{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Instructions","Physician Tool","Non-Physician Tool","Physician Tool Details","Non-Physician Details","Notes"],"not_rendered":{"charts":0,"images":2,"macros":1,"external_links":0,"defined_names":2,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":52,"n_cols":2,"rows_kept":52,"cut":false,"hidden":false,"merged":[[7,1,16,13],[18,1,30,13],[32,1,46,13],[51,1,55,13],[0,1,5,6],[48,1,49,13]]}
[null,"John Snow, Incorporated"]
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[null,"Introduction:\n\nThe STAR² Center is a project of the Association of Clinicians for the Underserved (ACU).  In partnership with the Federal Bureau of Primary Health Care (BPHC), ACU created the STAR² Center to provide free resources, training, and technical assistance to the health centers facing high workforce need. ACU has contracted with John Snow, Inc. to provide support to the STAR² Center, including the development of this Financial Impact Tool.\n\nEnsuring access to the full range of primary care services lies at the heart of the federal health center movement. Health centers are an essential part of providing health, dental, vision, behavioral, and other care to underserved populations throughout the United States. The STAR2 Center recognizes the need to assist health centers with clinical workforce issues. The inability to recruit and retain a qualified and appropriate healthcare workforce creates ongoing difficulties for an organization and the community it serves.\n"]
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[null,"Purpose: \n\nThe purpose of this Financial Impact Tool is to assist you in realizing the actual costs of provider turnover. These costs can include direct costs, such as advertising and recruiting services, but also indirect costs, such as staff time dedicated to finding locum tenens (temporary) and permanent providers. This tool attempts to quantify the tangible costs involved in provider turnover. While there are also intangible costs associated with the loss of a provider—such as the morale cost to remaining staff absorbing an added workload—these are difficult to calculate and are not included in the tool. Wherever separate data are available for nurse practitioners, physician assistants, and physicians, they are parsed into separate tabs for “Non-Physician Providers” or “Physicians”. Even with the separation of data, several of the “National Estimates” are based solely on physician data and may or may not be applicable for non-physician providers. These include length of vacancy and locum tenens cost, among others. Please be aware that the values labeled under “National Estimates” may vary from real-world costs, especially between types of providers, specialties, and local living and business costs in your health center’s area. These estimates are provided to help guide your assessment when you cannot find more exact values, and are selected to be as widely applicable as possible. \n"]
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[null,"How to Use This Tool:\n\nThe workbook has six worksheets, each on its own spreadsheet tab. The first worksheet is this Instructions page. The second and third worksheets are the Physicians Financial Impact Tool and the Non-Physician Providers Financial Impact Tool. The fourth and fifth worksheets (Details) include the methodology, estimate calculations, and sources that have been used to create both financial impact tools, as well as notes providing pertinent context to those specific estimates. The sixth worksheet (Notes) documents overall assumptions.\n\nThe Financial Impact Tool worksheets include two tables on each worksheet. The first table is the Data Input Table. Below it is the second table, Tangible Cost, which will show the results of the Data Input Table.  \n\nIn the Data Input Table, please enter your actual values for each item in the column labeled Input Value. If you do not know the actual value, you may use your best estimate. If you do not have an estimate, suggested estimates derived from national averages and other sources are included in the gray column labeled National Estimate. Enter this number into the Input Value or click the radio button beside each estimate you would like to use. Clicking the button at the top of the column will automatically input all of the National Estimates. There is a Reset button available to remove all of the entries and begin again. If you do not expend costs in a given category, just input a \"0\". The sources and rationale for these estimates can be found in the corresponding Details worksheets. \n\nOnce the Data Input Table is complete, scroll down to the bottom row of the Tangible Costs table to see the Total Financial Impact of provider turnover for your health center.\n\n"]
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[null,"Before Using This Tool: How to Enable Macros in Excel\n\nThis workbook uses \"macros\"—coding that is written into Excel to create specific tools or features. Many computers automatically disable macro coding in Excel files. While this calculator tool will still work without enabling these macros, the feature allowing you to click on a national average cost estimate and have it populate into the calculator automatically may not work if macros are disabled. You can still manually type in the estimated value, just as when you are inputting your own known values, but if you wish to use the auto-fill feature, here is how you can enable macros for this document in Excel:\n\nUpon opening the document, you may see a yellow banner at the top of the Excel window stating \"Security Warning, Macros have been disabled.\" In that banner will be a button labeled \"Enable Content\"—you can click this button to allow Excel to run the macros in the worksheet. Your computer's other security settings will remain unchanged. \n\nTo enable macros before opening the file:\n1. Download the spreadsheet.\n2. On the downloaded file's icon (probably in your \"Downloads\" folder), RIGHT CLICK, and select \"PROPERTIES\" from the pop-up menu.\n3. The Document Properties window will open. At the bottom (under the \"General\" Tab) you will see three check-boxes. Click the one next to \"Security\" that says UNBLOCK.\n4. The UNBLOCK check-box should now have a checkmark in it.\n5. Close the Document Properties window.\n6. Open the spreadsheet file. If a banner appears at the top asking \"DO YOU WANT TO ENABLE MACROS,\" select YES.\n7. The radio buttons and other macro-based tools should now work. \n\n*NOTE: Some antivirus software and some computer networks may also block macros in downloaded files for additional security. Speak with your IT staff and/or consult your antivirus software instructions page on whether or not you can enable macros in this Excel document. "]
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[null,"For more information and tools to assist in recruitment and retention, check out the STAR2 Center website found at https://www.chcworkforce.org. If you have any questions or suggestions, please contact the STAR2 Center team at 844-ACU-HIRE, info@clinicians.org, or using the contact form on the STAR2 Center website.\n\nThis project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $825,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. \n"]

{"sheet":"Physician Tool","index":1,"n_rows":68,"n_cols":4,"rows_kept":68,"cut":false,"hidden":false,"merged":[[42,0,42,1],[2,0,2,2],[12,0,12,3],[19,0,19,3],[15,0,15,3],[25,0,25,3],[34,0,34,3]]}
["Physician Data Input Table"]
["Description","Input Value","National Estimate","Select Estimate"]
["Salary Information"]
["Business Office (Patient Accounts/Billing) Salary and Benefits per hour",null,42]
