (n=186)
81
Nearly half (47%) of rheumatologists practicing in private practice report they currently use e-prescribe
with 24% planning to within the next year. More physicians in the W. Central region report the usage of
e-prescribe (70%), while fewer physicians in the West (33%) and SE (35%) report usage at the time of
the study.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
EHR Use in Your Practice
Q60. Do you use an EHR in your practice? (n=186)
82
About 50% of rheumatologists practicing in private practice report they use EHR in their practice, with one in ten using
EHR along with paper charts. Fifteen percent do not use EHR in their practice and have no intention of implementing any
EHR system within the next three years. Clinics in the W. Central region appear to have adopted EHR use more quickly
than clinics in other regions.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Year EHR Was Implemented
Q63. In what year did you implement EHR in your practice? (n=96)
83
Nearly 50% of rheumatologists in private practice report they implemented EHR in their practice within
the last three to four years.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Two percent of the participating rheumatologists report that their practice has sold equity.
There were no rheumatologists in the W. Central or West regions that report their practice sold equity.
Have you sold Equity in your practice?
Q67. Have you sold equity in your practice? To whom have you sold equity in your practice?
84
(n=186)
(n=56)
(n=26)
(n=30)
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Overall, 5% of rheumatologists report their practice has merged with another practice in the last five
years. W. Central clinics appear to be more likely to merge (11%) compared to SE clinics (0%).
Merger With Another Practice in the Last Five Years
Q68. Have you merged your practice with another in the last five years?
85
(n=186)
(n=37)
(n=26)
(n=30)
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Fifty-four percent of the rheumatologists, overall, have had charges reduced or denied during the
last year. Charges have been reduced or denied for about six in ten rheumatologists in the W.
Central region, followed by the Midwest (58%).
Reduced or Denied Charges During the Last Year
Q69. Have you had your charges reduced or denied during the last year?
86
(n=186)
(n=37)
(n=26)
(n=30)
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Does Your Practice Have a Web site?
Q71. Does your practice have a Web site?
87
(n=186)
(n=37)
(n=26)
(n=30)
The majority of rheumatologists in the W. Central region (78%) report that their practice has a Web
site, followed by the Midwest (62%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Does Your Practice Advertise Its Services?
Q72. Does your practice advertise its services?
88
(n=186)
(n=37)
(n=26)
(n=30)
Slightly more than half of rheumatologists in the W. Central region (54%) report that their practice
advertises its services, followed by 30% of practices in the West. In the NE, only 20% of
rheumatologists report that their practice advertises its services.
2009 Benchmark Survey – Private Practice Findings
(n=56)
(n=37)
Europe • Asia • Americas Confidential
Private Practice Findings by Age
89
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Percentage of Desire to be Dedicated to Rheumatology [Physicians answering “primary care” in Q32.]
Q32a. What percentage of your practice do you desire to be dedicated to rheumatology?
(n = 37)
90
Rheumatologists in the 30 – 49 age range tend to have a greatest desire to be solely dedicated to
rheumatology.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Type of Compensation
Q33. What type of compensation method does your practice have? Q33a. What type of incentive bonus does your practice have?
(n=186)
91
(n=34)
Type of Incentive Bonus
[Other responses <2% of total mentions]
[Those answering “salary plus incentive bonus” in Q33]
The majority of rheumatologists in private practice are compensated by their fee for services rendered. This is
particularly true for physicians in the 50 - 59 age range.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Restriction of Insurance Carriers
Q37. Do you restrict any insurance carriers?
(n=186)
92
Fifty-five percent of rheumatologists practicing in private practice restrict certain insurance carriers in their
practice. This appears to be fairly consistent across age categories.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Collection of Measures of Function and Disease Activity
Q54. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc?
93
(n=186)
(n=33)
(n=75)
(n=57)
Approximately 50% of rheumatologists report that they routinely collect measures of function and disease
activity from their patients,(e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc). This varies very
little by age of physician.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Reporting of Data for Pay-for-Performance/Other Quality
Measures Encouraged/Required By Payers
Q55. Are you encouraged / required by payers to report data for pay for performance or other quality measures?
94
(n=186)
(n=33)
(n=75)
(n=57)
One-quarter of rheumatologists surveyed are encouraged or required by payers to report data for pay for
performance or other quality measures.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
New Patient Requirement to Have a Physician Referral
Q56. Do you require new patients to have a physician referral?
95
(n=186)
(n=33)
(n=75)
(n=57)
Just over half (55%) of the participating rheumatologists require patients to have a physician referral.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Participation in the 2007 Physician Quality Reporting
Initiative Program
Q57. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program?
