PEDIATRICS Vol. 108 No. 1 July 2001, pp. 79-84
Characteristics and Financial Performance of a Pediatric Faculty Inpatient Attending Service: A Resource-Based Relative Value Scale Analysis
Received Aug 2, 2000; accepted Nov 11, 2000.
From the Department of Pediatrics, University of
Washington School of Medicine and Children's Hospital and Regional
Medical Center, Seattle, Washington.
Objectives. In many children's
hospitals, inpatient attending physician services are provided by
academic faculty who function as part-time inpatient specialists or
hospitalists. Although some have claimed that hospitalist care can
reduce length of stay and total hospital resource use and expenses,
there are few benchmarks or data regarding physician productivity or
the characteristics and financial performance of these programs. The
resource-based relative value scale (RBRVS) is a valuable tool for
developing national benchmarks and comparing the financial performance
of inpatient programs at varying daily census and reimbursement levels.
The objectives of this study were to 1) describe physician productivity
on an inpatient service as measured by total relative value units
(TRVUs) and professional charges, 2) determine whether inpatient
collections were adequate to support faculty salaries for the time
spent attending, and 3) develop a model to evaluate financial
performance of inpatient programs at varying census and TRVU
reimbursement levels.
Methods. A retrospective review of hospital discharge and
faculty practice billing data between June 1997 and July 1998 was
conducted in a general medical service in a regional, 208-bed,
university-affiliated children's hospital in the Pacific Northwest.
Results. Of 4113 patients who were admitted to the
children's hospital general medical service during a 12-month period,
faculty part-time hospitalists (N = 28) served as
the attending physician for 1738 (42%). On an annual basis, faculty
attended for an average of 29.1 days (median: 21.0; range: 7.0-97.0),
with an average daily patient census (ADC) of 7.2 (median: 6.5; range:
2.8-12.0). Inpatient attendings billed for 1738 initial visits and
3957 subsequent visits. Total physician productivity for the inpatient
attending group during 1 year included 12 085 TRVUs and gross
professional charges of $777 743. The average payment, or conversion
factor (CF), was $24.46/TRVU (71% of Medicare CF). The cash collection rate was 38%, reflecting a payor mix that included 54% Medicaid, 28%
commercial payors, 12% health maintenance organization, and 6% other
payors. On a weekly basis, physicians generated an average of 109 TRVUs
and collected $2665 in cash. The average salary cost per RVU was
$23.40, and weekly faculty salary and benefit expenses were $2550.
After operating expenses and academic taxes totaling 24% were deducted
($5.87/TRVU), RBRVS-based payments and cash collections covered 79% of
average faculty weekly salaries. Financial modeling showed that either
an average CF of $31/TRVU or an ADC of 9 patients per day on the
inpatient service would be required to generate sufficient revenue to
support physician salaries and operating expenses.
Conclusions. For a faculty inpatient attending service in
a children's hospital with an ADC of 7, a $24.46 RBRVS-based CF
payment is inadequate to support faculty salaries and operating
expenses for the time spent attending. Inpatient services in similar
payor environments with comparable expenses and staffed by faculty who
care for fewer than 9 patients per day will not cover typical faculty
salary costs and operating expenses.
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