OK, Tell me about Abt -III · 2008-07-29 · 6 – Abt delivered the final report to AAPM Who was on the Preliminary ... Reviewing the patient case in initial presentation, simulation,

The Abt study of Medical Physicist Work Values forThe Abt study of Medical Physicist Work Values forRadiation Oncology Physics Services: Round IIIRadiation Oncology Physics Services: Round III ––

Negotiate wisely and avoid greedNegotiate wisely and avoid greed –– Michael D. MillsMichael D. Mills AbtAbt--III? What (who) is that?III? What (who) is that?

Abt Associates, Inc. is one of the nationAbt Associates, Inc. is one of the nation’’ssmost respected medical economicsmost respected medical economicsconsulting organizationsconsulting organizations –– after all look atafter all look atthe client list: AAPM and ACMP!the client list: AAPM and ACMP!

The AbtThe Abt--III study measured medicalIII study measured medicalphysicist work for both routine and specialphysicist work for both routine and specialproceduresprocedures

Wait a minuteWait a minute –– was there an Abtwas there an Abt--IIstudy? An Abt II?study? An Abt II?

Sure, the AAPM and ACMP did this backSure, the AAPM and ACMP did this backin 1995 and again in 2002, but:in 1995 and again in 2002, but:

They are out of dateThey are out of date

They did not measure certain proceduresThey did not measure certain proceduressuch as IGRT and HDRsuch as IGRT and HDR

The 2002 study was performed beforeThe 2002 study was performed beforeIMRT was widespread and in common useIMRT was widespread and in common use

Stereotactic Body Radiation Therapy?Stereotactic Body Radiation Therapy?Forget it!Forget it!

OK, Tell me about AbtOK, Tell me about Abt--IIIIII

We started back in 2007We started back in 2007

AAPM agreed to fund another work studyAAPM agreed to fund another work studywith Abt Associates and foot the entirewith Abt Associates and foot the entirecost!cost!

AAPM pays $95,000AAPM pays $95,000

This time we measured work associatedThis time we measured work associatedwith IGRT, Stereotactic Body, HDR andwith IGRT, Stereotactic Body, HDR andother special proceduresother special procedures

What were the steps to the AbtWhat were the steps to the Abt--IIIIIIsurvey?survey?

11 –– Establish the Preliminary PanelEstablish the Preliminary Panel

22 –– Survey Qualified Medical PhysicistsSurvey Qualified Medical Physicists

33 –– Convene an Expert Panel to review dataConvene an Expert Panel to review data

44 –– Abt staffer Kevin Coleman wrote finalAbt staffer Kevin Coleman wrote finalreportreport

55 –– The Expert Panel reviewed the reportThe Expert Panel reviewed the report

66 –– Abt delivered the final report to AAPMAbt delivered the final report to AAPM

Who was on the PreliminaryWho was on the PreliminaryPanel?Panel?

AAPMAAPM ––�� Michael MillsMichael Mills

�� Michael HermanMichael Herman

�� Herbert MowerHerbert Mower

�� James HeveziJames Hevezi

And Who from Abt Associates?And Who from Abt Associates?

David KidderDavid Kidder

Lois OlingerLois Olinger

Kevin ColemanKevin Coleman

What did the Preliminary PanelWhat did the Preliminary PanelDo?Do?

Defined the scope of codes associatedDefined the scope of codes associatedwith medical physicist workwith medical physicist work

Selected appropriate benchmarkSelected appropriate benchmarkprocedure (77336procedure (77336 –– Continuing MedicalContinuing MedicalPhysics Consultation)Physics Consultation)

Developed survey codesDeveloped survey codes’’ vignettesvignettes

Refined the survey instrumentRefined the survey instrument

How did the survey measureHow did the survey measureQualified Medical Physicist work?Qualified Medical Physicist work?Collected time estimates (nonCollected time estimates (non--proceduralproceduraland procedural) associated with providingand procedural) associated with providingmedical physics servicesmedical physics services

Collected intensity estimates for eachCollected intensity estimates for eachservice relative to the baseline serviceservice relative to the baseline service

Collected serviceCollected service--mix data (annual numbermix data (annual numberof each procedure provided by a practice)of each procedure provided by a practice)

Analyzed survey data to developAnalyzed survey data to developpreliminary QMP work estimates by servicepreliminary QMP work estimates by service

Who received the surveyWho received the surveyinstrument?instrument?