96
(n=186)
(n=33)
(n=75)
(n=57)
Overall, twenty percent of rheumatologists participated in the 2007 Physician Quality Reporting Initiative
Program. Rheumatologists in the 30 – 49 age range had the lowest participation in the program at 15%.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Receipt of 2007 PQRI Program Bonus
Q57a. Did you or your practice participate in the 2007 Physician Quality Reporting Initiative Program? If yes, did you receive your bonus?
97
(n=37)
(n=5)
(n=17)
(n=12)
Nearly six in ten rheumatologists 60 and older who participated in the 2007 program received their bonus,
while only about one-third of physicians in the 50 – 59 category received their bonus.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Participation in the 2008 PQRI Program
Q58. Did you or your practice participate in the 2008 PQRI program?
98
(n=186)
(n=33)
(n=75)
(n=57)
Participation in the 2008 PQRI program (21% of rheumatologists surveyed) was very similar to 2007
(20%). Slightly more physicians in the 30 – 49 age category participated in 2008 than 2007 and slightly
less in the 60+ category.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Receipt of 2008 PQRI Program Bonus
Q58a. Did you or your practice participate in the 2008 PQRI program?
99
(n=39)
(n=8)
(n=18)
(n=8)
Receipt of bonuses for the 2008 PQRI program (44% of rheumatologists) was also very similar to 2007
(46%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Use of E-Prescribe on Eligible Prescriptions
Q59. Do you currently e-prescribe all eligible prescriptions using a qualified system? (n=186)
100
Nearly half (47%) of rheumatologists practicing in private practice report they currently use e-prescribe
with 24% planning to within the next year. The use of e-prescribe varies very little by age category.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
EHR Use in Your Practice
Q60. Do you use an EHR in your practice? (n=186)
101
About 50% of rheumatologists practicing in private practice report they use EHR in their practice, with one in ten using
EHR along with paper charts. Fifteen percent do not use EHR in their practice and have no intention of implementing any
EHR system within the next three years. A higher percentage of rheumatologists in the 30 – 49 category report EHR use.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Year EHR Was Implemented
Q63. In what year did you implement EHR in your practice? (n=96)
102
Six in ten rheumatologists in the 30 – 49 age range report they implemented EHR in their practice within
the last three to four years, compared to three in ten rheumatologists in the 60+ range.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Have You Sold Equity In Your Practice?
Q67. Have you sold equity in your practice? To whom have you sold equity in your practice?
103
(n=186)
(n=33)
(n=75)
(n=57)
Two percent of the participating rheumatologists reported that their practice has sold equity. The
percentage is slightly higher for physicians in the 60+ ranges.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Merger With Another Practice in the Last Five Years
Q68. Have you merged your practice with another in the last five years?
104
(n=186)
(n=33)
(n=75)
(n=57)
Overall, 5% of rheumatologists reported their practice has merged with another practice in the last five
years. A higher percentage of rheumatologists in the 60+ category report merging with another practice.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Reduced or Denied Charges During the Last Year
Q69. Have you had your charges reduced or denied during the last year?
105
(n=186)
(n=33)
(n=75)
(n=57)
Fifty-four percent of the rheumatologists, overall, have had charges reduced or denied during the last year.
This appears to be consistent across age categories.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Does Your Practice Have a Web site?
Q71. Does your practice have a Web site?
106
(n=186)
(n=33)
(n=75)
(n=57)
Rheumatologists in the 30 – 49 age category report the highest incidence of a Web site, followed by
rheumatologists in the 50 – 59 category.
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Does Your Practice Advertise Its Services?
Q72. Does your practice advertise its services?
107
(n=186)
(n=33)
(n=75)
(n=57)
About four in ten rheumatologists in the 30 – 49 age range report that their practice advertises its
services, followed by 60+ physicians (28%) and 50 – 59 physicians (25%).
2009 Benchmark Survey – Private Practice Findings
Europe • Asia • Americas Confidential
Section 3
Academic Findings
108
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Predominant Source of Payment
Q4. Which of the following is your predominant source of payment? (n=133)
109
The majority of rheumatologists practicing in academia receive their predominant source of payment from
academic clinical practice.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Predominant Source of Payment
Q4. Which of the following is your predominant source of payment? (n=133)
110
Rheumatologists in smaller academic settings tend to receive their predominant source of payment from
academic clinical practice more so than rheumatologists in larger academic settings. Larger academic
settings also rely more on payment from both clinical and academic administration.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Percentage of Rheumatologists Who Are Clinician Teachers
Or Clinical Investigators [Physicians answering “academic clinical practice” or “clinical research” in Q4.]
