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2005 MGMA OF GREATER ST. LOUIS SALARY SURVEY

Curt Mayse & Tamara O’Reilly

LarsonAllen Health Care Group

August 16th, 2005

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Session Objectives

2005 MGMA Salary Survey— Process outline— Key Survey outcomes

Survey Historical Perspective— Trends over past surveys

“Pearls” of the process

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How does is this information benefit you?

• Benchmark your practice against peers regarding compensation and benefits

• Local Healthcare Trend Analysis

• Specific job/position categorization

• Historical examination of Salary data

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Process Outline

• Survey distributed to all members – 150 groups

• For the first time, Survey respondents were able to begin, end and return to the Survey multiple times ~ it wasn’t necessary for the survey to be completed all at once

• Multi-dimensional completion avenues were provided to respondents (e.g. on-line; manually; etc.)

• 38% response rate

• 57 surveys considered valid

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Process Outline (continued)

• 904 physicians were represented, 164 Mid-level Providers— 43% Primary Care— 57% Specialist

• Nearly 2,972 employees were represented (19% increase)

• 80% from independent groups

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Respondents by Type of Affiliation

Individual Hospital1.96%

University9.80%

Health System5.88%

Insurance Company

7.84%

Owned/Managed by Practice

Management Company

3.92%

Independent Medical Group

80.39%

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Respondents Grouped by

• Type of Affiliation

• Practice Size

• Practice Type

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Respondents by Practice Size

10.53%

35.09%

21.05%

15.79%

10.53%

3.51%3.51%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

1 Physician

2 - 3Physicians

4 - 5Physicians

6 - 10Physicians

11 - 15Physicians

16 - 20Physicians

> 20Physicians

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Respondents by Revenue

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

2004 22.22% 22.22% 18.06% 18.06% 9.72% 9.72%

2005 11.32% 18.87% 28.30% 5.66% 16.98% 11.32% 7.55%

< $1MM$1MM to $1.99MM

$2MM to $3.49MM

$3.5MM to

$5MM to $9.99MM

$10MM to $20MM

> $20MM

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Respondents by Practice Type

Single Specialty only Primary Care

12.28%

Multi-specialty predominantly specialty care

7.02%

Multi-specialty but predominantly primary care

7.02%

Multi-specialty only

7.02%

Single Specialty without primary

care66.67%

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Local Trends

• Average salaries rose by 3.5% overall from 2004

• Biggest increases:— RN Specialty – 18.33%— Coder (Non Certified) – 14.28%— Business Office Manager – 8.00%— LPN – 5.93%— Ultra Sound Technician – 5.94%— Billing Clerk – 5.30%— Medical Secretary – 5.06%

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Local Trends (continued)

• Biggest decreases:— Lab Technician (Certified) – 23.25%— Phlebotomist – 15.46%— Medical Records Clerk – 12.52%— Referral Coordinator – 13.06%

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How Salary Increases are Determined?

Merit80.36%

General, Across the Board12.50%

Cost of Living7.14%

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When are Salary Increases Given?

Employee's anniversary date

60.00%

Fiscal year12.73%

Calendar year27.27%

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How Often is Salary Reviewed?

Annually94.64%

Semi-Annually1.79%

Quarterly3.57%

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Average Salary Increases 2003-2004-2005

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2003 1.59% 6.35% 52.38% 22.22% 17.46%

2004 3.08% 9.23% 43.08% 18.46% 26.15%

2005 4.17% 6.25% 54.17% 18.75% 16.67%

< 1.99% 2.00 - 2.99% 3.00 - 3.99% 4.00 - 4.99% 5.00%+

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Reviews at Time of Salary Increase

Reviews at Same Time of Salary Increase

Yes87.72%

No12.28%

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Bonuses

• Annual bonuses – 75% provided some sort of staffing bonuses

• Criteria for bonuses based on:— percentage of productivity and/or physician income— percentage of organization’s net profit— deferred compensation— discretionary

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Bonuses by Practice Size

77.78%

100.00% 100.00%100.00%

86.67%

72.73%

50.00%

75.00%

66.67%66.67%

100.00%

73.33%63.64%

50.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

<$1MM $1MM to$1.99MM

$2MM to$3.49MM

$3.5MM to$4.99MM

$5MM to$9.99MM

$10MM to$20MM

>$20MM

Administrator Staff

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Bonus Determination

8.62%

15.52%

3.45%5.17%

12.07%

55.17%

8.89%

2.22%

6.67%6.67%

2.22%

73.33%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%50.00%55.00%60.00%65.00%70.00%75.00%80.00%

Discretionary % of Productivityand/or physician

income

% of organization's

net profit

Other formulabonus

Deferredcompensation

Combination of all factors

Admin Staff

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Salary and Benefits ~ what do employees expect?