100 QMPs were chosen, all members from the100 QMPs were chosen, all members from theAAPMAAPMMembers were chosen based on data from theMembers were chosen based on data from themost recent AAPM Professional Surveymost recent AAPM Professional SurveyMembers were selected to reflect the sameMembers were selected to reflect the same

practice type and geographic locationpractice type and geographic locationpercentages as found in the AAPM populationpercentages as found in the AAPM populationas reported in the Professional Informationas reported in the Professional InformationSurveySurvey

OK, who were the members of theOK, who were the members of theExpert Panel?Expert Panel?

AAPMAAPM�� Michael MillsMichael Mills�� Ned SternickNed Sternick�� Jim HeveziJim Hevezi�� Herbert MowerHerbert Mower�� Rene SmithRene Smith�� Michael HermanMichael Herman�� James GoodwinJames Goodwin

And what did the Expert Panel Do?And what did the Expert Panel Do?

Examined the intensity, nonExamined the intensity, non--procedural,procedural,and procedural survey time dataand procedural survey time data

Validated the time, intensity and workValidated the time, intensity and workestimates for clinical face validityestimates for clinical face validity

Performed a rigorous clinical review ofPerformed a rigorous clinical review ofpreliminary QMP work estimatespreliminary QMP work estimates

Reviewed the final report for accuracy ofReviewed the final report for accuracy ofreported information and validity of thereported information and validity of theconclusionsconclusions

Where were the steps toWhere were the steps tocomplete in the process?complete in the process?

The survey was completedThe survey was completedThe Expert Panel met and validated the surveyThe Expert Panel met and validated the surveyresultsresultsThe report was released for the Expert Panel toThe report was released for the Expert Panel toreviewreviewThe Expert Panel met by conference call toThe Expert Panel met by conference call toapprove the draft reportapprove the draft reportThe final report was submitted to the AAPMThe final report was submitted to the AAPMBoard of Directors on April 30, 2008Board of Directors on April 30, 2008The report is being provided in .pdf format forThe report is being provided in .pdf format foreasy distribution to the medical physicseasy distribution to the medical physicscommunity on the AAPM websitecommunity on the AAPM website

How can we be sure the survey isHow can we be sure the survey isvalid?valid?

Survey responses were tested forSurvey responses were tested for�� practice type (private/community hospital, medicalpractice type (private/community hospital, medical

school university hospital, physician group, medicalschool university hospital, physician group, medicalphysics group)physics group)

�� Census region and state (compared to the AAPMCensus region and state (compared to the AAPMsalary survey)salary survey)

The respondents were not statistically differentThe respondents were not statistically differentfrom the AAPM salary surveyfrom the AAPM salary survey

What is procedural time and whatWhat is procedural time and whatis nonis non--procedural time?procedural time?

Procedural time is that spent with aProcedural time is that spent with aspecific patient, performing a service forspecific patient, performing a service forthat patient (including the time to bill thethat patient (including the time to bill thepatient)patient)

NonNon--procedural time is that spent withprocedural time is that spent withequipmentequipment –– commissioning, daily andcommissioning, daily andmonthly checks, annuals,monthly checks, annuals,recommissionings after repair, etc.recommissionings after repair, etc.

Start with median nonStart with median non--proceduralproceduraltimetime –– how do you measure it?how do you measure it?

77295, 77300, 77301, 77305, 77310,77295, 77300, 77301, 77305, 77310,77315, 77321 medi an time77315, 77321 medi an time

Hour sHours

Initial Commissioning (annualized over 5Initial Commissioning (annualized over 5years; raw value was 492 hours)years; raw value was 492 hours)

98.498.4

Recalibrations (annualized over 5 years)Recalibrations (annualized over 5 years) 2020

Annual CalibrationsAnnual Calibrations 4545

Daily, Weekly, Monthly ChecksDaily, Weekly, Monthly Checks 144144

Total Commissioning TimeTotal Commissioning Time 308.3308.3

More median nonMore median non--procedural timeprocedural time

AnnualAnnualHoursHours

Reporte dReporte d

77326, 27,2877326, 27,2877781, 2, 3, 477781, 2, 3, 4

7737733131

7737733232

7737733333

7737733434

InitialInitialCommis s.Commis s.