Q5. Do you regard yourself primarily as a clinician teacher or clinical investigator at an academic medical center?
(n=97)
111
Among the rheumatologists who receive their predominant source of payment from academic clinical
practice or clinic research, most view themselves primarily as a clinical teacher or clinical investigator at
an academic medical center.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Number and Type of Patients Seen Per Week [Physicians answering “Yes” in Q5]
Q6. How many patients do you see per week? / Q6a. What percentage of these patients are…?
(n=90)
[Mean number of patients = 44.0]
(n=90)
Number of Patients Seen Type of Patients Seen
112
Among the rheumatologists who view themselves primarily as a clinical teacher or clinical investigator
see an average of 44 patients per week. The majority (72%) of their patients seen are established
patients.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Source of Primary Salary
Q8. Where does your primary salary come from?
(n=133)
113
More than one-third of rheumatologists practicing in academia report their primary salary source is from
clinical income, while one in five rely on grant support for their salary.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Number of Years Full-Time at the Academic Medical Center
Q9. How long have you been full-time at the academic medical center? (n=133)
[Mean number of years = 14.0]
114
Rheumatologists practicing in academia have worked an average of 14 years full-time at the academic
medical center.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Academic Rank
Q10. What is your academic rank?
(n=133)
[Other responses <2% of total mentions]
115
Nearly three out of four rheumatologists report their academic rank as “associate professor”.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Number of Rheumatologists in Your Academic Practice
Q11. How many rheumatologists are in your academic setting? / Q11a. How many are part-time?
(n=133)
[Mean number of rheumatologists = 10.0] Number That Are Part-Time
[Mean number of PT rheumatologists = 1.8]
116
Rheumatologists report an average of 10 doctors in their academic practice, with an average of nearly
two part-time rheumatologists.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Number of Clinical and Basic Research Rheumatologists
Q12. How many clinical rheumatologists are in your academic practice?
Q13. How many basic research rheumatologists are in your academic practice?
(n=133)
[Clinical Mean = 6.2; Basic Research Mean = 2.6]
117
Rheumatologists report an average of six clinical doctors in their academic practice and an average of
three basic research doctors in their practice.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Scheduled Clinic Time
Q14. How many hours of scheduled clinic time do you have per week? / Q15. How often are you in the clinic?
(n=133)
[Mean hours = 15.8] Frequency Scheduled
Number of Hours Scheduled
118
Rheumatologists practicing in academia schedule an average of 16 hours per week of clinic time. One in
four rheumatologists are in the clinic at least once a week, one in three are in the clinic at least two to
three days per week, and nearly one-fourth are in the clinic four to six days.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Services Rendered in the Outpatient Clinic
Q16. Do you render services in the outpatient clinic? / Q16a. How many hours in a typical week do you render services in the outpatient clinic?
(n=133)
Weekly Service Hours
Rendered in Outpatient Clinic Services Rendered
[Mean hours = 15.9]
Nearly all rheumatologists (97%) render services in the outpatient clinic for an average of 15.9 hours per
week.
119
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Need for More FTE Rheumatologists
Q17. Do you feel that your clinical activities need fewer, more, or about the same number of rheumatologists?
Q17a. How many more FTE rheumatologists are needed?
(n=133)
Number of FTE Rheumatologists Needed Additional FTE Rheumatologists Needed
[Mean hours = 2.2]
120
(n=74)
More than half of rheumatologists practicing in academia report they need about the same number of
FTE Rheumatologists. One in four did report they need more FTE rheumatologists and felt they needed
an average of two more FTE rheumatologists.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Number of Patients Seen Per Month in the Academic Clinic
Q18. On average, how many patients are seen per month in the academic clinic?
(n=133)
121
On average, rheumatologists practicing in academia see an average of 527 patients per month in the
academic clinic.
2009 Benchmark Survey – Academic Findings
Mean = 527
Europe • Asia • Americas Confidential
Type of Compensation
Q19. What type of compensation method does your practice use? / Q19a. What type of incentive bonus is used?
(n=133)
122
Overall, half of the academic rheumatologists surveyed receive their compensation through salary plus an
incentive bonus. In smaller practices, compensation is more likely salary only.
(n=66)
Type of Incentive Bonus
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Personal Sources of Compensation (see next slides for breakout by % of income)
Q21. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from each of
the following.
