1. How Does Your Practice
Compare?
• 2007 RPA Survey Report
– 2007 Participants
How Does Your Practice
– 2007 Results
Compare? • National
• Regional
2007 RPA Benchmarking Survey • Large, Mid-Size, Benchmark, VAC
• Trends
RPA Annual Meeting
• What does this mean for your practice?
March 23, 2009
Survey Participation
RPA 2007 Nephrology Survey Participation
Practice Business 1600
Number of Participants
1400 Total Number of
1200 Participating Practices
Benchmarking Survey 1000
Total Number of
800
Nephrologists
600
Report Total RPA Members
400
Represented in Data
200
0
2003 2004 2005 2007
Year
Survey Participation Survey Participation
US GEOGRAPHIC REPRESENTATION OF PARTICIPATING PRACTICES
Practice Characteristics
100%
100.00%
90%
90.00%
% Reporting
30%
32% 80.00%
36% 37%
80% 70.00% 2007
60.00%
Percent of Practices
50.00% 2005
70%
40.00%
30.00% 2004
East
60%
20.00%
South
10.00%
38%
50% 37% 30% 0.00%
Midwest
38%
West
40%
Sin
MS
MS
So
Gr
Ac
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o
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30%
up
w/
w/
r
Pr
em
16%
16%
16%
Sp
Pr
Sp
Pr
ac
ic
20%
im
ac
14%
ec
ec
t ic
Pr
ar
tic
ialt
ialt
e
a
10% 18%
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16%
cti
15%
y
y
11%
ce
...
ar
0%
e
2003 2004 2005 2007
Type of Practice
Year
N=73, 76, 106, 212
1

2. 2007 National Results 2007 National Results
Providers Staff
per FTE
per FTE
Total Nephrologist
Total Nephrologist
FTE Clerical Staff 1,939.1 1.56
FTE Nephrologists 1,383.7
Non-Interventional 1,271.4 0.96
FTE Clinical Support Staff 1,086.9 1.10
Interventional 112.3 0.24
FTE Ancillary Staff 127.9 0.50
FTE Interventional Radiologists 24.0 0.47
FTE Vascular Surgeons 37.0 0.63 FTE Admin/Mgt Staff 442.4 0.43
FTE NP / PA 297.4 0.38
Total FTE non-provider staff 3,596.3 3.59
2007 National Results
2007 National Results
Mean Revenue per FTE
Practice Characteristics
Nephrologist
Gross FFS Charges $1,127,660
per FTE
Net FFS Revenue 541,050
Total Nephrologist
Satellite Offices 479 0.65
Dialysis Units Serviced 1,852 1.77
Total Other Income 94,890
Hospitals Serviced 1,158 1.17
Dialysis Patients Serviced 111,718 82.01
Total Net Practice Revenue 641,520
(cash basis)
2007 National Results
2007 National Results
Mean Expenses per FTE
Mean Physician Compensation
Nephrologist
Total Personnel Expenses $118,170
Total Physician Benefits
Total Occupancy Expenses 34,500
$48,090
Total Medical Supplies Expense 68,830
Total G&A Expenses 55,230
Total Physician Compensation
Total Operating Expenses $276,730
$283,010
2

3. Geographic Regions
Regional Results
2007 Results (Regional) 2007 Results (Regional)
TOTAL INCOME PER FTE NEPHROLOGIST BY REGION MEAN PHYSICIAN COMPENSATION PER FTE NEPHROLOGIST BY REGION