99 7.57.5 1.41.4

MonthlyMonthlyChecksChecks

4040 4545 3636

Total nonTotal non --procedura lprocedural

TimeTime

7979 53.253.2 22 2.52.5 40.440.4

CPTCPT Procedur eProcedure Non PNon P ProcProc TotalTotal7729577295 Simulation 3Simulation 3--DD 0.250.25 0.730.73 1.181.18

7730077300 Bas Dos CalcBas Dos Calc 0.250.25 0.250.25 0.550.55

7730177301 IMRT Tx PlanIMRT Tx Plan 0.250.25 4.004.00 4.534.53

7730577305 S IsodoseS Isodose 0.250.25 0.330.33 0.690.69

7731077310 I IsodoseI Isodose 0.250.25 0.500.50 0.780.78

7731577315 C IsodoseC Isodose 0.250.25 0.500.50 0.980.98

7732177321 Tele Port PlanTele Port Plan 0.250.25 0.600.60 1.071.07

QMP Time (table 1)QMP Time (table 1)

CPTCPT ProcedureProcedur e Non PNon P ProcProc TotalTotal

7732677326 S Br IsodoseS Br Isodose 0.900.90 1.001.00 2.522.52

7732777327 I Br IsodoseI Br Isodose 0.900.90 1.751.75 2.702.70

7732877328 C Br IsodoseC Br Isodose 0.900.90 3.003.00 4.784.78

7733177331 Sp DosimetrySp Dosimetry 0.350.35 1.001.00 2.062.06

7733277332 S Tx DeviceS Tx Device 0.020.02 0.000.00 0.130.13

7733377333 I Tx DeviceI Tx Device 0.050.05 0.250.25 0.340.34

7733477334 C Tx DeviceC Tx Device 0.020.02 0.170.17 0.240.24


CPTCPT ProcedureProcedur e Non PNon P ProcProc TotalTotal

7733677336 Continuing MPContinuing MPConsultationConsultation

N/AN/A 1.001.00 1.001.00

7737077370 Special MPSpecial MPConsultationConsultation

N/AN/A 3.453.45 3.453.45

7778177781 HDR 1HDR 1--44 0.900.90 1.501.50 2.702.70

7778277782 HDR 5HDR 5--88 0.900.90 2.502.50 3.793.79

7778377783 HDRHDR ––1212 0.900.90 3.253.25 4.704.70

7778477784 HDR >12HDR >12 0.900.90 2.502.50 3.433.43


Median support staff time estimatesMedian support staff time estimatesin hours by CPT codein hours by CPT code

7729577295 2.752.75 7733177331 0.630.63

7730077300 0.50.5 7733277332 0.500.50

7730177301 4.254.25 7733377333 0.500.50

7730577305 1.001.00 7733477334 1.001.00

7731077310 1.501.50 7733677336 N/AN/A

7731577315 2.002.00 7737077370 N/AN/A

7732177321 2.002.00 7778177781 0.500.50

7732677326 1.001.00 7778277782 0.880.88

7732777327 1.671.67 7778377783 1.001.00

7732877328 2.002.00 7778477784 1.131.13

How does the 2007 AbtHow does the 2007 Abt--3 time data3 time datacompare to the 2002 Abtcompare to the 2002 Abt--2 and the2 and the

1995 Abt1995 Abt--1 data?1 data?Commissioning times are reported to be aCommissioning times are reported to be alittle shorter in 2007 compared with 2002,little shorter in 2007 compared with 2002,possible reflecting greater familiarity withpossible reflecting greater familiarity withIMRT commissioningIMRT commissioningProcedural times are a little shorter for IMRTProcedural times are a little shorter for IMRTprocedures, a little longer for brachytherapyprocedures, a little longer for brachytherapyprocedures, but not significantly differentprocedures, but not significantly differentSpecial MP Consultation time was 4.00Special MP Consultation time was 4.00hours in 1995, 5.6 hours in 2003, and 3.45 inhours in 1995, 5.6 hours in 2003, and 3.45 in20072007

Once we have time, how do weOnce we have time, how do wemeasure work?measure work?