(n=133)
123
Direct patient care is the most frequently mentioned source of personal compensation (50%) for academic
rheumatologists, followed by research (18%) and administration (11%).
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Collaborative Arrangements with Private Rheumatologists
Q22. Are there collaborative arrangements with private rheumatologists in your geographic area?
(n=133)
Types of Collaborative Arrangements Are there collaborative arrangements?
124
[Multiple mentions allowed]
(n=19)
More than eight in ten rheumatologists practicing in academia report they do not have collaborative
arrangements with private rheumatologists in their geographic area. Among those rheumatologists
having collaborative arrangements, consultation, teaching, and research are the primary three types of
arrangements.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
University Sponsored Insurance Plan
Q23. Is there an insurance plan sponsored by the university?
(n=133)
125
More than half of the rheumatologists practicing in academia reported they have a university sponsored
insurance plan. Medium to large size academic clinics tend to have a university sponsored insurance
plan more often than smaller academic clinics.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Routine Collection of Measures of Function and Disease Activity From Patients (MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.)
Q24. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.?
(n=133)
126
Forty percent of rheumatologists practicing in academia report they routinely collect measures of function
of disease activity from their patients. Smaller academic clinics are much less likely to collect this type of
information from their patients.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Use of E-Prescribe on Eligible Prescriptions
Q25. Do you currently e-prescribe all eligible prescriptions using a qualified system?
(n=133)
127
Overall, about 40% of rheumatologists reported that they currently e-prescribe all eligible prescriptions.
Larger academic practices are twice as likely to e-prescribe than smaller practices.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
EHR Use in Your Practice
Q26. Do you use an EHR in your practice?
(n=133)
128
Nearly seven in ten rheumatologists practicing in academia report they use EHR in their practice, with one in four
using EHR along with paper charts. Eight percent do not use EHR in their practice and have no intention of
implementing any EHR system within the next three years. Smaller academic clinics have not adopted EHR use
as much as the larger clinics and will be slower to adopt EHR use in the near future.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
EHR Systems [Physicians answering “Yes” at Q26]
Q27. s your EHR CCHIT certified? Q28. Which EHR system do you currently have in your office?
(n=92)
Current EHR System Is your EHR system certified?
129
(n=92)
[Other mentions <4.0% of total]
Among the rheumatologists practicing in academia who report using an EHR system, one in three indicate their EHR
system is CCHIT certified. The majority do not know whether their EHR system is CCHIT certified. The top mentioned
EHR systems currently being used are EPIC, Allscripts, custom built, CPRS (VA), Cerner, and Centricity.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Year EHR Was Implemented
Q29. In what year did you implement EHR in your practice? (n=92)
130
Nearly six in ten rheumatologists practicing in academia reported they implemented EHR in their practice
within the last seven years.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Various Functions Performed By EHR
Q30. I use my EHR to perform the following functions:
Enter and review lab orders
Basic functions (i.e., review chart info., create visit notes)
Update and review medication lists
Scan and store paper reports
Enter and review radiology orders
Print prescriptions
Update and review problem lists
Electronically place radiology orders
Electronically transmit prescriptions
Electronically place lab orders
Disease-based registries (built or fed into your EHR)
Rheumatologists practicing in academia report that their EHR is used primarily used for basic functions
like reviewing chart information (96%), to update and review medication lists (84%), scan and store paper
reports (82%), and enter and review lab orders (80%).
2009 Benchmark Survey – Academic Findings
131
Europe • Asia • Americas Confidential
Academic Findings by Geography
132
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Predominant Source of Payment
Q4. Which of the following is your predominant source of payment? (n=133)
133
Seven in ten rheumatologists in the NE receive their predominant source of payment from academic
clinical practice compared to about five in ten in the SE. Payment from clinical research is highest in the
Midwest and from basic research in the W. Central region.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Type of Compensation
Q19. What type of compensation method does your practice use? / Q19a. What type of incentive bonus is used?
(n=133)
134
Overall, half of the academic rheumatologists surveyed receive their compensation through salary plus an incentive
bonus. Rheumatologists in the SE are the most likely to receive their compensation through this method, compared
to a higher percentage in the Midwest and West who receive compensation by salary alone.
(n=66)
Type of Incentive Bonus
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
University Sponsored Insurance Plan
Q23. Is there an insurance plan sponsored by the university?