["CEO/Administrator Salary and Benefits per hour",null,78]
["Chief Medical Officer Salary and Benefits per hour",null,182]
["Human Resources Salary and Benefits per hour",null,42]
["IT Hourly Rate plus benefits",null,38]
["Leaving Provider Salary plus benefits for length of vacancy",null,345000]
["Nurse/MA Hourly Rate plus benefits",null,53]
["Other Providers Average Hourly Rate plus benefits",null,166]
["Support Staff Salary and Benefits per hour",null,29]
["Outside Recruiting Expenses"]
["Recruiting Service",null,20000]
["Advertising Costs (2 national journal print ads, 1 national online service x 3 mths)",null,14550]
["Leaving Provider Practice Information"]
["Average patient visits per day by leaving provider",null,12]
["Average revenue/collections per visit",null,205]
["Malpractice Tail Coverage (if any)",null,10000]
["Locum Tenens or Temporary Provider Arrangements"]
["Estimated length of vacancy in work days",null,120]
["Locum Tenens daily rate",null,1600]
["Housing Expense (per month)",null,1350]
["Travel ",null,330]
["Estimated patient visits per day by Locum Tenens",null,7]
["Interview Expense"]
["Number of in-person interviews",null,4]
["Hotel Expense per night (2 nights per interview)",null,220]
["Travel Expense per interview",null,330]
["All Staff breakfast with candidate per interview",null,360]
["CMO lunch with candidate per interview (incl. candidate and guest)",null,60]
["Number of people included in interview dinner per interview",null,10]
["Interview Dinner Cost per person per interview, including tax and gratuity",null,36]
["Cost of other interview items, such as gift baskets, baby sitting service",null,150]
["Hiring Expenses"]
["Relocation Costs",null,10000]
["Signing Bonus",null,25000]
["Publicity Costs",null,250]
["Other Costs (ex: lab coats or scrubs, other individual equipment)",null,180]
[]
[]
["Tangible Costs","Cost"]
["A. Termination Costs"]
["1. Human Resources and/ or Business Office Expense for terminating benefits, COBRA adminstration (if applicable), notifying health plans of provider change in status.",{"$f":"B4*16","v":0}]
["2. Estimated cost of a Locums Tenens or other part time provider",{"$f":"((B22*B21)+(B23*(B21/20))+B24)-((B9/230)*B21)","v":0}]
["3. Malpractice tail coverage costs, if any ",{"$f":"B19","v":0}]
["A. Total Termination Costs",{"$f":"SUM(B44:B46)","v":0}]
["B. Replacement Costs"]
["4. Advertising Costs",{"$f":"B15","v":0}]
["5. Pre-Interview Staff Time -  to arrange advertising; accept, sort and document applications (written and electronic);  respond to telephone and written inquiries, arrange visits including logistics (hotel, travel, recruitment dinner), schedule telephone interviews and meetings with medical director, other staff involved in the decision process.",{"$f":"(B7*60)+(B12*40)+(B5*10)+(B6*24)","v":0}]
["6. Professional Recruiting Service Expenses",{"$f":"B14","v":0}]
["7. Interview Staff Expenses",{"$f":"(B7*80)+(B12*40)+(B5*32)+(B6*48)","v":0}]
["8. Interview Direct Costs (on-site face-to-face interview visits)",{"$f":"(B29+(B28*2)+B30+B31+(B32*B33)+B34)*B27","v":0}]
["9. Post Interview Expenses - staff time for negotiation, other hiring expenses (bonus, relocation)",{"$f":"(B7*16)+(B5*4)+(B6*4)+B36+B37","v":0}]
["B. Total Replacement Costs",{"$f":"SUM(B49:B54)","v":0}]
["C. Net Impact to Revenue"]
["10. Revenue Loss from Leaving Provider",{"$f":"B17*B18*B21","v":0}]
["11. Revenue Recovered from Locum Tenens",{"$f":"B25*B18*B21","v":0}]
["C. Total Net Impact to Revenue [Recovered - Loss]",{"$f":"B57-B58","v":0}]
["D.  New Hire/Onboarding Costs"]
["12. Payroll startup, Benefit Enrollment, establish passwords,email account ",{"$f":"B7*4.5","v":0}]
["13. Credentialing services cost (internal or Credentialing Verification Organization (CVO))",{"$f":"B4*16","v":0}]
["14. Internal and external publicity announcements ",{"$f":"B38","v":0}]
["15. Equipment and Uniform expense ",{"$f":"B39","v":0}]
["16. Orientation Costs",{"$f":"(B4*8)+(B8*8)+(B11*6)+(B10*20)+(B12*10)+(B5*4)+(B6*10)","v":0}]
["17. Cost of Productivity lost to startup",{"$f":"((0.75*20*B17)+(0.5*40*B17)+(0.3*60*B17)+(0.2*120*B17))*B18","v":0}]
["D.  Total New Hire/Onboarding Costs",{"$f":"SUM(B61:B66)","v":0}]
["Total Financial Impact",{"$f":"B47+B55+B59+B67","v":0}]

{"sheet":"Non-Physician Tool","index":2,"n_rows":68,"n_cols":4,"rows_kept":68,"cut":false,"hidden":false,"merged":[[42,0,42,1],[2,0,2,2],[12,0,12,3],[15,0,15,3],[19,0,19,3],[25,0,25,3],[34,0,34,3]]}
["NonPhysician Provider Data Input Table"]
["Description","Input Value","National Estimate","Select Estimate"]
["Salary Information"]
["Business Office (Patient Accounts/Billing) Salary and Benefits per hour",null,42]
["CEO/Administrator Salary and Benefits per hour",null,78]
["Chief Medical Officer Salary and Benefits per hour",null,182]
["Human Resources Salary and Benefits per hour",null,42]
["IT Hourly Rate plus benefits",null,38]
["Leaving Provider Salary plus benefits for length of vacancy",null,153000]
["Nurse/MA Hourly Rate plus benefits",null,53]
["Other Providers Average Hourly Rate plus benefits",null,74]
["Support Staff Salary and Benefits per hour",null,29]
["Outside Recruiting Expenses"]
["Recruiting Service",null,8700]
["Advertising Costs (2 national journal print ads, 1 national online service x 3 mths)",null,14550]
["Leaving Provider Practice Information"]
["Average patient visits per day",null,11]
["Average revenue/collections per visit",null,205]
["Malpractice Tail Coverage (if any)",null,3000]
["Locum Tenens or Temporary Provider Arrangements"]
["Estimated length of vacancy in work days",null,120]
["Locum Tenens daily rate",null,708]
["Housing Expense (per month)",null,1350]
["Travel ",null,330]
["Estimated patient visits per day by Locum Tenens",null,7]
["Interview Expense"]
["Number of in-person interviews",null,4]
["Hotel Expense *per night* (2 nights per interview)",null,220]
["Travel Expense per interview",null,330]
["All Staff breakfast with candidate per interview",null,360]
["CMO lunch with candidate per interview (incl. candidate and guest)",null,60]
["Number of people included in interview dinner per interview",null,10]
["Interview Dinner Cost per person per interview, including tax and gratuity",null,36]
["Cost of other interview items, such as gift baskets, baby sitting service",null,150]
["Hiring Expenses"]
["Relocation Costs",null,10000]
["Signing Bonus",null,7000]
["Publicity Costs",null,250]
["Other Costs (ex: lab coats or scrubs, other individual equipment)",null,180]
[]
[]
["Tangible Costs","Cost"]
["A. Termination Costs"]
["1. Human Resources and/ or Business Office Expense for terminating benefits, COBRA adminstration (if applicable), notifying health plans of provider change in status.",{"$f":"B4*16","v":0}]
["2. Estimated cost of a Locums Tenens or other part time provider",{"$f":"((B22*B21)+(B23*(B21/20))+B24)-((B9/240)*B21)","v":0}]
["3. Malpractice tail coverage costs, if any ",{"$f":"B19","v":0}]
["A. Total Termination Costs",{"$f":"SUM(B44:B46)","v":0}]
["B. Replacement Costs"]
["4. Advertising Costs",{"$f":"B15","v":0}]
["5. Pre-Interview Staff Time -  to arrange advertising; accept, sort and document applications (written and electronic);  respond to telephone and written inquiries, arrange visits including logistics (hotel, travel, recruitment dinner), schedule telephone interviews and meetings with medical director, other staff involved in the decision process.",{"$f":"(B7*60)+(B12*40)+(B5*10)+(B6*24)","v":0}]
["6. Professional Recruiting Service Expenses",{"$f":"B14","v":0}]
["7. Interview Staff Expenses",{"$f":"(B7*80)+(B12*40)+(B5*32)+(B6*48)","v":0}]
["8. Interview Direct Costs (on-site face-to-face interview visits)",{"$f":"(B29+(B28*2)+B30+B31+(B32*B33)+B34)*B27","v":0}]