(Revenue - Adjustments + Other Income)
100%
12%
100% 13%
16% 17% 19%
90%
15%
90% 22% 9%
26% 26%
29% 80%
80% 21% 29%
Percent of Practices
23%
Percent of Practices
70% 26%
70% 29%
16%
27% $400K or more
$800K or more 60%
60% 41%
33%
29% $300K-$399.9K
$600K-$799.9K
50%
50%
$200K-$299.9K
35%
$400K-$599.9K 29%
40% 44% 40% 27% Under $200K
Under $400K 43%
39% 53%
30% 30%
29% 33%
20% 20% 37%
29%
28%
10% 25%
18% 10%
12% 13% 8% 13%
5%
0%
0%
National East M idwest South West
National East Midwe st South West
2007 Results (Regional) 2007 Results (Regional)
Financial Highlights
Mean Rev / Exp per FTE
Total Relative Value Units per FTE Nephrologist $600,000
18,000
15,901
RVU per FTE Nephrologist
16,349
15,566 16,200 $400,000
16,000
12,999
14,000
$200,000
12,000
10,000
$-
8,000
6,000 National East South Midwest West
4,000
2,000
Net Practice Revenue(cash) Total Operating Exp
0
Total Other Income Total Phys Comp
National East South Midwest West
3

4. 2007 Results (Practice Type)
2007 Practice Types
• Large: 10 or more FTE Nephrologists FTEs per FTE Nephrologist
(n=34) National Large Mid-size Benchmark VAC
Clerical Staff 1.56 1.38 1.22 1.42 2.04
• Mid-Size: 2 – 7 FTE Nephrologists (n=130) Clinical Support Staff 1.10 0.80 0.92 0.96 1.51
Ancillary Staff 0.50 0.21 0.58 0.46 0.29
• Benchmark: Greater than median Net Admin/Mgt Staff 0.43 0.36 0.32 0.40 0.44
Income before Phys Exp ($333,098) and less Total non-provider staff 3.59 2.75 3.04 3.24 4.28
than median Total Operating Exp per NP/PAs 0.38 0.28 0.4 0.35 0.28
RVU ($18) (n=39)
• VAC: participating in a Vascular Access
Center (n=43)
2007 Results (Practice Type)
2007 Results (Practice Type)
Financial Highlights
Mean RVUs per FTE Nephrologist
Mean Rev / Exp per FTE
$800,000
20,000
$600,000
18,000
16,000
$400,000
14,000
12,000
RVUs
$200,000
10,000
8,000
$-
6,000
National Large Mid-size Benchmark VAC
4,000
2,000
Net Practice Revenue(cash) Total Operating Exp
0
National Large Mid-size Benchmark VAC Total Other Income Total Phys Comp
Patient Load, NP/PA Trends
Dialysis Patient, NP/PA Increases
100 0.40
0.35
Patients per FTE
80
NP/PA per FTE
0.30
0.25
Survey Trends 60
0.20
40 0.15
0.10
20
0.05
0 0.00
2003 2004 2005 2007
Dialysis patients NP,PA
4

5. Increasing Complexity Staffing Trend
High Level E&M Trends
FTE Staff / FTE Nephrologist
60%
percent of total
50%
4.00
40%
3.50
30%
20% 3.00
10%
2.50
0%
2.00
99244 99245 99254 99255 99214 OV 99215 OV
1.50
Office Office Hosp Hosp level 4 level 5
Consult Consult Consult Consult 1.00
level 4 level 5 level 4 level 5 0.50
0.00
2003 2004 2005 2007
1999 2000 2001 2003 2004 2005 2007
Financial Trends 2007 RPA Nephrology Practice
Business Benchmarking Custom
Report
Key Financial Indicators
600 30.00
500 25.00
Net FFS rev/FTE