(n=133)
135
More than half of the rheumatologists practicing in academia report they have a university sponsored
insurance plan. Academic clinics in the W. Central and West regions tend to have a university sponsored
insurance plan more often than NE and Midwest regions.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Routine Collection of Measures of Function and Disease Activity From Patients (MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.)
Q24. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.?
(n=133)
136
Thirty-seven percent of rheumatologists practicing in academia report they routinely collect measures of
function of disease activity from their patients. Clinics in the Midwest are most likely to collect this type of
information from their patients.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Use of E-Prescribe on Eligible Prescriptions
Q25. Do you currently e-prescribe all eligible prescriptions using a qualified system?
(n=133)
137
Overall, about 40% of rheumatologists report they currently e-prescribe all eligible prescriptions.
Academic practices in the Midwest are twice as likely to e-prescribe than practices in the SE. Physicians
in the West have the highest percentage reporting no plans to e-prescribe.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
EHR Use in Your Practice
Q26. Do you use an EHR in your practice? (n=133)
138
Seventy-five percent of rheumatologists practicing in the W. Central region report they use EHR in their
practice, compared to 37% in the West. In the West, 47% of rheumatologists do use EHR along with
paper charting.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Year EHR Was Implemented
Q29. In what year did you implement EHR in your practice? (n=92)
139
Nearly six in ten rheumatologists practicing in academia reported they implemented EHR in their practice
within the last seven years, with the highest percentage of practices in the West (75%).
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Academic Findings by Age
140
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Predominant Source of Payment
Q4. Which of the following is your predominant source of payment? (n=133)
141
Nearly eight in ten rheumatologists in the 60+ age category report their predominant source of payment
from academic clinical practice, compared to the average of six in ten. Physicians surveyed in the 60+
category did not report payment from clinical or basic research.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Type of Compensation
Q19. What type of compensation method does your practice use? / Q19a. What type of incentive bonus is used?
(n=133)
142
Overall, half of the academic rheumatologists surveyed receive their compensation through salary plus an
incentive bonus. A higher percentage of rheumatologists in the 30 – 49 age range receive compensation
from salary only.
(n=66)
Type of Incentive Bonus
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
University Sponsored Insurance Plan
Q23. Is there an insurance plan sponsored by the university?
(n=133)
143
More than half of the rheumatologists practicing in academia reported they have a university sponsored
insurance plan. Physicians in the 30 – 49 age category tend to have a university sponsored insurance
plan more often than physicians in the 60+ category.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Routine Collection of Measures of Function and Disease Activity From Patients (MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.)
Q24. Do you routinely collect measures of function and disease activity from your patients, e.g., MHAQ, HAQ, SLICC, WOMAC, BASDAI, pain scale, etc.?
(n=133)
144
Forty percent of rheumatologists practicing in academia report they routinely collect measures of function
of disease activity from their patients. Rheumatologists in the 30 – 49 age range are more likely to collect
this type of information from their patients.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Use of E-Prescribe on Eligible Prescriptions
Q25. Do you currently e-prescribe all eligible prescriptions using a qualified system?
(n=133)
145
Overall, about 40% of rheumatologists report that they currently e-prescribe all eligible prescriptions.
Physicians in the 50 - 59 age category report significantly higher usage than physicians in the 60+ category.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
EHR Use in Your Practice
Q26. Do you use an EHR in your practice?
(n=133)
146
Two-thirds of rheumatologists in the 50 – 59 age range use EHR in their practice, compared to one-third
in the 60+ range. When looking at the combined responses of “yes” and “yes with paper charting”, the 30
– 49 and 50 – 59 age ranges are nearly equal.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Year EHR Was Implemented
Q29. In what year did you implement EHR in your practice? (n=92)
147
Nearly six in ten rheumatologists practicing in academia reported they implemented EHR in their practice
within the last seven years. Rheumatologists in the 30 – 49 age range implemented EHR earlier.
2009 Benchmark Survey – Academic Findings
Europe • Asia • Americas Confidential
Section 4
Shared Findings Between Academic and Private Practice
148
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Practice Type of Participating Rheumatologists
Q3. What is your practice type? (n=319)
149
More than half (53%) of rheumatologists surveyed are in private practice, while one-fourth (42%) report
practicing in academia.
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Yearly Compensation
Q20/Q34. What is the range of your yearly compensation?
(n=133) (n=186)
150
More than half (53%) of the rheumatologists practicing in academia report yearly compensation in the
range of $150,001-$250,000, while more than one-fourth (29%) report a compensation range of
$100,001-$150,000. Nearly one in four rheumatologists in private practice report yearly compensation of
less than $150,000, while more than one-third (37%) of rheumatologists in private practice report yearly
compensation in the range of $150,001-$250,000.