["9. Post Interview Expenses - staff time for negotiation, other hiring expenses (bonus, relocation)",{"$f":"(B7*16)+(B5*4)+(B6*4)+B36+B37","v":0}]
["B. Total Replacement Costs",{"$f":"SUM(B49:B54)","v":0}]
["C. Net Impact to Revenue"]
["10. Revenue Loss from Leaving Provider",{"$f":"B17*B18*B21","v":0}]
["11. Revenue Recovered from Locum Tenens",{"$f":"B25*B18*B21","v":0}]
["C. Total Net Impact to Revenue [Recovered - Loss]",{"$f":"B57-B58","v":0}]
["D.  New Hire/Onboarding Costs"]
["12. Payroll startup, Benefit Enrollment, establish passwords,email account ",{"$f":"B7*4.5","v":0}]
["13. Credentialing services cost (internal or Credentialing Verification Organization (CVO))",{"$f":"B4*16","v":0}]
["14. Internal and external publicity announcements ",{"$f":"B38","v":0}]
["15. Equipment and Uniform expense ",{"$f":"B39","v":0}]
["16. Orientation Costs",{"$f":"(B4*8)+(B8*8)+(B11*6)+(B10*20)+(B12*10)+(B5*4)+(B6*10)","v":0}]
["17. Cost of Productivity lost to startup",{"$f":"((0.75*20*B17)+(0.5*40*B17)+(0.3*60*B17)+(0.2*120*B17))*B18","v":0}]
["D.  Total New Hire/Onboarding Costs",{"$f":"SUM(B61:B66)","v":0}]
["Total Financial Impact",{"$f":"B47+B55+B59+B67","v":0}]

{"sheet":"Physician Tool Details","index":3,"n_rows":85,"n_cols":6,"rows_kept":85,"cut":false,"hidden":false,"merged":[[2,0,2,5],[14,0,14,5],[38,0,44,0],[38,1,38,5],[16,1,16,5],[16,0,21,0],[4,1,4,5],[4,0,11,0],[23,1,23,5],[23,0,28,0],[29,1,29,5],[29,0,37,0],[46,0,46,5],[52,0,56,0],[63,1,63,5],[63,0,71,0],[90,0,90,5],[47,1,47,5],[47,0,51,0],[72,1,72,5],[72,0,83,0],[52,1,52,5],[91,0,91,5],[97,0,97,5],[99,0,99,5],[102,0,102,5],[105,0,105,5]]}
["Methodology, estimates, and sources."]
["Tangible Costs","Inputs","National Estimate ","References","Calculation","Notes"]
["A. Termination Costs"]
["1. Human Resources and/ or Business Office Expense for terminating benefits, COBRA adminstration (if applicable), notifying health plans of provider change in status.","HR/Business Office Hourly Rate plus benefits","$42 per hour\n16 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts","Hourly Salary/Benefit Rate:\n\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 1, 11: Employer Benefits Overhead = 38% for state/local government; 31% for civilian employees = 34.5% mean overhead. Healthcare and social assistance industry: Management, professional, and related occupations - $54.10 mean total hourly compensation cost (incl benefits). Sales and office occupations - $30.22. Office and administrative support occupations - $28.68. Estimate average HR hourly cost: $38.  \n_____\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resources Workers) mean hourly wage $34.24. Total employer cost = $34.24 + 34.5% overhead = $46/hr total cost. \n________\nFinal estimate: $42/hr average total cost for general HR/office activities ","Estimating for combined work from a variety of HR and business office personnel, including supervisors, entry-level staff, and mid-level staff. \n\"National Estimate\" hourly cost value is inclusive of benefits and other overhead for full-time staff. \n\nTime input from HR/office staff to complete termination of employee based on input from HR professional subject matter expert. Inclusive of time for \"deactivating access rights and passwords,  turning in equipment and conducting exit interviews to gather feedback.\"\n\nNOTE: Time to process termination of an employee who was fired/released involuntarily or who quit with less than two weeks notice may be longer, and therefore more costly. "]
["2. Estimated cost of a Locums Tenens or other part time provider","Locum Tenens Expense"]
[null,"Daily locum tenens rate","$1,600 per day","Rates for various specialties: \n\nhttps://www.staffcare.com/locum-tenens-blog/news/salary-finance-101/\n\nhttps://locumstory.com/spotlight/locum-tenens-compensation-trends/\n\nhttps://www.locumtenens.com/resource-center/interactive-tools/cost-comparison-calculator/","Locum salaries will vary by location, competition, availability, and whether you hire an individual or through an agency:\n\nhttps://www.staffcare.com/locum-tenens-blog/news/salary-finance-101/\nFamily medicine physician: $90-$125 per hour\nHospitalist: $140-$180 per hour\nPsychiatrist: $145-$180 per hour\n\nhttps://www.locumtenens.com/resource-center/interactive-tools/cost-comparison-calculator/ \nyearly locum tenens cost = $439,858 divided by 52 weeks divided by 5 work days per week = $1700/day\n\nhttps://locumstory.com/spotlight/locum-tenens-compensation-trends/\nFamily Medicine $90-$125 per hour\nInternal medicine $140-$190\nOBGYN $100-$140\nPhysical Medicine & Rehab $125-$190 hourly\n\nEstimate hourly rate of $110/hr for physician, $200/hr to Locum agency inclusive of salary and agency overhead x 8 hrs / day = 1600/day ","Locum costs will vary by specialty, location, if you are contracting with an individual provider or using an agency that charges additional overhead. May also need to provide costs like relocation, malpractice insurance, etc (see other sections of this tool for some of those estimates). "]
[null,"Estimated length of vacancy","120 working days (~180 calendar days)","120-280 days depending on specialty (120 working days assumed for this calculation):\n\nData from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx October 2015\n\nhttps://apploi.com/blog/hiring-tips/average-time-to-hire-in-healthcare/\n\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","Locum Daily Rate x Length of Vacancy (Days)\n\n180 calendar days or 120 working days at 5 days per week for 6 months","—"]
[null,"Travel Expense",330,"US Dept of Transportation\nhttps://www.transtats.bts.gov/averagefare/\n","National average for cost of a domestic round-trip ticket as of Q1 2022","The Bureau of Transportation Statistics updates flight cost averages quarterly and they can be narrowed based on airport, so you can find and insert your local major airport's average costs \nhttps://www.transtats.bts.gov/averagefare/"]
[null,"Housing Expense","$1350 per month","Averages by state\nhttps://worldpopulationreview.com/state-rankings/average-rent-by-state\n\nNational Averages by apartment size\nhttps://www.statista.com/statistics/1063502/average-monthly-apartment-rent-usa/","$1350 per month x 6 months length of vacancy = $8100\n\nBased on one bedroom apartment (National Average $1129/mo) plus 20% increase for security deposit and 6-month shortened lease. Multiplied by average position vacancy of 180 days (6 months). ","These two sites can be used to update predicted costs based on your state and the size of apartment:\nAverages by state\nhttps://worldpopulationreview.com/state-rankings/average-rent-by-state\n\nNational Averages by apartment size\nhttps://www.statista.com/statistics/1063502/average-monthly-apartment-rent-usa/\n\nWorking with a local apartment complex to provide safe, secure housing may also give your health center the opportunity to lease an apartment for locum tenens staff at a reduced rate. "]
[null,"HR/Business Office Hourly Rate plus benefits","$42 /hr\n20 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts\n\nFor detailed salary calculations, see HR/Business Office calculations above (A-1)","$42/hr x 20 hrs\n\nOnboarding of locum tenens employee, including negotiations with locum agency or freelance employee, credentialing, other basic onboarding, etc. ","The amount of time needed to onboard temporary staff will depend on several factors, including any contracting company the health center works with (as opposed to hiring a freelance locum physician) and what administrative burdens the contractor covers versus the health center (insurance, housing, travel, etc). There will be significant time saved as most locum tenens employees will not be receiving benefits through the health center like insurance, retirement, etc. Activities like license verification will likely still be required, however. "]