Work = time X intensityWork = time X intensityWe select a common representativeWe select a common representativeprocedure and use it as a benchmark withprocedure and use it as a benchmark withintensity = 1.0intensity = 1.0The preliminary panel selected 77336 asThe preliminary panel selected 77336 asour benchmark and assigned it anour benchmark and assigned it anintensity of 1.0intensity of 1.0Respondents assigned all otherRespondents assigned all otherprocedures an intensity using 77336 as aprocedures an intensity using 77336 as areverencereverence

CPTCPT Procedur eProcedure TimeTime Inten.Inten. WorkWork

7729577295 Simulation 3Simulation 3--DD 1.181.18 2.002.00 1.631.63


7730177301 IMRT Tx PlanIMRT Tx Plan 4.534.53 6.006.00 28.6628.66





QMP Work (table 1)QMP Work (table 1)

CPTCPT ProcedureProcedur e TimeTime Inten.Inten. WorkWork









CPTCPT Proc edureProcedu re TimeTime Inten.Inten. WorkWork


1.001.00 1.001.00 1.001.00


3.453.45 3.383.38 13.9413.94

7778177781 HDR 1HDR 1--44 2.702.70 2.02.0 5.75.7

7778277782 HDR 5HDR 5--88 3.793.79 2.52.5 10.310.3

7778377783 HDR 9HDR 9--1212 4.794.79 3.03.0 14.714.7

7778477784 HDR >12HDR >12 3.433.43 3.03.0 13.913.9


CPTCPT ProcedureProcedur e 19951995 20022002 20072007

7729577295 Simulation 3Simulation 3--DD 1.181.18 2.002.00 1.631.63


7730177301 IMRT Tx PlanIMRT Tx Plan N/AN/A 18.6418.64 28.6628.66





QMP Work Abt 1,2 &3 (table 1)QMP Work Abt 1,2 &3 (table 1)

CPTCPT Proc edureProc edure 19951995 20022002 20072007








QMP Work Abt 1,2 &3 (table 2)QMP Work Abt 1,2 &3 (table 2)

CPTCPT ProcedureProcedur e 19951995 20022002 20072007


1.501.50 1.501.50 1.001.00


15.0015.00 20.9220.92 13.9413.94

7778177781 HDR 1HDR 1--44 N / AN / A N / AN / A 5.725.72

7778277782 HDR 5HDR 5--88 N / AN / A N / AN / A 10.3410.34

7778377783 HDR 9HDR 9--1212 N / AN / A N / AN / A 14.6714.67

7778477784 HDR >12HDR >12 N / AN / A N / AN / A 13.8513.85

QMP Work Abt 1,2 & 3 (table 3)QMP Work Abt 1,2 & 3 (table 3) OK, how does MP work in 2007OK, how does MP work in 2007compare to 2002 and 1995?compare to 2002 and 1995?

Across the board, the work values areAcross the board, the work values aresimilar to those in 1995 and 2003similar to those in 1995 and 2003

–– 77370, Special MP Consultation77370, Special MP Consultationincreased in value from 15.00 to 20.92,increased in value from 15.00 to 20.92,then decreased to 13.94then decreased to 13.94

–– 77336 , Decreased from1.50 in 199577336 , Decreased from1.50 in 1995and 2002 to 1.0 in 2007and 2002 to 1.0 in 2007

What is the meaning of the timeWhat is the meaning of the timevalue of 60 minutes for 77336?value of 60 minutes for 77336?Fluxuations of this magnitude are commonFluxuations of this magnitude are commonin this type of survey; the work probablyin this type of survey; the work probablyhas not changed that much.has not changed that much.

The AMA Practice Expense AdvisoryThe AMA Practice Expense AdvisoryCommittee (PEAC) survey measuresCommittee (PEAC) survey measures77336:77336:�� 6 minutes of medical physicist time6 minutes of medical physicist time

�� 26 minutes of combined medical physicist /26 minutes of combined medical physicist /dosimetrist time (at 50% each)dosimetrist time (at 50% each)

What are the components ofWhat are the components of77336 according to ACR/ASTRO?77336 according to ACR/ASTRO?