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Main Practice’s Geographic Setting
Percentage of Rheumatologists
Q73. What is your main practice’s geographic setting?
151
(n=319)
(n=133)
(n=186)
Eight in ten rheumatologists practicing in academia report practicing in an urban setting, while the
majority (57%) practicing in private practice/other are located in a suburban setting.
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Change in Practice Type
Q74. Have you changed your practice type in the last 5 years? / Q74a. What was your practice type before you changed?
(n=319)
Practice Type Before The Change Change in Practice Type
Nearly 90% of rheumatologists have remained in the same practice type during the last five years.
152
(n=39)
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Clinical and Non-Clinical Half Days Scheduled Per Week
Q75. Currently, in a typical work week, how many clinical half days do you schedule per week?
Q75a. Currently, in a typical work week, how many non-clinical half days do you schedule per week?
(n=319)
153
Clinical Half Days Non-Clinical Half Days
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Age When Plan to Substantially Reduce Patient Care Hours
Percentage of Rheumatologists
Q76. At what age do you plan to substantially reduce your direct patient care hours (i.e., partially retire)?
154
(n=319)
(n=133)
(n=186)
Nearly one-third of all rheumatologists report they have no plans to partially retire. The majority plan to
partially retire by the age of 64.
Mean
Age
64
65
63
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Age When Plan to Completely Retire From Patient Care
Percentage of Rheumatologists
Q77. At what age do you plan to completely retire from patient care?
155
(n=319)
(n=133)
(n=186)
Most rheumatologists report they plan to completely retire from patient care by age of 66+, with a mean
age of 69.
Mean
Age
69
70
69
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Membership in a State Rheumatology Society
Percentage of Rheumatologists
Q78. Are you a member of a state Rheumatology Society?
156
(n=319)
(n=133)
(n=186)
Four in ten rheumatologists report membership in a state rheumatology society. More than one-third
claim no membership and 21% state there is no state society available to join.
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Meeting Your Practice Support Needs [Physicians answering “yes” in Q78.]
Percentage of Rheumatologists
Q78a. Does your state Rheumatology Society meet your practice support needs?
157
(n=137)
(n=41)
(n=96)
Among rheumatologists reporting membership in a state society, nearly six in ten report their state
rheumatology society is meeting their needs.
2009 Benchmark Survey – Shared Findings
Europe • Asia • Americas Confidential
Section 5
Comparisons With 1999 ACR National Economic Survey
158
Benchmark Survey Comparisons
Europe • Asia • Americas Confidential
Scheduled Clinic Time
Q14. How many hours of scheduled clinic time do you have per week?
159
The comparison between scheduled clinic time for 1999 and 2009 is shown for academic clinical practice
only, which is the only common group between the two administrations of the survey asked this question.
Benchmark Survey Comparisons - Academic
Europe • Asia • Americas Confidential
Services Rendered in the Outpatient Clinic
Q16. Do you render services/attend in the outpatient clinic?
160
The comparison between services rendered in the outpatient clinic for 1999 and 2009 is shown for
academic clinical practice only, which is the only common group between the two administrations of the
survey asked this question.
Benchmark Survey Comparisons - Academic
Europe • Asia • Americas Confidential
Yearly Compensation
Q20/Q34. What is the range of your yearly compensation?
161
This data is presented for visual comparison only. Please note that the compensation ranges between
1999 and 2009 are quite different.
Benchmark Survey Comparisons
Europe • Asia • Americas Confidential
Personal Sources of Compensation
Q21/Q35. What are your personal sources of compensation from the practice of rheumatology? Indicate the percentage of income you receive from
each of the following.
162
Direct patient care continues to be the largest personal source of compensation.
Benchmark Survey Comparisons – Private Practice
Please note that three new categories were added in 2009. For comparison, infusion therapies were added into in office lab, and in office MRI and
ultrasound were added into in office x-ray.
Europe • Asia • Americas Confidential
Percent of Booked Charges Collected
Percentage of Rheumatologists
Q38. Of your total booked charges, what percentage is collected?
163
About In all three practice types, the percent of booked charges collected decrease slightly between 1999 and
2009.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Percent of Total Collections to Physician Compensation
Percentage of Rheumatologists
Q39. What percentage of your total collections goes directly to physician compensation and benefits, insurance and professional liability?
