2007 Greater St. Louis Physician Practice Survey

Practice Structure

What is your area of medical specialty?

What is the legal organization of your practice?

Corporation	S Corporation
Partnership/LLC	Sole Proprietorship
Hospital Owned	Other

How many years has your practice been in operation?

What is the total annual gross revenue for the practice?

Does your organization have the following revenue streams outside of patient visits?

Yes	No
		Freestanding ambulatory surgery
		Drug trials
		Contract medical work for others
		Other

Physician Information

How many physicians do you have in the following age groups?

	Male	Female
30 - 39 years
40 - 49 years
50 - 59 years
60 - 64 years
65+ years
Total Physicians

Do you use physician extenders? YesNo
If yes, how many:

What is the average total annual compensation per physician?

What is the staffing ratio of physicians to all other personnel?

Medical Liability

Are your malpractice rates higher or lower than three years ago? HigherLower

Have you changed carriers in the past three years? YesNo

What type of company is your current malpractice carrier? Standard
383 Mutual
Risk Retention Group (RRG)
Unsure

How much do you pay for malpractice coverage, per physician? Less than $10,000$35,000 - $50,000
$10,000 - $20,000$50,000 - $65,000
$20,000 - $35,000More than $65,000

Electronic Medical Records

Have you purchased an electronic medical records system? YesNo

On a per-physician basis, how would you quantify the costs? $5,000$10,000$15,000$20,000

Do you plan to utilize IRS Tax Code 179 as part of your EMR purchase? YesNoUnsure

Do you plan to take advantage of the 1.5% PQRI incentive offered by Medicare? YesNo

Asset Protection

Do you have a business succession plan in place in the event of disability or death (for single owner of a practice)? YesNo

Do you have a buy/sell agreement in place (for multiple owners of a practice)? YesNo

If yes, does it cover the death of the principals? YesNo

If yes, does it cover the disability of the principals? YesNo

If yes, is your buy/sell agreement funded with disability and/or life insurance? YesNo

Has your practice experienced asset loss due to fraud? YesNo

Has your practice's fraud measures been reviewed by an independent fraud specialist? YesNo

Which of the following do you review on a regular basis? (Please check all that apply.) Fee Schedule
MGMA Format Financial Statements
Compensation Benchmarks
Fraud and Abuse Compliance
Practice Marketing
Strategic Planning

Optional