[null,"Leaving Provider Total Salary and Benefits for Length of Vacancy",173000,"Physician Salary Report - Medscape 2022\nhttps://www.medscape.com/slideshow/2022-compensation-overview-6015043\n\nBureau of Labor Statistics March 2022 Compensation Report (pg 5) https://www.bls.gov/news.release/pdf/ecec.pdf","($260,000 per year PCP salary + $85,800 benefits) x 6 months vacancy = $173,000\n\nUsed average primary care physician (PCP) reported salary of $260,000 from Medscape's 2022 Physician Compensation Report.  Assumed average employer overhead of 33% (based on Hospital and Healthcare sectors listed on page 5 of the Bureau of Labor Statistics March 2022 report https://www.bls.gov/news.release/pdf/ecec.pdf )","Remember to factor in any bonuses or incentives that would add to this number. "]
[null,"Total Locum Tenens Expense",null,null,"Sum Locum Expenses - Leaving Provider Expenses"]
["3. Malpractice tail coverage costs, if any ","Malpractice Tail Costs (if any)",10000,"Medscape Malpractice Report 2021\nhttps://www.medscape.com/slideshow/2021-malpractice-report-6014604#7\n\nAMA Policy Research Perspectives liability insurance report 2020\nhttps://www.ama-assn.org/system/files/2021-03/prp-mlm-premiums-2020.pdf","This is assuming an annual premium of $20,000 (high end of average for internal medicine/primary care) with a vacancy of 6 months, and malpractice coverage provided by the locum tenens physician or contracting company, not by the health center. ","Malpractice insurance premiums vary radically based on state and profession. OBGYN premiums are often over $100,000 per year (up to $200,000+ in states like New York), while primary care specialties are often under $10,000 per year. Providing a known value from your health center's records will yield a much more accurate result. "]
["A. Total Termination Costs",null,null,null,"Sum of Sections A-1,-2, & -3"]
["B. Replacement Costs"]
["4. Advertising Costs","Advertising Costs",14550,"UHC Solutions, quoting a Merritt Hawkins whitepaper = $25,000 for \"Agency or in-house recruiter\" + $3000 for marketing and incidentals\nhttps://www.uhcsolutions.com/whats-the-average-cost-per-hire-for-physicians/\nhttps://www.merritthawkins.com/uploadedFiles/merritthawkins_physicianvacancy_whitepaper_2018.pdf\n\nIdealist.org rates\nhttps://www.idealist.org/en/help/how-much-does-it-cost-to-post-listings-on-your-site\n\nGlassdoor summary of major online job posting platform costs\nhttps://www.glassdoor.com/employers/blog/how-much-it-costs-to-post-a-job-online/\n\nBreakdown on ad spending, including radio and TV media options\nhttps://hubbardchicago.com/how-much-should-you-spend-on-recruitment-ads/","Based on Glassdoor cost estimates for largest hiring sites (https://www.glassdoor.com/employers/blog/how-much-it-costs-to-post-a-job-online/):\nZip Recruiter = $250/month\nIdealist = $105-195/month\nWorkable = $100/month\nCraigslist = $75/month\nCareerBuilder = $300/month\nMonster = $250/month\nIndeed/Glassdoor = \"pay per click\" rates ($.10 - $5 per click)\nLinkedIn = \"pay per click rates\"\nEstimated $250/month budget for LinkedIn and Indeed each\nTotal = $1675/month x6 months = $10,050\n\nAdded additional budget for specific ads in professional publications and on occupation-specific recruiting sites (3 publication or recruiting sites at $500/month each x 3 months ea = $4500\n\nTotal = $14550","Tracking results from different job posting and recruitment platforms (cost, time to receive applications, number of interviews/hires from each outlet) is invaluable and over time will help you reduce recruiting costs by tailoring your postings to only those sites that generate candidates that move to the interview process. \n\nAlso remember that a well-written job posting (clear, accurate, listing salary ranges and the benefits of working at your health center, and mission-forward) is worth any amount of staff time involved in writing, editing, and perfecting. The job posting itself is probably more important than any one outlet it might be posted to or printed in. "]
["5. Pre-Interview Staff Time -  to arrange advertising; accept, sort and document applications (written and electronic);  respond to telephone and written inquiries, arrange visits including logistics (hotel, travel, recruitment dinner), schedule telephone interviews and meetings with medical director, other staff involved in the decision process.","Pre-Interview Staff Time"]
[null,"HR Staff Salary and Benefits per hour","$42 /hr \n60 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts\n\nFor detailed salary calculations, see HR/Business Office calculations above (A-1)","$42/hr (HR management staff rate + benefits) x 60 hours for staff time arranging and tracking advertising; accepting, sorting, and tracking applications; arranging candidate interview logistics, including visits (hotel, travel, etc); coordinating with other personnel involved in recruitment process (CEO, medical director, etc). \n"]
[null,"Support Staff Salary and Benefits per hour","$29 /hr\n40 hours","Office support staff\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000","$29/hr (HR Support staff + benefits) x 40 hours supporting HR staff activities invovled with recruitment, processing applications, and arranging interview logistics. \n\nOffice support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\nHR Assistants $21.94 + 31% benefits/overhead = $28.74"]
[null,"CEO Salary and Benefits per hour","$78 /hr\n10 hours","Salary: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n\nTimeframe: JSI and ACU subject matter experts","$78/hr x 10 hours developing position advertising materials, job descriptions, phone interviews.\n\nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77"]
[null,"CMO Salary and Benefits per hour","$182 /hr\n24 hours","Salary: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n\nTimeframe: ACU and JSI subject matter experts","$182/hr x 24 hours developing position advertising materials, job descriptions, phone interviews.\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Total Pre-Interview Staff Costs",null,null,"Sum B5"]
["6. Professional Recruiting Service Expenses","Recruiting Service Cost",20000,"Recruiting Service cost estimate:\nhttps://eddy.com/hr-encyclopedia/recruitment-fees/","Recruiting Service cost estimate based on fee of 15% of salary of employee to be hired x 6 months of recruiting time","Note, various outside recruiters have different fee structures, including some that only require payment when a candidate is interviewed or hired. Carefully select an external recruiter if you plan to use one, and be sure to choose a fee structure that is beneficial to your health center. Ask if the recruiting company provides a discount for non-profit status organizations. Not everyone needs to use a recruiting service or will find value in using an outside recruiter. This need will be determined by your unique needs, including staff time available, immediacy of need, how challenging the position/location is to recruit for, and many other potential factors. "]
["7. Interview Staff Expenses","Interview Staff Expenses"]
[null,"HR Staff Salary and Benefits per hour","$42 /hr \n80 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts","$42/hr x 80 hours\nFour in-person interviews at 20 hours per interview","The amount of interview preparation and review, as well as number of HR staff and other staff involved, will greatly affect these costs. "]