164
About For solo and multi-specialty practices, the percent of total collections going directly to physician
compensation has remained consistent from 1999 to 2009. For single specialty groups, the percent has
decreased.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Overhead Percentages*
Q40. The remaining revenue not applied to physician compensation and benefits, insurance and professional liability (Q.39) is generally referred to as
overhead. Overhead may be direct or indirect. What are your overhead percentages for the following types of costs?
165
2009 1999
Benchmark Survey Comparisons – Private Practice
Caution: Overhead percentages in 2009 did not include a clinical labor category, so some of the 2009 categories will be naturally inflated.
*These comparisons are made between the three private practice groups that are common to both survey administrations.
Europe • Asia • Americas Confidential
Number of Physician Associates in the Practice
Q43. Number of physician associates in your practice (excluding yourself)?
166
Overall, the number of physician associates in the practice is less than half than in 1999. This is
particularly due to multi-specialty practices.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Replacement of Retiring Rheumatologists in Next Five Years
Q45. Does your practice plan to replace retiring rheumatologists within the next five years?
167
The number of practices that planned to replace retiring rheumatologists in 2009 is significantly less than
those who planned to do so in 1999.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Waiting Time (in weeks) to Next Consultation
Q47. What is the waiting time (in weeks) to next consultation with a physician?
168
Overall, the average waiting time in weeks for the next consultation with a physician has increased by
approximately one week from 1999 to 2009.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Waiting Time (in weeks) to Next Return Visit With a Physician
Q48. What is the waiting time (in weeks) to the next return office visit with a physician?
169
The average waiting time in weeks for the next return office visit with a physician has increased by
approximately one week from 1999 to 2009 as well.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Number of Support Personnel in Practice*
170
Support Personnel 2009 1999
RNs 1.2 0.3
LPNs/LVNs 1.1 0.3
Medical assistants 3.6 0.7
Mid-level providers (PAs and NPs) 0.5 0.1
Lab, x-ray and bone density technicians 1.7 0.5
Research support 0.7 0.1
Secretarial / front desk 4.8 1.7
Q41. How many support personnel are employed in your practice? [INDICATE THE FULL TIME EQUIVALENCY (FTE) PER MD].
Across all support personnel categories, the number of support personnel employed by the practice has
increased substantially since 1999.
[Mean number of personnel]
Benchmark Survey Comparisons – Private Practice
*These comparisons are made between the three private practice groups that are common to both survey administrations.
Europe • Asia • Americas Confidential
Summary of Productivity / Scheduled Hours Per Week *
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
Based on the number of scheduled hours of office time per week 2009
Means
1999
Means
Time interval, in minutes, for
New patients 48 Min. 49 Min.
Return patients 22 Min. 17 Min.
Number of patients seen per week
New patients 12 12
Return patients 81 71
Number of
Hospital visits 3 7
Hospital consultations 2 2
Arthrocentesis, joint, tendon or bursa injections performed per week 15 16
Office no-show rate (a percentage) 7 % 6%
RVU work components per week (if known) 54 Not reported
Benchmark Survey Comparisons – Private Practice
* These comparisons are made between the three private practice groups that are common to both survey administrations: Solo practice,
Single specialty group practice, and Multispecialty group practice .
171
Europe • Asia • Americas Confidential
Number of Hours Charged to Specific Visit Codes in the Last
Fully Scheduled Week *
Visit Codes 2009 Means 1999 Means
New patient /office
99203 1 2
99204 2 3
99205 1 2
Total new 5 6
Established patient/office
99213 25 32
99214 31 32
99215 4 4
Total established 60 68
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
Data in this table show mean hours for each code by payment source.
Benchmark Survey Comparisons – Private Practice
* These comparisons are made between the three private practice groups that are common to both survey administrations: Solo practice, Single
specialty group practice, and Multispecialty group practice .
172
Europe • Asia • Americas Confidential
Number of Hours Charged to Specific Visit Codes in the Last Fully
Scheduled Week * (cont.)
Visit Codes 2009 Means 1999 Means
Consult/office
99243 2 3
99244 6 6
99245 3 4
Total consult 11 13
Consult/inpatient
99253 0 2
99254 1 2
99255 1 2
Total established 3 5
Mean weeks worked per year 47 48
Q53. Add up the actual scheduled hours per week in your office or clinic. Do not list the total time you spend in the office. If you see clinical trial
patients, please include them in the appropriate visit category. Then, complete the grid with values from your practice for the Last Fully Scheduled Week.
Benchmark Survey Comparisons – Private Practice
* These comparisons are made between the three private practice groups that are common to both survey administrations: Solo practice, Single
specialty group practice, and Multispecialty group practice .