Weekly chart reviewsWeekly chart reviews

Review and analysis of medical physicsReview and analysis of medical physicstreatment changestreatment changes

Consult on patient setup / treatment changesConsult on patient setup / treatment changes

Verification of dose calculation dataVerification of dose calculation data

Reviewing accuracy of current data recordReviewing accuracy of current data record

Review of patient specific therapist treatmentReview of patient specific therapist treatmentand technical notesand technical notes

Patient radiation safetyPatient radiation safety

What are the components ofWhat are the components of77336 according to Abt III77336 according to Abt III

Reviewing the patient case in initial presentation, simulation,Reviewing the patient case in initial presentation, simulation,planning & treatmentplanning & treatment

Performing weekly chart check of all charting, diagnosticPerforming weekly chart check of all charting, diagnosticstudies, port films, and patient calculationsstudies, port films, and patient calculations

Reviewing charts with other members of the patientReviewing charts with other members of the patientmanagement team in chart roundsmanagement team in chart rounds

Viewing patient positioning & machine setViewing patient positioning & machine set--upup

Researching treatment scheme (assuming a special medicalResearching treatment scheme (assuming a special medicalradiation physics consultation (CPT 77370) is not billedradiation physics consultation (CPT 77370) is not billed

Performing final chart check and validationPerforming final chart check and validation

Some activities not alwaysSome activities not alwaysassociated with 77336associated with 77336

Correcting problems and process issues with theCorrecting problems and process issues with therecord and verify system for individual patientsrecord and verify system for individual patients

Planning and treatment approval before the firstPlanning and treatment approval before the firsttreatment fractiontreatment fraction

Investigating why shifts from expected to clinicalInvestigating why shifts from expected to clinicalisocenter are larger than expected.isocenter are larger than expected.

Medical physicists presence for HDR, stereotacticMedical physicists presence for HDR, stereotactictreatments, respiratory gating, etc.treatments, respiratory gating, etc.

Clearly a there is a potential for a lot of 77336 workClearly a there is a potential for a lot of 77336 workto be overlooked by administrators or physicians asto be overlooked by administrators or physicians asthey fill out the PEAC questionnaire.they fill out the PEAC questionnaire.

Besides work, what else did youBesides work, what else did youmeasure?measure?

We measured the acceptance of newWe measured the acceptance of newtechnologies in the marketplacetechnologies in the marketplace

We measured the time required to performWe measured the time required to performsome patient specific special proceduressome patient specific special procedures

We measured staffing by practice type, notWe measured staffing by practice type, notjust for medical physicists, but for alljust for medical physicists, but for allprofessionals working in radiationprofessionals working in radiationoncologyoncology

OK, What about new technologyOK, What about new technologyacceptance?acceptance?

Total Skin IrradiationTotal Skin Irradiation 34%34%

Total Body IrradiationTotal Body Irradiation 37%37%

Remote Afterloading BrachyRemote Afterloading Brachy 68%68%

Stereotactic RadiotherapyStereotactic Radiotherapy 61%61%

Stereotactic Body IrradiationStereotactic Body Irradiation 39%39%

Stereotactic RadiosurgeryStereotactic Radiosurgery 68%68%

Intraoperative RadiotherapyIntraoperative Radiotherapy 17%17%

Prostate Seed BrachytherapyProstate Seed Brachytherapy 78%78%

IMRTIMRT 95%95%

IGRTIGRT 78%78%

And what about the acceptance ofAnd what about the acceptance ofnew external beam features?new external beam features?