— PTO (paid time off) has become an administratively flexible alternative for employers trying to meet ever increasing employee needs

— The PTO solution reduces a Practice’s time and energy to manage employee’s Vacation and Sick time

◊ National Average 24 Days◊ St. Louis (2003) 23 Days◊ St. Louis (2004) 25 Days◊ St. Louis (2005) 26 Days

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PTO Days by Years Employed

11.45

20.46

25.54

29.39 30.5027.70 28.61

21.46

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

<1 Year

1.1 - 3 Years

3.1 - 5 Years

5.1 - 10 Years

10.1 - 15 Years

15.1 - 20 Years

20.1 - 25 Years

>25 Years

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What is Considered Full Time?

Determination of Hours for Full Time Employee

35 - 40 Hours75%

30 - 34 Hours25%

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Positions Surveyed

• Office Manager

• Administrator

• Assistant Administrator

• Business Office Manager

• Administrative Assistant

• Accounts Payable

• Billing Clerk

• Coder/Analyst (Certified)

• Coder/Analyst (Not Certified)

• Collector

• File Clerk

• Information Systems Technician

• Patient Accounts Rep/Collections

• Receptionist

• Referral/Managed Care Coordinator

• Switchboard/Telephone Operator

• Medical Records Clerk

• Medical Secretary

• Transcriptionist

• Clinical Supervisor• Licensed Practical Nurse• Medical Assistant (Certified) • Medical Assistant (Not Certified)• Registered Nurse• Registered Nurse (Specialty Certified)• Surgery Scheduler• Lab Technician (Certified)• Lab Technician (Not Certified)• Phlebotomist• Lead/Chief Lab Technician• Ultrasound Technician• X-Ray Technician• Lead/Chief X-Ray Technician• Nurse Practitioner• Physician Assistant• Surgical Technician• Aesthetician

• Audiologist

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Sample Salary Page

Billing ClerkEnters charges and payments daily; responsible for billing and follow up on both

insurance and patient accounts; assists with patient inquiries.

CategoryLow

SalaryAverage

SalaryHigh

SalaryTotal FTE's

Average Years of Service

Average Years of Education

All Practices $25,667 $28,766 $32,094

$12.34 $13.83 $15.43

Under $1MM $28,870 $31,470 $28,600

$13.88 $15.13 $13.75

$1MM to $2MM $30,867 $32,323 $33,883

$14.84 $15.54 $16.29

$2MM to $3.5MM $25,646 $28,808 $32,510

$12.33 $13.85 $15.63

$3.5MM to $5MM $28,080 $29,120 $30,160

$13.50 $14.00 $14.50

$5MM to $10MM $23,941 $27,581 $31,720

$11.51 $13.26 $15.25

$10MM to $20MM $18,866 $23,712 $30,243

$9.07 $11.40 $14.54

> $20MM $21,715 $26,333 $31,158

$10.44 $12.66 $14.9845.00 7.68 *

101.20

*

9.00

14.20

2.00

24.00

6.00

6.42

*

5.25

7.63

4.00

6.41

5.00

*

1.29

1.00

0.96

*

1.67

0.29

By Revenue Type

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Sample Salary Page (continued)

CategoryLow

SalaryAverage

SalaryHigh

SalaryTotal FTE's

Average Years of Service

Average Years of Education

All Practices $25,667 $28,766 $32,094$12.34 $13.83 $15.43

Multi Specialty $23,608 $26,603 $29,037(but predominantly primary care) $11.35 $11.35 $13.96Multi Specialty $19,344 $23,941 $31,013(predominantly specialty care) $9.30 $11.51 $14.91Multi Specialty Only $17,306 $22,755 $24,128

$8.32 $10.94 $11.60Single specialty $27,310 $27,435 $27,560(with primary care) $13.13 $13.19 $13.25Single Specialty $26,333 $29,494 $33,114(without primary care) $12.66 $14.18 $15.92Specialty $28,080 $30,680 $32,240(with primary care) $13.50 $14.75 $15.50

101.20 6.42 0.96

37.00 5.00 *

3.00 * *

6.00 11.00 *

2.00 2.25 *

3.00 2.50 *

50.20 7.07 1.28

By Practice Type

•Insufficient Responses

NOTE: Low, average and high salary amounts are compiled from survey responses and each category is then averaged. If a respondent did not respond to all data elements, no adjustment was made and data may appear to be inconsistent in some instances (e.g., average salaries may be lower than low salaries).