173
Europe • Asia • Americas Confidential
Have You Sold Equity In Your Practice?
Q67. Have you sold equity in your practice?
174
The percentage of rheumatologists reporting that their practice sold equity has drastically fallen off
between 1999 and 2009.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
To Whom Have You Sold Equity in Your Practice?
Q67a. If yes, to whom have you sold equity in your practice?
175
Because only three rheumatologists reported that their practice had sold equity in 2009, an accurate
comparison between 1999 and 2009 cannot be made.
Benchmark Survey Comparisons – Private Practice
[Rheumatologists reporting “yes” in Q67]
Europe • Asia • Americas Confidential
Merger With Another Practice in the Last Five Years
Q68. Have you merged your practice with another in the last five years?
176
Across the three practice types, the percentage of rheumatologists reporting that their practice merged
with another company in the last five years is less than half than was reported in 1999.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Reduced or Denied Charges During the Last Year
Q69. Have you had your charges reduced or denied during the last year?
177
The number of single specialty rheumatologists reporting that their charges were reduced or denied during
the last year has remained consistent between 1999 and 2009; however, solo practices and multi-specialty
groups report this occurs far less often in 2009.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Percentage of Reduced or Denied Charges [Physicians answering “yes” in Q69]
Q69a. What percentage of the charges have been reduced or denied during the last year?
178
The percentage of charges that were reduced or denied has decreased between 1999 and 2009.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Most Frequent Problem for Having Charges Reduced or Denied
[Physicians answering “yes” in Q69]
Q69b. What was your most frequent problem for having your charges reduced or denied during the last year?
179
The most frequent problem for having charges reduced or denied continues to be “payment schedule by a
third-party payer is inadequate”.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Formal Audit by Medicare in the Last Year
Q70. Have you had a formal audit by Medicare in the last year?
180
Overall, the percentage of rheumatologists reporting formal audits by Medicare had remained the same
from 1999 to 2009.
Benchmark Survey Comparisons – Private Practice
Europe • Asia • Americas Confidential
Services Rendered in the Outpatient Clinic
Q77. At what age do you plan to completely retire from patient care?
181
The average age of retirement has increased from age 64 in 1999 to age 69 in 2009.
Benchmark Survey Comparisons
Europe • Asia • Americas Confidential
Section 6
Comparisons With Findings of the 2006 Workforce Study
182
Benchmark Survey Comparisons
Europe • Asia • Americas Confidential
Comparisons with 2006 Workforce Study Some questions asked in the 2009 Rheumatology Economic Survey can be compared with
the findings of the 2006 Workforce Study of Rheumatologists. The comparisons include the
following:
Do you require new patients to have a physician referral?
The 2006 Workforce Study reported that 48% of rheumatologists were requiring their
patients to provide physician referrals. The current found that this percentage has
increased to 55%.
At what age do you plan to substantially reduce your direct patient care hours (i.e.,
partially retire)?
The 2006 Workforce Study reported that a large number of rheumatologists who were
between 50 – 59 years of age “will have greatly reduced hours of work, over the next 15
years.
The current study supports this prediction. Forty-two percent of the physicians who
participated in the 2009 Rheumatology Economic Survey report that they plan to
substantially reduce their direct patient care hours by the time they reach 60 – 65 years
of age. In addition, another 20% of the participants report that they plan to substantially
reduce their direct patient care hours when they become older than 65 years of age.
183
Benchmark Survey Comparisons
Europe • Asia • Americas Confidential
Comparisons with 2006 Workforce Study (cont.)
At what age do you plan to completely retire from patient care?
The 2006 Workforce Study used labor force participation rates for professionals, based
on data from the Census Bureau for 2000, to predict substantial numbers of retirements
among rheumatologists beginning at age 59 and continuing through age 68.
Beyond age 68, the retirement rate begins to level off until these older rheumatologists
approach 75 years of age. At 75 years of age, the Workforce model assumed that all
remaining rheumatologists would be retired.
Again, the current study supports this prediction. A small number of the physicians who
participated in the 2009 Rheumatology Economic Survey report that they plan to retire
between 55 – 60 years of age (6%). However, a larger group of the rheumatologists
(26%) are planning to retire when they reach 61 – 65 years of age, and 46% report that
their goal for complete retirement is somewhere between 66 – 70 years of age.
Finally, the remaining 22% of the participants report that they will completely retire when
they pass 70 years of age.
184
Benchmark Survey Comparisons