RVU in 1,000s
400 20.00
$ in 1,000s
Total Other Inc/FTE
300 15.00 Phys comp /FTE
Nephrology Associates USA (NAUSA)
Total op exp/FTE
200 10.00
RVU / FTE
6 Nephrologists
100 5.00
0 0.00
Located in the Eastern Region
2003 2004 2005 2007
Your Practice is included in the following sorts:
Practice ID: xxx Financial Information
National East Large VAC
Fees for Service Charges per FTE Nephrologist
2007 RPA Nephrology Practice Business Benchmarking Custom Report Your Practice National East Benchmark Large VAC
**** CONFIDENTIAL **** Sources of Income (000's) Difference Difference Difference Difference Difference
Mean % Difference Mean % Difference Mean % Difference Mean % Difference Mean % Difference
Gross Fees for Service Charges $1,050.98 $1,127.66 -$76.68 -6.80% $1,021.65 $29.33 2.87% $1,286.77 -$235.79 -18.32% $1,482.70 -$431.72 -29.12% $1,455.61 -$404.63 -27.80%
Total Adjustments to Fees for Service Charges $544.64 $586.61 -$41.97 -7.15% $536.49 $8.15 1.52% $658.47 -$113.83 -17.29% $847.16 -$302.52 -35.71% $829.31 -$284.67 -34.33%
Net Fees for Service Revenues $506.34 $541.05 -$34.71 -6.42% $485.16 $21.18 4.36% $628.29 -$121.95 -19.41% $635.54 -$129.20 -20.33% $626.30 -$119.96 -19.15%
Fees received by the practice and/or
individuals of the practice for Dialysis Facility
Medical Directors $61.99 $68.14 -$6.15 -9.02% $56.38 $5.61 9.94% $101.00 -$39.01 -38.62% $81.36 -$19.37 -23.80% $84.90 -$22.91 -26.99%
Practice Characteristics Reimbursement for Research Activity $3.85 $4.55 -$0.70 -15.40% $6.65 -$2.80 -42.09% $1.46 $2.39 164.29% $9.39 -$5.54 -58.98% $9.46 -$5.61 -59.30%
Legal Work $0.15 $0.11 $0.04 37.02% $0.21 -$0.06 -29.78% $0.00 $0.15 $0.07 $0.08 115.43% $0.21 -$0.06 -29.87%
Employees per FTE Nephrologist
Royalties $0.00 $0.003 $0.00 -100.00% $0.00 $0.00 -100.00% $0.003 $0.00 -100.00% $0.004 $0.00 -100.00% $0.003 $0.00 -100.00%
Rents $0.33 $0.26 $0.07 27.66% $0.42 -$0.09 -21.93% $0.02 $0.31 1557.44% $0.07 $0.26 393.20% $0.05 $0.28 519.47%
Your Practice National East Benchmark Large Other $10.62 $21.82 -$11.20 -51.34% $18.01 -$7.39 -41.04% $10.26 $0.36 3.48% $57.08 -$46.46 -81.39% $58.75 -$48.13 -81.92%
Total Other Income $76.94 $94.89 -$17.95 -18.91% $81.68 -$4.74 -5.81% $112.74 -$35.80 -31.75% $147.96 -$71.02 -48.00% $153.38 -$76.44 -49.84%
Difference Difference Difference Difference
Mean % Difference Mean % Difference Mean % Difference Mean % Difference Total Income $583.28 $635.94 -$52.66 -8.28% $566.85 $16.43 2.90% $741.03 -$157.75 -21.29% $783.50 -$200.22 -25.55% $779.68 -$196.40 -25.19%
Non-Interventional Nephrologist 0.98 0.96 0.02 2.31% 0.97 0.01 1.42% 0.93 0.05 4.93% 0.89 0.09 10.10% *Percent change can not be calculated, because the average for the sort was zero.