[null,"Support Staff Salary and Benefits per hour","$29 /hr\n40 hours","Office support staff salary estimates:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\n\nTime estimate: JSI and ACU subject matter experts","$29/hr (HR Support staff + benefits) x 40 hours supporting HR staff activities invovled with arranging and carrying out four in-person interviews. \n\nOffice support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\nHR Assistants $21.94 + 31% benefits/overhead = $28.74"]
[null,"CEO Salary and Benefits per hour","$78 /hr\n32 hours","Salary: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n\nTimeframe: JSI and ACU subject matter experts ","$78/hr x 32 hours supporting and taking part in in-person interviews, interview meals, etc.\n\nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77"]
[null,"CMO Salary and Benefits per hour","$182 /hr\n48 hours","Salary: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n\nTimeframe: ACU and JSI subject matter experts ","$182/hr x 48 hours supporting and taking part in in-person interviews, crafting interview questions and activities, hosting interview meals, etc..\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Total Interview Staff Expenses",null,null,"Sum B7"]
["8. Interview Direct Costs (on-site face-to-face interview visits)","Interview Direct Costs (Non-staff)"]
[null,"Travel Expense per interview","$330 per interview","USDOT https://www.transtats.bts.gov/averagefare/","3 candidate face-to-face interviews; 1 repeat interview for final candidate; Total of 4 on-site interviews\n\nNational average for cost of a domestic round-trip ticket as of Q1 2022\nhttps://www.transtats.bts.gov/averagefare/","This number may increase if you opt to pay for a spouse to accompany the candidate or if there are no major airports located near your health center (flights into smaller local or regional airports are often more costly); it may decrease if the candidate lives within driving distance. "]
[null,"Hotel Expense per night","$220 per night x 2 nights per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","Average between all 12 months listed for lodging rates for Washington, DC on US General Services Administration site (for US fiscal year 2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=\n\n2 nights per interview for 3 candidate face-to-face interviews; 1 repeat interview for final candidate; Total of 4 on-site interviews","Rates will vary depending on time of year, hotel options available, and general cost profile in your part of the country."]
[null,"Number of people included in interview dinner, per interview","10 people per interview","JSI subject matter expert","CEO couple, CMO couple, MD in same specialty couple, HR/in-house recruiter couple, Candidate couple","Offering to pay for child care during the interview activities--including dinner and other outings--could be a good incentive to interview if the candidate has children. "]
[null,"Interview Dinner Cost per person per interview, including tax and gratuity","$360 per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","GS per diem rate (dinner) for Washington, DC 2023 Fiscal Year https://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=\n\n$36 per person x 10 people per interview x 4 interviews","Remember to budget for tax and tip (usually 20% for parties of 6 or more). This suggested figure is an estimate inclusive of tax and tip based on US government per diem rates for Washington, DC for the 2023 fiscal year. "]
[null,"All Staff breakfast with candidate per interview","$360 per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","Estimate for cost of all-staff continental breakfast based on GSA 2023 per diem of $18 per person x 20 people x 4 interviews","A basic continental style breakfast will likely be more economical, though costs can quickly add up for large staff—but it is important for workplace solidarity and showing candidates a commitment to \"community\" to involve all staff in this process and allow them to meet candidates. "]
[null,"CMO lunch with candidate per interview","$60 per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","GSA per diem (Lunch) for 2023 FY x 3 (candidate + 1 guest and CMO) x 4 interviews","Remember to budget for tax and tip. Bringing candidates to a \"local\" spot can be a good way to avoid more costly options and provide a candidate exposure to the community where they will be working/living. "]
[null,"Cost of other interview items, such as gift baskets, baby sitting service","$150 per interview x 4 interviews","JSI subject matter expert","Cost of other interview items, like gift basket and child care during interviews, etc","Gift baskets do not have to be expensive or elaborate, they can include branded items (like coffee mugs or other promotional items with your health center's logo) and/or some local items from community shops or attractions. Childcare during interview activities can be very expensive, and should be provided through a vetted and trusted provider. "]
[null,"Total  Direct Costs (Non-staff)",null,null,"Sum B8"]
["9. Post Interview Expenses - staff time for negotiation, other hiring expenses","Post-Interview Expenses"]
[null,"HR Staff Salary and Benefits per hour","$42 /hr \n16 hours","Pay rate: \nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTimeframe: ACU HR subject matter expert","16 hours negotiation, contracts, processing signing bonus & relocation expenses","This cost could be much higher if consultation with staff legal counsel or special work for licensure verification or transfer is required. "]
[null,"CEO Salary and Benefits per hour","$78 /hr \n4 hours","Timeframe: JSI and ACU subject matter experts\n\nPay rate: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 ","4 hours negotiation and contracting + contract review and approval\n\nPay rate: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77"]
[null,"CMO Salary and Benefits per hour","$182 /hr \n4 hours","Timeframe: ACU and JSI subject matter experts\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm","4 hours Q&A + check-ins during onboarding (and preferably again during 30-, 60-, and 180-day onboarding and stay interviews). \n\nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Signing Bonus",25000,"Merritt Hawkins Incentive Review 2021\nhttps://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdf","Low end of average for Family Med, Internal Med, Radiology, and Psychiatry\nMerritt Hawkins Incentive Review 2021\nhttps://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdf\nAverage Column By Specialty (pg 17)\nNurse Practitioner $6,939 \nFamily Medicine  $34,644 \nRadiology $23,235 \nPsychiatry $33,260 \nInternal Medicine $22,861 \n\nMedscape Annual Physician Compensation Report (2022) https://www.medscape.com/slideshow/2022-compensation-overview-6015043\nAverage Incentive Bonus (NO signing bonus statistics given) = $30k for Family Med; $28k Peds, $49k OBGYN","This is likely a low estimate. Especially in the southern US and in more rural areas, signing bonuses for physicians may be closer to $50,000, with around $30,000 of additional annual incentives, CME compensation, and/or student loan repayment compensation. "]
[null,"Relocation Costs",10000,"Merritt Hawkins Incentive Review 2021\nhttps://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdf","Average relocation allowance in 2020/2021"]
[null,"Total Post-Interview Expenses",null,null,"Sum B9"]
["B. Total Replacement Costs",null,null,null,"Sum of B-4, -5, -6, -7, -8, & -9"]
["C.Net Impact to Revenue"]
["10. Revenue Loss from Leaving Provider","Revenue Lost"]
