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Nephrology Business / Renal Physicians Association (RPA)

Renal Physicians Association benchmarking survey shows changes in nephrology practice size, revenue sources

March 20, 2013
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The benchmarking survey from the Renal Physicians Association, detailed in a 300-page report available from the RPA, is based on returns from 111 nephrology practices around the country in 2011, down from the 151 practices that supplied information in 2009, according to Jennifer Huneycutt, CPA, who manages the Metrolina Associates nephrology practice in Charlotte, N.C. and provided an analysis of the survey results. But the number of nephrologists represented by the responding practices to the 2011 survey was only slightly less than in 2009 because larger practices participated in the new survey. On average, practices responding to the survey had about 11 nephroligists, up from nine in 2009, Huneycutt said. Of the total respondents, 30% were RPA members.

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The highest percentage of respondents were from the South (32%), with 16% from the Midwest, 22% from the West, and 30% from the East. Huneycutt offered several conclusions in her analysis of the survey data:

  • Revenue per full-time equivalent nephrologist was higher in larger practices. That could also be influenced by additional revenue from practice-owned vascular access centers, which tend to be more common among larger nephorlogy practices vs. smaller ones.
  • A greater portion of income is coming from sources that aren’t directly linked to patient care
  • Although compensation was up in 2011 vs. 2009, based on the survey data, higher physician work hours (i.e., relative value units tied to reimbursement) did not always lead to higher physician compensation in some practices. .


Nephorlogy practice size is changing
The results of the survey suggest some shift in practice size. The biggest decrease was in the 4-7 physician-sized nephrology practices, and the biggest increase was seen in the number of practices with 11 physicians or more. The median practice size was still close to seven physicians per practice.

The average FTE nephrologist treating 78.47 ESRD patients (the South showed the highest with 104 patients/FTE nephrologist), and the percentage of physicians with patient visit frequency/face-to-face encounters of four or more/month was up compared to data from the 2009 survey (68% vs. 76%). The percentage of nephrologists who made 2-3 patient visits/month went up also, from 22% to 29%.

Overall, there was a 27% increase in RVUs/FTE nephrologists when compared to the 2009 survey results. Categories with growing revenue included research and EHR incentive programs; less revenue was link to fee-based services (down 3%). Those additional sources of revenue, Huneycutt said, helped to increase the average compensation per FTE nephrologist from $660,000 a year in 2009 to $717,000 in 2011. Temporary incentives like EHR compliance will not last indefinitely, Huneycutt warned. “When the carrots go away, be prepared.”

The report also includes information on practice expenses, staff ratios, profession liability costs, characteristics of practice-owned dialysis clinics, and information on the inclusion of nurse practitioners and physician assistants.
The 2012 Nephrology Practice Business Benchmarking Survey Report is available to Renal Physicians Association members for $200 ($300 for nonmembers). Order the report through the RPA’s online store (link at the top of the home page) at

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