Record and Verify SystemRecord and Verify System 9595

Dynamic WedgeDynamic Wedge 5959

Multileaf collimatorMultileaf collimator 9595

Electronic Portal ImagingElectronic Portal Imaging 8080

Multileaf Collimator based IMRTMultileaf Collimator based IMRT 8888

Respiratory Gating SystemRespiratory Gating System 3939

OK, show me some 77370 medianOK, show me some 77370 medianspecial procedure times in hoursspecial procedure times in hours

Total Skin IrradiationTotal Skin Irradiation 8.58.5

Total Body IrradiationTotal Body Irradiation 9.59.5

Remote Afterloading BrachyRemote Afterloading Brachy 2.02.0

Stereotactic Body TherapyStereotactic Body Therapy 4.04.0

Stereotactic RadiosurgeryStereotactic Radiosurgery 6.06.0

Stereotactic RadiotherapyStereotactic Radiotherapy 3.53.5

More median special physicsMore median special physicsconsultation times in hoursconsultation times in hours

Routine 77370 ProcedureRoutine 77370 Procedure 2.02.0

Intraoperative RadiotherapyIntraoperative Radiotherapy 4.04.0

Prostate Seed BrachyProstate Seed Brachy 4.04.0

IMRTIMRT 4.04.0

IGRTIGRT 1.01.0

Show me median staffing results forShow me median staffing results formedical physicists by patient loadmedical physicists by patient load

Practice TypePractic e Type # Patients per QMP# Patients per QMP

Private Community Hosp.Private Community Hosp. 368368

Med School Univ. Hosp.Med School Univ. Hosp. 220220

MP Consult. GroupMP Consult. Group 464464

Physicians GroupPhysicians Group 260260

OverallOverall 304304

OK, how about median overallOK, how about median overallstaffing information?staffing information?

# Patients treated per year# Patients treated per year 595595

# Qualified Medical Physicists# Qualified Medical Physicists 2.02.0

# Radiation Oncologists# Radiation Oncologists 3.03.0

# Dosimetrists or Junior Medical Physicists# Dosimetrists or Junior Medical Physicists 3.03.0

# Maintenance Engineers# Maintenance Engineers 0.00.0

# Radiation Therapists# Radiation Therapists 8.08.0

# Radiation Oncology Nurses# Radiation Oncology Nurses 3.03.0

What is the median number ofWhat is the median number ofphysics services by CPT code?physics services by CPT code?7729577295 300300 7733177331 114114

7730077300 2,4952,495 7733277332 5757

7730177301 150150 7733377333 1313

7730577305 2525 7733477334 2,2002,200

7731077310 1010 7733677336 2,4952,495

7731577315 299299 7737077370 142142

7732177321 7373 7778177781 2020

7732677326 55 7778277782 1313

7732777327 22 7778377783 4242

7732877328 4545 7778477784 7878

And what is the median number ofAnd what is the median number ofservices provided per QMP?services provided per QMP?

7729577295 115115 7733177331 1818

7730077300 1,0301,030 7733277332 2424

7730177301 6161 7733377333 44

7730577305 99 7733477334 810810

7731077310 33 7733677336 1,0241,024

7731577315 103103 7737077370 5050

7732177321 2323 7778177781 0.00.0

7732677326 11 7778277782 0.10.1

7732777327 11 7778377783 0.80.8

7732877328 1414 7778477784 1.71.7

How can we use this data?How can we use this data?

We use it to defend staffing levelsWe use it to defend staffing levelsWe use it to defend QMP work effortWe use it to defend QMP work effortWe also use it to defend patient chargesWe also use it to defend patient chargesPhysicians use a similar surveyPhysicians use a similar survey--based studybased studyto defend reimbursement amounts from CMSto defend reimbursement amounts from CMSHowever, instead of relying on accountants,However, instead of relying on accountants,economists, and lobbyists, we have to learneconomists, and lobbyists, we have to learnto use this information ourselves to negotiateto use this information ourselves to negotiatecompensation and staffingcompensation and staffing

What steps to I follow to defendWhat steps to I follow to defendstaffing levels?staffing levels?

Measure your patient load in new patientsMeasure your patient load in new patientsper yearper year

Determine the median caseload for yourDetermine the median caseload for yourpractice typepractice type

Determine the median staffing levels forDetermine the median staffing levels forthat practice typethat practice type

Calculate your institutional staffing basedCalculate your institutional staffing basedon your patient loadon your patient load

What are the median patientWhat are the median patientvolumes by practice type?volumes by practice type?