[null,"Estimated length of vacancy","120 working days (6 months)","Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx October 2015\n\nhttps://apploi.com/blog/hiring-tips/average-time-to-hire-in-healthcare/\n\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","120-280 days depending on specialty\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","Much of the data available is from pre-Pandemic periods. There is also a large variation in average times between specialties (sometimes more than 100 days), and data are not usually broken down by state or region. Basing this timeframe off of your Health Center's prior time-to-fill durations will provide a much more accurate result. "]
[null,"Average # patients per day by leaving provider","12 visits per day","UDS Data Table 5 (2021)\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","UDS Table 5 (2021) Staffing and Utilization Line 8 \"Total Physicians\" \nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021\n\nGross visits per day lost due to vacancy (national average estimate):\nTotal Clinic Visits + Virtual Visits divided by total FTEs = \n2750 patients per annual FTE divided by 230 working days per year (5 days per week x 48 work weeks - 10 holidays) = 12 patient visits per day. ","This number is a reflection of a national average, but average patient visits per provider per day vary widely by health center and even individual provider. "]
[null,"Average revenue/collections per visit with leaving provider","$205 per visit","UDS Data Tables, Community Health Centers, Expanded Summaries of UDS Data Tables 2021\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national","Average revenue per patient visit (virtual and in-clinic, all specialties) = $204\n(2021 UDS Table 9D: Patient Related Revenue, Collections, Line 14, total for \"Amount Collected This Period\" [total revenue collected = $25,345,338,569] divided by 2021 UDS Table 5: Staffing and Utilization, Personnel by Major Service Category, Line 34, total for \"Grand Total\" Clinic + Virtual visits [total patient visits = 124,211,391]. \nUDS Table 9D (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=9D&year=2021\nUDS Table 5 (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021\n","This is an average based on the total national revenue of health centers (excluding lookalikes) divided by the total national patient visits for every health center (inclusive of all specialties and of patients who are unable to pay and are uninsured). This number might be significantly higher or lower for a specific provider type in your health center. "]
[null,"Total Revenue Lost",null,null,"Gross visits X Collections per visit \n($205 per visit x 12 visits per day x 120 working days)","Other Revenue loss estimate for primary care: \n$1,541,532 average Primary Care Physician revenue per year. Merritt Hawkins Physician Revenue Survey 2019 \nhttps://www.merritthawkins.com/uploadedFiles/MerrittHawkins_RevenueSurvey_2019.pdf\n\n6 months revenue loss = $771,000\nAssume 36% non-payment at health centers (Per UDS 2021 data: Table 9D Patient Related Revenue)  = $493,000 6-month revenue loss for health centers based on this alternate estimate"]
["11. Revenue Recovered from Locum Tenens","Revenue Recovered"]
[null,"Estimated length of vacancy","120 working days (6 months at 5 days per week)","Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx October 2015\n\nhttps://apploi.com/blog/hiring-tips/average-time-to-hire-in-healthcare/\n\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","120-280 days depending on specialty\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2"]
[null,"Visits per day by locum tenens","7 visits per day","JSI subject matter expert. \n\nBarton and Associates discussion of locum tenens to supplement staff or fill vacancies to increase productivity:\nhttps://www.bartonassociates.com/blog/improving-healthcare-staffing-roi-with-locum-tenens-providers/","JSI subject matter expert assumes 25% to 50% loss of productivity due to lack of patient familiarity with a locum tenens physician, as well as the temporary physician's lack of familiarity with the organization, staff, and processes. ","Bringing in temporary support may not be as productive in patient care or revenue generation as having a full-time permanent hire, but it can still reduce burnout and other detrimental effects from other staff having to take up the entire workload of a lost provider. "]
[null,"Average revenue/collections per visit with Locum Tenens","$205 per visit","UDS Data Tables, Community Health Centers, Expanded Summaries of UDS Data Tables 2021\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national","Average revenue per patient visit (virtual and in-clinic, all specialties) = $204\n(2021 UDS Table 9D: Patient Related Revenue, Collections, Line 14, total for \"Amount Collected This Period\" [total revenue collected = $25,345,338,569] divided by 2021 UDS Table 5: Staffing and Utilization, Personnel by Major Service Category, Line 34, total for \"Grand Total\" Clinic + Virtual visits [total patient visits = 124,211,391]. ","There may be a loss of revenue per patient visit due to a temporary provider being less likely to order labs or other procedures that add to revenue, but there is no current literature directly examining if this loss exists, and if so, how great a loss it is. Likely, in most out-patient clinics, the primary loss will be due to lower patient visit rates. "]
[null,"Total Revenue Recovered",null,null,"7 visits per day x $205 per visit average revenue x 120 working day vacancy"]
["C. Total Net Impact to Revenue [Recovered - Loss]",null,null,null,"Total Revenue Recovered - Total Revenue Lost"]
["D.  New Hire/Onboarding Costs"]
["12. Payroll startup, Benefit Enrollment, establish passwords,email account ","HR Hourly Rate plus benefits","$42 /hr\n4.5 hours","JSI subject matter expert","Hourly Salary/Benefit Rate X 4.5 hours","Payroll and benefit enrollment, email account and password setup"]
["13. Credentialing services cost (internal or Credentialing Verification Organization (CVO))","Business Office Hourly Rate plus benefits","$42 /hr\n16 hours","JSI and ACU HR subject matter experts\n\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)","Time estimate (based on input from HR professional subject matter expert): 16 hours\n\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 1, 11: employer benefits overhead = 38% for state/local government; 31% for civilian employees = 34.5% mean overhead. Healthcare and social assistance industry: Management, professional, and\nrelated occupations - $54.10 mean total hourly compensation cost (incl benefits). Sales and office occupations - $30.22. Office and administrative\nsupport occupations - $28.68. Estimate average HR hourly cost: $38.  \n_____\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resources Workers) mean hourly wage $34.24. Total employer cost = $34.24 + 34.5% overhead = $46/hr total cost. \n________\nFinal estimate: $42/hr average total cost for general HR/office activities","The time and cost of credential verification may vary; transfer of credentials from another state may increase the time and could incur additional expense depending on licensure requirements of your state for the provider license type. "]
["14. Internal and external publicity announcements ","Publicity Cost",250,"JSI subject matter expert estimate",null,"This cost will vary widely depending on what type of publicity your health center engages in for a newly hired clinician. Simply an announcement on the health center website, for instance, will be a negligible expense, but an advertisement in one or more local newspapers may be more. "]
["15. Equipment and Uniform expense ","Lab coat or other uniform/equipment costs","$180 (two lab coats with embroidery)","Embroidery Cost for two lab coats = $40\nhttps://sayitinstitches.com/price-list/\n\nTwo lab coats = $140 total\nhttps://www.uniformadvantage.com/","$140 for uniforms/lab coats + $40 for embroidering with health center logo, practitioner name","This cost assumes recurring cost items—like a provider cell phone—are factored into employer overhead for benefits and pay. "]
