Benchmark Survey:
* Physician(s) specialty
Number of full-time physician(s)
Number of part-time physicians(s)
Total number of full time (30 hr/week or more) Nurse practitioners, physiican assistants, and other paraprofessionals
Total number of part time (less than 30 hr/week) Nurse practitioners, physiican assistants, and other paraprofessionals
Is practice owned or managed by a hospital or hospital affiliated organization?
Yes
No
Please give annual figures from fiscal year ending 2009 (Must be for 12 month reporting period)
1. Gross charges (all professional services including non-physician & ancillary)
2. Adjustments (contractual write-offs, bad debt, courtesy discounts
3. Net charges (gross charges minus adjustments)
4. Total collections (receipts) for all patient services
5. Amount or percentage of charges that are Medicare
6. Amount or percentage of charges that are Medicaid
7. Total amount of accounts receivable
8. Amount of accounts receivable that were 1 - 30 days old (as of 12-31-09)
9. Amount of accounts receivable that were over 90 days old (as of 12-31-09)
10. Bad debt (total amount written off as not collectible
11. Total annual practice expenses (exclude physicians, Nurse Practitioners, Physician Assistants, paraprofessionals compensation & benefits)
12. Business supplies (clerical and administrative office supplies
13. Medical supplies & drugs
14. Office space (rent, utilities/maintenance, housekeeping)
15. Lab (costs for in-office & technical services outside)
16. Malpractice & professional liability insurance premiums
17. Outside professional services (attorney, accountant & consulting fees)
18. Employee benefits (FICA, unemployment, health, life, disability, retirement/profit-sharing, license, dues, CME) Exclude physiicans and paraprofessionals
19. Equipment & furniture (including depreciation)
20. Marketing/advertising (services and materials to promot practice)
21. Physicians(s) compensation (salary & bonuses)
22. Physician benefits (profit sharing, retirement plan contributions, health, life, disability insurance premiums)
23. Average # of outpatient visits per week (Includes any office, clinic, or ER encounter between physician and patient)
24. Average # of surgery procedures per week (inpatient and outpatient)
25. Total active patients (number of Patients receiving services at least Once in the last 12 months)
26. Average number of patient hospital visits per week by doctors
Enter # of Full Time Staff at this position (20 hr/week or more)
Receptionist
Transcriptionist
Appointment Secretary
Bookkeeper
File Clerk
Nurse Practitioner
Physician Assistant
Nurse (LPN)
Nurse (RN)
Medical Assistant
X-ray Technician
Lab Technician
Billing Clerk
Insurance Secretary
Business Office Supervisor
Office Manager
Practice Administrator
Other
