1. REVENUE GENERATION Richard Wolfe, MD Beth Israel Deaconess Medical Center

2. “If you want to know what God thinks of money, just look at the people he gave it to.”

3. Revenue Generation Goals and Means  Alignment of Goals  Personal goals  Leadership goals  Departmental goals  Institutional goals  What means are needed to achieve your goals?

5. Why generate revenue?  Protected time  Seed money and bridging money for research  Additional training  Infrastructure  Building new areas for practice, research, and education  Reserves for the future Faculty Development

6. Individual Gain Versus Group Gain

7. The Future of Academic Health Care

8. Life Expectancy and Expenditure per Capita

9. Cost of Care: Percentage of GDP

11. The Economic Future of Emergency Medicine Will ED utilization and clinical revenue change?  Risk contracts  Effect of co-pays  Patient behavior during hard times  Reimbursement for professional services  EMRs and patient per hour speeds

12. Economics of Academics  Hospital and medical school funds flow  Federal funding of research  Industrial funding of research  Professional societies  Development

13. Although prepared for martyrdom, I preferred that it be postponed.

14. Know Your Institution Who controls the money?  Clinical income?  Consultations?  Indirect reimbursement for grants?  Societal and industrial grant revenue?  Moonlighting?

15. Practice Plans Mushroom Management  Kept in the dark  Fed bullshit  When grown big, canned  Loss of transparency  Loss of trust  Personal goals predominate over departmental goals

16. Practice Plans The Philosopher King or Queen  Trustworthy and equitable leader  Inspires a shared vision in those they lead  Can produce remarkable revenue growth  Depends on the skills of the leader rather than the system

17. Practice Plans The Secret Life of the Bees  Staff specialized into academic or clinical  Academic track receives lion share of development  Loss of shared incentives  Revenue generation depends on limited number of members in the group

19. Practice Plans Partnership with the Faculty  Shared vision established as a group  Complete financial transparency  Mutual trust  Taxation with representation  Eat what you kill after taxes

20. Revenue Generation Golden Rules  One should treat others as one would like others to treat oneself  The one with the gold, makes the rule  You can’t make up negative margins with volume  Lost indirect revenue sinks departments  What do you call academic activities that cannot lead to revenue generation?

21. Sources of Revenue  Areas that you control financially  Incentives based on performance  Negotiations with your leadership

22. Principles of Departmental Taxation  Equity: tax everything!  Incentives: size matters  Transparency: maintain trust  Representation Taxation with representation ain't so hot either. Gerald Barzan

23. Sister Irene Krause Daughters of Charity No Margin, No Mission

24. Sources of Revenue

25. Clinical Grants Education Administrative Classic Sources of Revenue

26. Revenue Generation Clinical: Every penny counts  Easiest and most lucrative source  Clinical revenue vs. cost of a provider  Quality of documentation  Coding, billing, and revenue cycle  Knowing who the customer is  volume growth

27. Revenue Generation Clinical: Diversifying Clinical Income  Observation units  Emergency department contracts  Urgent care  Ultrasound

28. Revenue Generation Clinical: Subspecialization  Toxicology  Hyperbarics  Sports Medicine  Urgent Care  Hospitalists  Intensivists

29. Funds Flow: Institution vs. Faculty Clinical Research Education Administration

30. Institutional Funds Flow Administrative Stipends  Leadership  Residency and medical school  Quality improvement  EMS  Hospital committees and positions

31. Revenue Generation Institutional Funds Flow  Office space  Lab space  Administrative assistants  Seed money and bridging for research  Academic titles and affiliations There ain't no such thing as a free lunch…

32. Revenue Generation Administrative Consulting  Quality improvement  Patient flow  Patient satisfaction  Revenue enhancement

33. Dirty Money: Industry  Hand outs  Speaker panels  Meeting sponsorship  Research Grants

34. A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. http://iom.edu/CMS/3740/47464/65721.aspx Institute of Medicine

35. Potential Impact of Conflict of Interest in Practice  Education – introduction of commercial bias  Research – misrepresentation, suppression of data  Practice – compromises professional judgment, erodes public trust

36. Development: Sources  Development office  Grateful and ungrateful patients  Board and trustees  Alumni

37. Revenue Generation EMS  Hospital support  Medical direction  Municipal  Private companies  Fire departments  Small community EMS  CME  Government contracts and positions

38. Revenue Generation Education: Residency Building an Education Fund for the Residency Program  Medicare reimbursement for teaching  Indirects for funded outside rotations  Residency and research  Extramural funding for international trainees

39. Revenue Generation Education  Speaker reimbursement  CME courses  Regional, national, international  Online education

40. Revenue Generation Consulting and Education  Clinical simulation  Residency development  International activities  Jump starting academic emergency departments  Designing training programs  Train the trainers

41. Revenue Generation Research  Value of grant salary vs. clinical salary  Wet space versus dry space  Share of the indirect costs  Federal versus Industry  Clinical operations and future funding

42. Revenue Generation Patents and Royalties  Know who owns the IP rights and the rules  Royalties are usually shared between the researcher, the department, and the institution  Creating corporations

43. International Consulting American Medicine: Simply the most expensive way to enjoy health care….

44. Emergency Medicine. Thriving through the work aversion of others