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Staffing Ratio per FTE Physician*

* MGMA’s Better Performing Practices annual guide states that in some cases a higher staffing ratio can create higher profitability

17.54%

28.07%

22.81%

15.79%15.79%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

< 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5+

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Staffing Ratio Per FTE Physician

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

2004 14.08% 28.17% 15.49% 16.90% 25.35%

2005 17.54% 28.07% 15.79% 15.79% 22.81%

< 1.99 2 - 2.99 3 - 3.99 4 - 4.99 5+

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Current Staffing Needs

12.90%

6.45%

3.23%

22.58%

3.23%

7.53%

25.81%

1.08%

6.45%

2.15%

4.30%4.30%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Physician Physician'sAssistant

Nurse Practitioner Nursing/Clinical Radiology Medical Records Front Desk Certified Coder Transcriptionist Billing/Collections Lab Manager

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Current Staffing Needs for Your Practice

0%

5%

10%

15%

20%

25%

30%

2004 28% 4% 4% 17% 3% 7% 17% 3% 4% 11% 1% 11%

2005 13% 6% 3% 23% 3% 8% 26% 4% 1% 6% 2% 4%

PhysicianPhysician's Assistant

Nurse Practitioner

Nursing/Clinical

RadiologyMedical Records

Front DeskCertified Coder

Transcriptionist

Billing/ Collections

Lab Manager

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Building Successful Teams in the Midst of Change

“Health and Mental health organizations are undergoing major changes in policies, procedures, structure and emphasis”,

Stewart Gabel, Leaders and Healthcare Organizational Change: Art, Politics, and Process

— One of the most significant essentials for success during transition is teambuilding

— Leaders that can challenge, motivate and empower their teams through change are successful

— Most change disrupts teamwork ~ the Leaders who can keep their work teams focused during changes will have Practices which thrive

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Essential One: Knowledge

Is your company/practice a learning organization? A learning organization includes the following characteristics:

— A belief that systems thinking is fundamental— A climate that encourages, rewards, and enhances individual and

collective learning— A view the holds surprises, mistakes, and failures as learning

opportunities— A desire for continuous improvement and renewal— Learning integrated with work

Knowledge is the foundation to Vision

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Essential Two: A Focused Vision

• The team must have a unified mission

• The team mission is not for customers, it is for the staff

• The team mission must be developed by the staff – for ownership

• Without Knowledge, the team mission is a false hope

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Essential Three: Faith

• Doubt and skepticism will erode the team spirit

• The dynamic team must have a strong faith and trust in the mission

• Faith is not stronger than the truth of its assumptions

• Therefore, Faith must be built on the first two factors:

• Faith, without Knowledge and Vision, is merely presumption

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Essential Four: Initiative

“Sooner or later all plans degenerate into work”- Peter F. Drucker, The Daily Drucker

How do you motivate your staff to do their part?— Motivation is an inside job ~ It is internal— Daily initiative comes from making sure each person is

doing the part of the whole that they feel best contributes to the overall mission

Initiative without Knowledge, Vision, and Faith is misguided energy AND without Initiative,

knowledge, vision and faith are just a dream!

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Essential Five: Training and Development

American Society of Training and Development found the following major competencies as models for human performance improvement:

- Industry or Corporation Awareness - Leadership Skills- Interpersonal-relationship skills - Technological Literacy- Problem-solving skills - Problem-definition skills- Systems thinking and understanding - Performance understanding- Knowledge of interventions - Business understanding- Organization understanding - Contracting skills- Advocacy skills - Coping skills- Ability to see the “BIG” picture

Great teams are made up of Knowledge workers, who have a focused Vision, believe in their mission and empower each other with their

Initiative and Skill Development

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Performance Management• Employee Performance Management Cycle

Measurable

Repeatable

Predictable

# 1 –JobDescription

# 2 –Hiring

# 3 –DiscussJobExpect.

# 4 –Training

# 5 –Determine1st and 2nd jobduties

# 6 –90 dayperformancereview

# 7 –Annualperformancereview

# 8 –SalaryIncreaseorDecrease

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Summary

A combination of competitive salaries and benefits along with an environment that fosters Knowledge; has a strong Vision and leads through Initiative and Skill Development creates productive and happy employees.

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Thank You

LarsonAllen Health Care Group

(314) 336-3726

www.larsonallen.com