["16. Orientation Costs","Orientation Costs"]
[null,"HR Hourly Rate plus benefits","$42 /hr \n8 hours","JSI and ACU HR subject matter experts\n\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)","Time estimate (based on input from HR professional subject matter expert): 8 hours\n\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 1, 11: employer benefits overhead = 38% for state/local government; 31% for civilian employees = 34.5% mean overhead. Healthcare and social assistance industry: Management, professional, and\nrelated occupations - $54.10 mean total hourly compensation cost (incl benefits). Sales and office occupations - $30.22. Office and administrative\nsupport occupations - $28.68. Estimate average HR hourly cost: $38.  \n_____\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resources Workers) mean hourly wage $34.24. Total employer cost = $34.24 + 34.5% overhead = $46/hr total cost. \n________\nFinal estimate: $42/hr average total cost for general HR/office activities"]
[null,"IT Hourly Rate plus benefits","$38 /hr \n8 hours","Time estimate: JSI and ACU HR Subject matter experts\n\nSalary: \nhttps://www.bls.gov/oes/current/oes_nat.htm#15-0000\n15-1230 Computer Support Specialists\n\nBenefits Cost:\nhttps://www.bls.gov/news.release/pdf/ecec.pdf \n2022 pg 11","Time based on input from HR subject matter experts: 8 hours for onboarding and tech setup.\n\nSalary: $29.11/hr (mean hourly salary)\nhttps://www.bls.gov/oes/current/oes_nat.htm#15-0000\n15-1230 Computer Support Specialists\n\nBenefits Cost: 30%\nhttps://www.bls.gov/news.release/pdf/ecec.pdf \n2022 pg 11\n\nTotal Cost for employer: $37.84/hr"]
[null,"Other Providers Average Hourly Rate plus benefits","$166 /hr \n6 hours","Time estimate: JSI and ACU HR Subject matter experts\n\nPhysician Salary Report - Medscape 2022\nhttps://www.medscape.com/slideshow/2022-compensation-overview-6015043\n\nBureau of Labor Statistics March 2022 Compensation Report (pg 5) https://www.bls.gov/news.release/pdf/ecec.pdf","6 hours assisting with orienting new hire and providing peer mentorship and support during onboarding process. \n\nUsed average primary care physician (PCP) reported salary of $260,000 from Medscape's 2022 Physician Compensation Report.  Assumed average employer overhead of 33% (based on Hospital and Healthcare sectors listed on page 5 of the Bureau of Labor Statistics March 2022 report https://www.bls.gov/news.release/pdf/ecec.pdf )\n\n$260,000 * 1.33  / 2080 hours per year FTE = $166/hr total cost to employer"]
[null,"Nurse/MA Hourly Rate plus benefits","$53 /hr \n20 hours","JSI and ACU HR Subject matter experts\n\nRegistered Nurse Hourly Rate: $40/hr\nhttps://www.bls.gov/oes/current/oes_nat.htm#29-0000\nLine 29-1141 (mean hourly salary)\n\nMedscape RN/LPN Salary Report 2021 = Avg $75,000/yr or $36/hr (for non-hospital clinic staff RNs)\nhttps://www.medscape.com/slideshow/2021-rn-lpn-compensation-report-6014514#9\n\nBenefits Overhead for Registered Nurses: \nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 11","$40/hr + 33% benefits cost = $53/hr x 20 hours supporting orientation and onboarding of new hire\n\n","There may be multiple support staff at various licensure levels supporting the onboarding process of a new provider. This estimate is based on an approximation of the collective time spent amongst these staff. "]
[null,"Support Staff  Hourly Rate plus benefits","$29 /hr\n10 hours","Office support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\n","$29/hr x 10 hours supporting logistics of new provider orientation and onboarding (ex: medical reception, medical records and billing, etc)\n\nOffice support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\nHR Assistants $21.94 + 31% benefits/overhead = $28.74","10 hours: Annual median Support Staff (Med Recept, Med Rec, Med Asst) salary of $40,271 plus 20% benefits for all tasks with 2080 hrs per year  = $23.23 per hour"]
[null,"CEO Salary and Benefits per hour","$78 /hr\n4 hours","Timeframe: JSI and ACU subject matter experts\n\nPay rate: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 ","$78/hr x 4 hours onboarding meetings and check-ins with new provider\n\nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77","4 hours: Annual median CEO salary of $94,500 plus 20% for benefits for all tasks with 2080 hrs per year = $54.52 per hour"]
[null,"CMO Salary and Benefits per hour","$182 /hr  \n10 hours","Timeframe: ACU and JSI subject matter experts\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm","$182/hr x 10 hours supporting onboarding and orientation of new provider, check-in meetings and mentoring or advising, etc. \n\nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Total Orientation Costs",null,null,"Sum D16"]
["17. Cost of Productivity lost to startup","Cost of Productivity lost to startup"]
[null,"Average # patients per day by leaving provider","12 visits per day","UDS Data Table 5 (2021)\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","Estimate from national data:\nUDS Table 5 (2021) Staffing and Utilization Line 8 \"Total Physicians\" \nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021\nTotal Clinic Visits + Virtual Visits divided by total FTEs = \n2750 patients per annual FTE divided by 250 working days per year (5 days per week x 48 work weeks) = 12 patient visits per day. ","You likely have your actual average patient visits per provider per day figure or can derrive it from your health center's records or using your Data Profile Dashboard, annually updated by ACU's STAR2 Center and JSI: https://chcworkforce.org/data-dashboards-login/  "]
[null,"Average revenue/collections per visit with leaving provider","$205 per visit","UDS Data Tables, Community Health Centers, Expanded Summaries of UDS Data Tables 2021\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national","Average revenue per patient visit (virtual and in-clinic, all specialties) = $205\n(2021 UDS Table 9D: Patient Related Revenue, Collections, Line 14, total for \"Amount Collected This Period\" [total revenue collected = $25,345,338,569] divided by 2021 UDS Table 5: Staffing and Utilization, Personnel by Major Service Category, Line 34, total for \"Grand Total\" Clinic + Virtual visits [total patient visits = 124,211,391]. \nUDS Table 9D (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=9D&year=2021\nUDS Table 5 (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","You may be able to derrive these numbers (or already have them available) from your health center's billing data. "]
[null,"Month 1 reduction factor","75% Reduction (3 patient visits per day)","Estimate from JSI subject matter expert","First month loss of revenue = average standard collections minus revenue generated by new provider.\n\nFirst month of work a new provider will likely be less productive in patient visits and revenue generation as they learn the systems, develop a routine, and take time to do trainings, attend meetings, and other onboarding/orientation activities.","These reduction factors for provider productivity will vary widely between providers. Those with significant previous experience may ramp up faster, or they may take longer time to get accustomed to a new system. Usually, it is estimated that new employees need about 6 months to fully onboard, and will not attain peak productivity for approximately the first year of employment. "]
[null,"Months 2 and 3 reduction factor","50% Reduction (6 patient visits per day)","Estimate from JSI subject matter expert","Standard collections – new provider revenue = revenue loss to ramp up."]
