transplant hepatology: finanacial program organization
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Transplant Hepatology: Finanacial Program OrganizationTRANSCRIPT
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Last revised 10/26/2013
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Transplant hepatology:
finanacial program organization
James Trotter, MDBaylor University Medical Center
Dallas, Texas
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Background
“Pick the set of problems you want to deal with.” Daniel Foster, MD, circa 1992
“In hepatology, there are no great jobs; only good jobs.” Thomas Boyer, MD, circa 1997
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institutional support
MDproductivity
MD/institutional equinimity
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Hepatology program support
1) It is impossible to earn salary + overhead evaluating and managing (E/M) complex patients.
Hepatology is a financially insolvent enterprise.
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Hepatology program support
2) To remain solvent, hepatology requires supplementation by liver transplantation profits.
3) Most transplant programs don’t provide sufficient support for hepatology.
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Lack of adequate hepatology support
A) Most programs don’t understand hepatology value (benefit/cost).
B) Hospitals will pay MD’s as little as possible to retain their services.
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Overview
4) The most common reason for hepatologist discontentment is the perception of
inadequate salary and support.
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MD productivity
institutional support
MD discontentment
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institutional support
MD productivity
Institutional discontentment
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MD/institutional equinimity
5) Hepatology funding/support is one of the
most important means of building and
stabilizing a liver transplant program.
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institutional support
MDproductivity
MD/institutional equinimity
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Hepatology program support
• How much of the following is fair/required:
• hepatology salary?• hepatology support staff FTE’s? • hepatology workload/RVU’s?
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GENERALHEPATOLOGY
POST-TRANSPLANTHEPATOLOGY
PRE-TRANSPLANTHEPATOLOGY
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Program background
• liver transplantation since 1984• approximately 4000 total liver transplants • yearly activity • –450 liver transplant evaluations • –442 active listed patients • –135 liver transplants • –co-manage 2500 liver recipients
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Program background
• hospital-based, 12-MD (11 FTE) practice • two hospitals – Dallas and Fort Worth • IM, GI and transpl hep training programs • HealthTexas –400+ MD, multi-specialty –subsidiary of Baylor Health System –employs transplant hepatologists/surgeons
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Clinical outreach sites
Frisco 25 Garland 10 Grand Prairie 15 Waxahachie 25 McKinney 20 Midlothian 25 Longview 125 Austin 200 Lubbock 350 Odessa 360
site miles from DFW
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Service distribution11 hepatology MD FTE
general hepatology
service
pre-transplanthepatology
clinic
post-transplanthepatology
clinic
clinical and administrative staff19 clinical 6 clinical 6 clinical24 admin 6 admin 6 admin
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Cost – administrative and clinical
$9.1 million per year
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Cost – administrative and clinical
overhead (31 %)
MD salary (49 %)
staff salary (20 %)
$9.1 million per year
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Support staff – total
administrative clinical
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Support staff – per hepatologist
administrative clinical
3.5 staff per hepatologist
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Hepatology - salarystarting salary $2X0,000
RVU > 3000/year + $42.65/RVU
RVU salary $2X0,000 + 3000 $2X0,0004000 $2X0,000 + $42,6505000 $2X0,000 + $83,3006000 $2X0,000 +
$127,9507000 $2X0,000 +
$170,600
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Cost – administrative and clinical
overhead (31 %)
MD salary (49 %)
staff salary (20 %)
cost of practice = $9.1 M
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Revenue
$9.1 million per year
$3.1 million hepatology revenue
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Funding – yearly revenuetotal per hepatologist 44,725 total work RVU’s 4066
22,623 encounters 2057 9508 office (42 %)13,115 hospital (58 %)
$5.36 M gross charges $487k
$3.06 M cash collections (57 %) $278k
Total revenue is $3.1 M
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Revenue - supplement
$6.1 million per year deficit22,643 encounters per year
$269.40 extra per encounter
=
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Revenue - supplement
$9.1 million per year
$3.1 M hepatology revenue
$6.0 M hospital supplement
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Funding - revenue
$3.1 M revenue - $9.1 M cost = $6.0 M loss
$6.14M = $511k support per MD 12 hepatologists
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Contribution margin
contribution margin = hospital revenue – direct costs,
where direct cost are
hepatology MD/staff salary benefit, supplies
indirect costs computers, hospital administration, etc.
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Contribution margin
contribution margin = hospital revenue – direct costs,
For hepatology $XX.2 M
$XX.2 M contribution margin - $X.1 M cost = $X.1 M margin
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institutional support
MDproductivity
MD/institutional equinimity
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Summary – support per hepatologist
• 2.0 administrative + 1.5 clinical FTE
• $2xx,000 + $42.65 per RVU > 3000
• cost approximately $500,000 per MD
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Summary – yearly revenue per MD
• 4066 RVU
• 2057 encounters
• $487k gross charges
• $278k collections
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Funding - revenuetotal per hepatologist 44,725 RVU’s 4066
22,623 encounters 2057
RVU/encounter 1.98
RVU/encounter range 1.6 for non-procedural
2.0 procedural (poor biller)
2.4 procedural (good biller)
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