Clinical Academic Rheumatology: A Boon for Health Systems

Finding a balance between clinical and scholarly productivity is a challenge for many academic clinician-educator rheumatologists. An examination of workload and downstream revenue determines if the financial value generated by services rendered by rheumatologists are proportionate to the financial value created for a health system. A 2005 study found that academic rheumatologists generate $10.02 for every $1.00 they receive for an office visit.

A retrospective analysis of ordering and billing practices of 5 full-time clinician-educator rheumatologists from August 2017 to February 2019 was conducted. Individual workload is defined as averaged full-time equivalent workload based on time spent on clinical and academic duties. Academic productivity was reviewed. Revenue-generating activities that benefited the division directly and downstream revenue were collected. Revenue was extrapolated based on volumes of referrals, publicly available drug costs, and estimated Medicare reimbursement values (average sales price) of representative drugs.

The total revenue by physician that benefited the division directly was $597,203, with evaluation and management codes accounting for $174,456. Downstream revenue by physician totaled $2,119,437. The largest contributor was from referrals to the hospital-based infusion center, at $1,287,496. The downstream revenue generated by rheumatologist per dollar of evaluation and management services was found to be $12.14 ($9.37 in 2005 dollars).

For every $1 generated though office visits by 5 practicing academic rheumatologists at our institution, $12.14 was generated through downstream revenue, which, when adjusted for inflation, shows stability in the value generated by academic rheumatologists ($10.02 versus $9.37).