Interventional Nephrologist 0.46 0.24 0.22 90.99% 0.27 0.19 70.17% 0.29 0.17 57.34% 0.14 0.32 219.99%
Percentage of Total Income Difference Difference Difference Difference Difference
Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent
Interventional Radiologists 0.60 0.47 0.13 28.98% 0.70 -0.10 -14.29% 0.07 0.53 800.00% 0.17 0.43 260.30%
Gross Fees for Service Charges 167.40% 170.10% -2.70% 172.10% -4.70% 173.59% -6.19% 192.43% -25.03% 183.54% -16.14%
Vascular Surgeons 0.69 0.63 0.06 9.53% 0.54 0.15 28.92% 0.04 0.65 1556.00% 0.25 0.44 178.19%
Net Fees for Service Revenues 88.20% 86.73% 1.47% 85.30% 2.90% 85.26% 2.94% 83.15% 5.05% 80.20% 8.00%
Nurse Practitioners/Physician Assistants 0.40 0.38 0.02 6.40% 0.39 0.01 2.87% 0.35 0.05 14.32% 0.28 0.12 41.73% Fees received by the practice and/or
Clerical Staff 1.22 1.56 -0.34 -21.81% 1.45 -0.23 -15.99% 1.42 -0.20 -13.82% 1.38 -0.16 -11.60% individuals of the practice for Dialysis Facility
Clinical Support Staff 0.92 1.10 -0.18 -16.20% 0.86 0.06 7.52% 0.96 -0.04 -3.86% 0.80 0.12 15.14% Medical Directors 8.00% 9.07% -1.07% 9.71% -1.71% 13.12% -5.12% 10.13% -2.13% 11.61% -3.61%
Reimbursement for Research Activity 1.18% 1.03% 0.15% 1.87% -0.69% 0.21% 0.97% 1.43% -0.25% 2.30% -1.12%
Ancillary Staff 0.58 0.50 0.08 17.16% 0.58 0.00 -0.77% 0.46 0.12 27.37% 0.21 0.37 171.75%
Legal Work 0.07% 0.04% 0.03% 0.11% -0.04% 0.00% 0.07% 0.01% 0.06% 0.14% -0.07%
Administrative/Management Staff 0.32 0.43 -0.11 -26.11% 0.38 -0.06 -16.47% 0.40 -0.08 -20.10% 0.36 -0.04 -12.30%
Royalties 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
Satellite Offices 0.62 0.65 -0.03 -3.98% 0.47 0.15 32.80% 0.52 0.10 18.49% 0.35 0.27 74.75% Rents 0.07% 0.05% 0.02% 0.09% -0.02% 0.00% 0.07% 0.01% 0.06% 0.01% 0.06%
Dialysis Units Serviced** 1.59 1.77 -0.18 -10.34% 1.37 0.22 16.08% 1.80 -0.21 -11.43% 1.07 0.52 48.25% Other 2.49% 3.07% -0.58% 2.91% -0.42% 1.41% 1.08% 5.27% -2.78% 5.73% -3.24%
Hospitals Serviced** 0.99 1.17 -0.18 -15.63% 0.85 0.14 16.94% 1.03 -0.04 -3.54% 0.71 0.28 38.74% Total Other Income 11.80% 13.27% -1.47% 14.70% -2.90% 14.74% -2.94% 16.85% -5.05% 19.80% -8.00%
Total Income 100.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% 0.00%
Dialysis Patients Serviced** 69.42 82.01 -12.59 -15.35% 76.65 -7.23 -9.43% 93.87 -24.45 -26.04% 102.30 -32.88 -32.14%
**This line does not refer to employees per FTE Nephrologist instead it is either units, hospitals, or patients per FTE Nephrologist Comparison of Total Income per FTE Nephrologist
Comparison of Number of Employees per FTE Nephrologist $900
2.20
$800
2.00
$700
1.80
Employees per FTE Neph
$600
Income (000's)
1.60
$500
1.40
$400
1.20
$300
1.00
$200
0.80
$100
0.60
$0
0.40
Your Practice National East Benchmark Large VAC
0.20
0.00
Non-Interventional Interventional Nephrologist Interventional Radiologists Vascular Surgeons Nurse Clerical Staff Clinical Support Staff Ancillary Staff Admi Comparison of Sources of Total Income per FTE Nephrologist
Nephrologist Practitioners/Physician
Assistants
100%
90%
80%
Percent of Total Income
Dialysis Patient Location 70%
60%
Percentage of Dialysis Patients Total Other Income*
50%
Net Fees for Service Revenue
40%
Your Practice National East Benchmark Large
30%
Difference Difference Difference Difference
Mean Percent Mean Percent Mean Percent Mean Percent
20%
In Center 84.54% 85.52% -0.98% 84.23% 0.31% 86.19% -1.65% 88.99% -4.45%
10%
At Home 11.32% 8.99% 2.33% 10.05% 1.27% 8.35% 2.97% 4.88% 6.44%
Transient 4.14% 5.49% -1.35% 5.72% -1.58% 5.46% -1.32% 6.13% -1.99% 0%
Your Practice National East Benchmark Large VAC
*Total Other Income includes Fees for Medical Directors, Reimbursement for Research Activity, Legal Work, Royalties, Rents, and Other.
5