Abt 2007 DataAbt 2007 Data# of Total# of Total # Patients# Patients

Practice Type Patients TreatedPractice Type Patients Treated Per QMPPer QMP

Private HospitalPrivate Hospital 591591 368368Med. Sch. Hosp.Med. Sch. Hosp. 999999 220220Med. Phys. Consult. Grp.Med. Phys. Consult. Grp. 382382 464464Physicians GroupPhysicians Group 415415 260260

OverallOverall 595595 304304

What were median staffingWhat were median staffingpatterns normalized to 800patterns normalized to 800

Patients/Year?Patients/Year?Abt 2007 DataAbt 2007 Data

MedicalMedical Radiation DosimeRadiation Dosime--Practice TypePractice Type Physicists Oncologists tristsPhysicists Oncologists trists

Private HospitalPrivate Hospital 2.42.4 3.43.4 4.14.1Med. Sch. Hosp.Med. Sch. Hosp. 4.64.6 4.54.5 2.62.6Med. Phys. Consult. Grp.Med. Phys. Consult. Grp. 4.24.2 4.24.2 4.84.8Physicians GroupPhysicians Group 2.92.9 3.93.9 2.52.5

OverallOverall 2.72.7 4.04.0 4.04.0

How do I defend the effort to provideHow do I defend the effort to providephysics services at my institution?physics services at my institution?

Determine the number and type of physicsDetermine the number and type of physicsservices your institution provides annuallyservices your institution provides annuallyUse the median service mix and the medianUse the median service mix and the mediantimes per procedure in the 2007 Abt report totimes per procedure in the 2007 Abt report tocalculate the median procedurecalculate the median procedure--hourshoursprovided by a medical physicistprovided by a medical physicistUse this information to show the serviceUse this information to show the service--hours provided by your program withhours provided by your program withreference to a national median standardreference to a national median standard

Time & Work measured to provide theTime & Work measured to provide themedian QMP Abt 2007 service mixmedian QMP Abt 2007 service mix

Abt 2007 DataAbt 2007 Data -- Median Patient Load 304/YearMedian Patient Load 304/Year

CPT CodeCPT Code Med. # / 304Med. # / 304 Medical PhysicistMedical Physicist QMP WorkQMP WorkPatients Per YearPatients Per Year Time (Ann.)Time (Ann.) (Ann.)(Ann.)

7729577295 123123 145145 2002007730077300 10301030 567567 5055057730177301 6161 276276 1,7481,7487730577305 99 66 667731077310 33 22 337731577315 103103 101101 1701707732177321 2323 2525 38387732677326 11 33 447732777327 11 33 667732877328 1414 6767 1681687733177331 1818 3535 48487733277332 2424 33 337733377333 44 11 117733477334 810810 194194 3653657733677336 1,0231,023 1,0231,023 1,0231,0237737077370 123123 242242 1,7151,715

Total TimeTotal Time 2,693 Total Work2,693 Total Work6,0036,003

Wait a minuteWait a minute –– are you saying weare you saying weshould work 2700 hours/year!?should work 2700 hours/year!?No!No! –– It is well known that time estimations inIt is well known that time estimations inabsolute hours by individuals performingabsolute hours by individuals performingservices overestimate that time byservices overestimate that time byapproximately 30approximately 30 -- 50%50%It is equally well known that systemsIt is equally well known that systemsengineers with stopwatches underestimateengineers with stopwatches underestimateservice times by up to 30service times by up to 30 -- 50%50%The usefulness of this data is it givesThe usefulness of this data is it givesmedical physicists a national workmedical physicists a national workbenchmark standard.benchmark standard.

2700 hours for 1 QMP responsible2700 hours for 1 QMP responsiblefor 304 patients/year? 6000 Workfor 304 patients/year? 6000 Work

units? What does this mean?units? What does this mean?The median FTE medical physicist provides servicesThe median FTE medical physicist provides servicesfor approximately 304 patients per yearfor approximately 304 patients per yearThe median time to provide the median service mixThe median time to provide the median service mixfor 304 patients is ~ 2,700 hoursfor 304 patients is ~ 2,700 hoursThe median number of work units Is ~ 6000The median number of work units Is ~ 6000For your institutional service mix, calculate the QMPFor your institutional service mix, calculate the QMPhours required to provide the physics services andhours required to provide the physics services andcalculate the QMP work unitscalculate the QMP work unitsDivide the QMP hours by 2,700 to defend QMP FTEDivide the QMP hours by 2,700 to defend QMP FTEstaffing and the number of QMP work units by 6,000staffing and the number of QMP work units by 6,000to defend QMP work.to defend QMP work.

