1. Taking a Fresh Look at the AAMC Faculty Practice Plan Survey (FPPS) Mary Patton Wheatley Hershel Alexander November 4, 2011

2. Overview  Brief description of the annual faculty practice plan survey  Highlight a few key data points  Discuss practice needs moving forward 2

3. FPPS: Why another survey?  To answer questions from members:  “What are other practices doing?”  “Who is similar to me?”  To answer questions from policy makers  “What’s different about faculty practices?” 3

4. Data collection FY2010 Survey  Organizational characteristics – Governance structure – Organizational structure – Degree of centralization – Locus of control  Basic financial data  Size of practice (encounters, faculty, etc) No FY2011 Survey  Assess data collection and reporting needs Note: Group on Faculty Practice also administers an executive compensation survey which is currently being collected for FY2011 4

5. Ownership Population N Population % Response Rate N Response Rate % Public7258% 2433% Private5342% 3668% Total125100% 6048% Source: FPPS, 2010 FPPS Response Rates 5

6. Governance 6

7. Source: Q4b, FPPS, 2010. Practices were asked to indicate number of positions on Board for the given categories. Typical Practice Plan Board Composition N=58 7

8. Executive Members2010 Dean of SOM21 Clinical Department Chair7 Hospital, Medical Center or Health System 4 Practice Plan CEO2 Faculty at Large2 Community Member1 Other5 Total Respondents42 Source: Q4b, FPPS, 2010. Practices where asked to check which board position was chair. 42 out of 58 practices uniquely identified who their chair was. Who is the Chair of the Practice Plan Board? 8

9. Position Number of Practices with Position Percent of Total Practices that Have the Position on the Board Percent of Positions that Have Voting Privileges Dean5493%80% Clinical Department Chair5188%100% Practice Plan CEO4781%49% Faculty at Large4272%95% Other4171%86% Hospital CEO3153%54% Other FPP Execs2441%45% Other University Reps2034%61% Community Members1729%93% Dept Appointee1424%100% Basic Science Rep916%100% Hospital Board Members712%83% 9 How Often a Given Position is on the Practice Plan Governing Board and Has Voting Rights Source: Q4b, FPPS, 2010. Practices were asked to indicate number of positions on Board for the given categories and whether the positions had voting privileges. N=58

10. Revenues and Outflows 10

11. Source: Q8f, FPPS, 2010. Responses indicated are self-reported. N=50 Average Percent of Revenue Derived from Various Sources 11

12. Practice Outflows CategoriesAverage 25th Percentile 50th Percentile 75th Percentile Physician Compensation (Percentage of Total Practice Plan Revenue used towards Physician Salaries) 47% 38%48%52% Institutional Taxes and Transfers (Percentage of Total Practice Plan Revenue used towards Taxes and Support) 9%4%8%10% Operational Expenses (Percentage of Total Practice Plan Revenue used towards Operational Expenses) 43%34%45%54% 12 Source: Derived from Revenues and Expenses in Q8 and Q9, FPPS, 2010, N=56

13. Control Across Academic Entities 13

14. Revenue Cycle Activities Faculty practices have much more control of the back-end revenue cycle processes than front end processes:  Scheduling (62% have complete or partial control)  Registration (68% have complete or partial control)  Coding (80% have complete or partial control)  Credentialing (88% have complete or partial control)  Back-end billing (92% have complete or partial control) Source: Q3, FPPS, 2010. Practices were asked to select which academic entities have complete or partial control of a function. Practices could select more than one entity for each function. N=60 14

15. Details for Scheduling Entities that Control SchedulingN%Cumulative % Practice and Department1627% Hospital/Health System Only1017%43% Practice, Department, and Hospital/Health System813%57% Department Only813%70% Practice and Hospital/Health System58%78% Department and Hospital/Health System58%87% Practice only47%93% Practice, School of Medicine, Department, and Hospital/Health System23%97% Practice, School of Medicine, and Department12%98% Practice and School of Medicine12%100% Source: Q3, FPPS, 2010. Practices were asked to select which academic entities have complete or partial control of a function. Practices could select more than one entity for each function. N=60 15

16. Other Parts of the Academic Enterprise Most Involvement (at least 50% have complete or partial control) Least Involvement (85% or more have no control) Clinical Departments  Revenue cycle (scheduling, registration, coding)  Practice development  Clinical care functions (Patient care, Clinic operations)  Compensation/Benefits for MDs/Providers  Information systems  Compliance  Audits  Investments  Managed care/contracting Hospital/ Health System  Revenue Cycle (scheduling and registration)  Business development o Marketing/Public Relations o Strategic planning  Clinical care functions o Patient care o Patient safety o Professional practices o Quality improvement  Infrastructure o Information Systems o Risk management/liability o Space  Compensation/benefits for MDs/Providers Source: Q3, FPPS, 2010. Practices were asked to select which academic entities have complete or partial control of a function. Practices could select more than one entity for each function. N=60 16

17. Most Involvement ( at least 50% have complete or partial control) Least Involvement (85% or more have no control) School of Medicine  Compensation/benefits for MD/Providers Strategic planning  Budget/Finance  Space  Revenue cycle functions (Scheduling, Registration, Coding, Credentialing, Billing and Collections)  Managed care and contracting  Investments Parent University  Audit  Investments  Personnel/HR  Very little involvement in revenue cycle, clinical care, practice development Other Parts of the Academic Enterprise Source: Q3, FPPS, 2010. Practices were asked to select which academic entities have complete or partial control of a function. Practices could select more than one entity for each function. N=60 17

18. 2012 Survey 18

19. Assessment/Feedback  Can the FPPS answer the crucial questions?  What do you need to know (that you cannot get from current data sources)?  How does the AAMC need to report the data?  Other feedback?  What do we need to know about tomorrow’s practice?  What is practice’s role within the larger academic clinical enterprise? Round table this afternoon to consider these questions 19

20. Next Steps  Transition survey administration to Data Operations and Services  Hershel Alexander, Director  Kajal Nayyar, Sr. Research Analyst  Implement a process for survey revision  Round table discussion  Additional steps forthcoming 20

21. Contact Information  Kajal Nayyar Sr. Research Analyst, Data Operations and Services knayyar@aamc.org, (202) 478-9913 knayyar@aamc.org  Hershel Alexander Director, Data Operations and Services halexander@aamc.org, (202) 828-0649 halexander@aamc.org  Mary Wheatley Manager, Health Care Affairs mwheatley@aamc.org, (202) 862-6297 mwheatley@aamc.org 21