Dean Dorton Salary Survey Results – Kentucky Adam Shewmaker, FHFMA Director of Healthcare Consulting Services Meagan Parker, MHA, CMA Manager of Healthcare Consulting Services Patti Bingham, CMM, CMPM Practice Administrator, All Children Pediatrics

Introductions Adam Shewmaker, FHFMA Meagan Parker, MHA, CMA Director of Healthcare Consulting | Dean Dorton Adam Shewmaker, FHFMA Manager of Healthcare Consulting | Dean Dorton Meagan Parker, MHA, CMA Practice Administrator | All Children Pediatrics Patti Bingham, CMM, CMPM

Objectives National and regional trends What employees value 2019 salary survey results All Children Pediatrics – a practice perspective

Detailed Summary: Five-Year Period Through Jan 2018 Measure July 2012 January 2018 % Increase Number of hospital-employed physicians 94,700 168,800 78.2% % of hospital-employed physicians 25.8% 44.0% 70.8% Number of hospital-owned practices 35,700 80,000 124.4% % of hospital-owned practices 13.6% 31.2% 128.7% National Trends Measure Region July 2012 January 2018 % Increase % of hospital-employed physicians Northeast South Midwest West AK & HI 22.1% 21.0% 34.3% 25.0% 18.3% 45.7% 39.2% 55.1% 41.2% 34.1% 107.0% 86.8% 60.7% 64.8% 86.1% % of hospital-owned practices 13.2% 12.2% 20.1% 11.3% 7.3% 31.6% 28.5% 38.4% 28.0% 29.4% 139.4% 133.6% 91.0% 147.8% 302.7% Regional Trends www.physiciansadvocacyinstitute.org

Number of Hospital-Employed Physicians From July 2016 to January 2018, the number of physicians employed by hospitals increased by 14,000 nationwide After a small decrease in July 2016 due to a reduction in total number of physicians, the number of employed physicians rose to nearly 170,000 by 2018 www.physiciansadvocacyinstitute.org | Avalere analysis of SK&A hospital/health system ownership of physician practice locations data with Medicare Standard Analytic Files

National Trends July 2016 through January 2018: Measure July 2016 % Increase Number of hospital-employed physicians 154,900 168,800 9.0% % of hospital-employed physicians 41.7% 44.0% 5.7% Number of hospital-owned practices 72,100 80,000 11.1% % of hospital-owned practices 29.7% 31.2% 5.0% July 2016 through January 2018: An additional 14,000 physicians were employed by hospitals An additional 8,000 practices were acquired by hospitals www.physiciansadvocacyinstitute.org

Regional Trends Measure Region July 2016 January 2018 % Increase % of hospital-employed physicians Northeast South Midwest West AK & HI 44.3% 37.4% 52.8% 38.7% 34.4% 45.7% 39.2% 55.1% 41.2% 34.1% 3.3% 5.0% 4.3% 6.6% -0.9% % of hospital-owned practices 30.6% 26.9% 37.0% 25.9% 29.0% 31.6% 28.5% 38.4% 28.0% 29.4% 6.0% 3.8% 8.1% 1.4% www.physiciansadvocacyinstitute.org

Hospital-Employed Physicians by Region Between July 2016 and January 2018, the percentage of hospital-employed physicians increased between 3% and 7% in most regions www.physiciansadvocacyinstitute.org | Avalere analysis of SK&A hospital/health system ownership of physician practice locations data with Medicare Standard Analytic Files

Other Trends Physician Pay (AMGA Consulting) Overall increased by a median of 2.92% in 2018 Primary care increased by 4.91% Specialists increased 3.39% Nurse Practitioners in primary care increased 2.92% Physician Assistants in primary care increased 2.50%

Other Trends Physician Age and compensation (2018) Older specialists (ages 40-69) made $72,000 more than younger specialists Older PCPs made $32,000 more in annual salary More women physicians 45% of younger physicians are female (up from 41%) 34% of older physicians (40-69) are female (up from 31%) 2017: first-time females enrolling in medical school surpassed males

Other Trends Employed vs. independent 58% of recently surveyed physicians do not think hospital employment will enhance quality or care or decrease costs (Continuumhealth.net) Hospital financial losses per physician Average loss of $200,000 per employed physician per year

Be a doctor, not a business person Reimbursement changes Decision Points Lifestyle and burnout Administrative tasks Be a doctor, not a business person Overhead costs Reimbursement changes Patient workload Call rotation

Growth and continued education Employees Recognition Flexibility Culture Growth and continued education Giving back

Survey Results History and approach

Demographics Urban: majority of the population, which the practice serves, is located in a city of 50,000 or more Suburban: located in a residential area adjacent to an urban area of 50,000 or more Small City: located in a city with a population greater than 2,500 but less than 50,000 Rural: located in a town of less than 2,500

Primary Specialty Other: Cardiology, anesthesiology/pain management, behavioral health, dermatology, emergency, endrocrinology, ENT, OB-GYN, radiology

Number of Full-Time Equivalents Medical providers: NP, PA Medical physicians: MD, DO Staff (non-providers)

Patient Revenue Collected in Last Fiscal Year

Patients Seen Per Day

Employee Salary

Executive Leadership: Practice Administrator $97,500 $87,269 $78,068

Mid-Level Management

Mid-Level Management: Deeper Dive Clinic/Office Manager Front Office Supervisor $87,269 $78,068 $66,250 $61,873 $61,555

Front Line Staff $23.73 $19.99 $19.26 $18.00 $15.51 $14.88 $14.26 $13.48

Clinical Support: Mid-Level Providers Mid-Level Provider (includes NP and PA) Nurse Practitioner Physician Assistant $120,506 $120,371 $111,688 $105,470 $96,104

Clinical Support: RN $32.49 $31.29 $28.92

Clinical Support Staff $24.10 $23.67 $21.97 $18.90 $17.62 $16.62

Clinical Support: Deeper Dive X-Ray Lab $33.44 30.89 $26.43 $25.81 $24.10 $23.67

Billing Manager $62,500

Billing Staff $19.50 $18.55 $18.23 $16.62 $13.48

All Children Pediatrics: A Practice Perspective Q&A with Patti Bingham All Children Pediatrics: A Practice Perspective

Adam Shewmaker, FHFMA Meagan Parker, MHA, CMA Patti Bingham, CMM, CMPM ashewmaker@ddafhealthcare.com | 502.566.1054 Meagan Parker, MHA, CMA mparker@ddafhealthcare.com | 859.425.7790 Patti Bingham, CMM, CMPM pbingham@allchildrepeds.com | 502.244.6373