What is the difference betweenWhat is the difference betweendefending staffing and work?defending staffing and work?

Staffing applies to the entire medical physicsStaffing applies to the entire medical physicsprogram, work applies only to the QMPprogram, work applies only to the QMPStaffing may include nonStaffing may include non--professional effort,professional effort,QMP work is professional in natureQMP work is professional in natureFor professionals, work is directly related toFor professionals, work is directly related tocompensation with respect to servicescompensation with respect to servicesprovided, staffing is notprovided, staffing is not

How do I use the Abt study toHow do I use the Abt study todefend QMP salaries?defend QMP salaries?

Center for Medicare and Medicaid Services (CMS)Center for Medicare and Medicaid Services (CMS)fee schedules are published and are publicfee schedules are published and are publicknowledgeknowledgePercentage of CMS patients varies amongPercentage of CMS patients varies amonginstitutionsinstitutionsTypically, 1/3 of all radiation oncology patients areTypically, 1/3 of all radiation oncology patients areCMSCMSIf so, CMS patients will account for approximatelyIf so, CMS patients will account for approximately1/5 of total patient revenue1/5 of total patient revenue

How can I use the Abt 2007 data toHow can I use the Abt 2007 data toestablish patient fees?establish patient fees?

Calculate fixed costs for the procedure includingCalculate fixed costs for the procedure includingmedical physicist and dosimetrist compensationmedical physicist and dosimetrist compensationbased on time and equipment depreciationbased on time and equipment depreciation

Calculate variable costs (from accounting)Calculate variable costs (from accounting)

Calculate indirect costs (from accounting)Calculate indirect costs (from accounting)

Total the direct (fixed and variable) costs andTotal the direct (fixed and variable) costs andindirect costsindirect costs

Add 10% allowed revenue per procedureAdd 10% allowed revenue per procedure

Sum total costs and revenue to show a chargeSum total costs and revenue to show a chargefor the procedurefor the procedure

So, what is the bottom line?So, what is the bottom line?

The Abt 2007 survey establishes theThe Abt 2007 survey establishes thework performed by the qualifiedwork performed by the qualifiedradiation oncology physicistradiation oncology physicist

CMS has a history of acceptingCMS has a history of acceptingindependent surveys from Abt, Inc.independent surveys from Abt, Inc.

The Abt 2007 survey allows the QMP toThe Abt 2007 survey allows the QMP todefend staffing, quantity of work anddefend staffing, quantity of work andcompensationcompensation

How should we view ourHow should we view ourcompensation for professionalcompensation for professional

services in 2008?services in 2008?The Abt Associates report empowers the medicalThe Abt Associates report empowers the medicalphysicist to negotiate from a middle ground forphysicist to negotiate from a middle ground forcompensationcompensation -- between direct billing and a nonbetween direct billing and a non--professional salaryprofessional salaryBoth QMPs and physicians use work studies toBoth QMPs and physicians use work studies tojustify compensationjustify compensationThe difference is that physicians negotiate withThe difference is that physicians negotiate withHCFA for their profession while QMPs negotiate withHCFA for their profession while QMPs negotiate withproviders, individuallyproviders, individuallyWhat we really need is the experience, patience andWhat we really need is the experience, patience andwisdom to negotiate a equitable compensationwisdom to negotiate a equitable compensation

What about 2014What about 2014 –– 2020?2020?If we have 125 CAMPEP slotsIf we have 125 CAMPEP slots



How about both research andHow about both research andclinical physicists!?clinical physicists!?

Documents

OK, Tell me about Abt -III · 2008-07-29 · 6 – Abt delivered the final report to AAPM Who was on the Preliminary ... Reviewing the patient case in initial presentation, simulation,