[null,"Months 4 - 6 reduction factor","30% Reduction (8 patient visits per day)","Estimate from JSI subject matter expert","Standard collections – new provider revenue = revenue loss to ramp up."]
[null,"Months 7 - 12 reduction factor","20% Reduction (10 patient visits per day)","Estimate from JSI subject matter expert","Standard collections – new provider revenue = revenue loss to ramp up."]
[null,"Cost of Lost Productivity - Month 1","12 x 20 x 205 x 0.75","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 75%"]
[null,"Cost of Lost Productivity - Months 2 and 3","12 x 40 x 205 x 0.5","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 50%"]
[null,"Cost of Lost Productivity - Months 4 - 6","12 x 60 x 205 x 0.3","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 30%"]
[null,"Cost of Lost Productivity - Months 7 - 12","12 x 120 x 205 x 0.2","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 20%"]
[null,"Total Cost of Productivity lost to startup",null,null,"Sum D17 (Lost Productivity)"]
["D.  Total New Hire/Onboarding Costs",null,null,null,"Sum D-12, -13, -14, -15, -16, & -17"]

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["Methodology, estimates, and sources."]
["Tangible Costs","Inputs","National Estimate ","Reference","Calculation","Assumptions"]
["A. Termination Costs"]
["1. Human Resources and/ or Business Office Expense for terminating benefits, COBRA adminstration (if applicable), notifying health plans of provider change in status.","HR/Business Office Hourly Rate plus benefits","$42 per hour\n16 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts","Hourly Salary/Benefit Rate:\n\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 1, 11: Employer Benefits Overhead = 38% for state/local government; 31% for civilian employees = 34.5% mean overhead. Healthcare and social assistance industry: Management, professional, and related occupations - $54.10 mean total hourly compensation cost (incl benefits). Sales and office occupations - $30.22. Office and administrative support occupations - $28.68. Estimate average HR hourly cost: $38.  \n_____\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resources Workers) mean hourly wage $34.24. Total employer cost = $34.24 + 34.5% overhead = $46/hr total cost. \n________\nFinal estimate: $42/hr average total cost for general HR/office activities ","Estimating for combined work from a variety of HR and business office personnel, including supervisors, entry-level staff, and mid-level staff. \n\"National Estimate\" hourly cost value is inclusive of benefits and other overhead for full-time staff. \n\nTime input from HR/office staff to complete termination of employee based on input from HR professional subject matter expert. Inclusive of time for \"deactivating access rights and passwords,  turning in equipment and conducting exit interviews to gather feedback.\"\n\nNOTE: Time to process termination of an employee who was fired/released involuntarily or who quit with less than two weeks notice may be longer, and therefore more costly. "]
["2. Estimated cost of a Locums Tenens or other part time provider","Locum Tenens Expense"]
[null,"Daily locum tenens rate","$708 per day","Nurse Practitioner National Average Locum Tenens Salary: $160,000/yr / 2080 hours FTE = $77/hr \n\nhttps://www.glassdoor.com/Salaries/locum-tenens-nurse-practitioner-salary-SRCH_KO0,31.htm\n\nPhysician Assistant Average Locum Tenens Salary: $207,000/yr = $100/hr\n\nhttps://www.ziprecruiter.com/Salaries/Locum-Tenens-Physician-Assistant-Salary\n\n[Note: Similar pay rates reported here: https://comphealth.com/resources/locum-tenens-pay-nps-pas/ ]","National Average Locum Tenens Pay:\nNurse Practitioner = $77/hr x 8hr/day = $616/day\n\nPhysician Assistant: $100/hr x 8 hr/day = $800/day\n\nAverage of NP + PA /2 = $708/day","Note: Locum tenens rates for NPs and PAs can vary significantly by state and by contracting organization or individual. "]
[null,"Estimated length of vacancy","120 working days at 5 days per week for 6 months","Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx October 2015\n\nhttps://apploi.com/blog/hiring-tips/average-time-to-hire-in-healthcare/\n\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","120-280 days depending on specialty\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","There is little research or information available on vacancy periods and time-to-fill PA and NP positions compared to physician specialties. \n\nMuch of the data available on physician specialty vacancies is from pre-Pandemic periods. There is also a large variation in average times between specialties (sometimes more than 100 days), and data are not usually broken down by state or region. Basing this timeframe off of your Health Center's prior time-to-fill durations will provide a much more accurate result. "]
[null,"Travel Expense",330,"US Dept of Transportation\nhttps://www.transtats.bts.gov/averagefare/\n","National average for cost of a domestic round-trip ticket as of Q1 2022","The Bureau of Transportation Statistics updates flight cost averages quarterly and they can be narrowed based on airport, so you can find and insert your local major airport's average costs \nhttps://www.transtats.bts.gov/averagefare/"]
[null,"Housing Expense","$1350 per month","Averages by state\nhttps://worldpopulationreview.com/state-rankings/average-rent-by-state\n\nNational Averages by apartment size\nhttps://www.statista.com/statistics/1063502/average-monthly-apartment-rent-usa/","$1350 per month x 6 months length of vacancy = $8100\n\nBased on one bedroom apartment (National Average $1129/mo) plus 20% increase for security deposit and 6-month shortened lease. Multiplied by average position vacancy of 180 days (6 months). ","These two sites can be used to update predicted costs based on your state and the size of apartment:\nAverages by state\nhttps://worldpopulationreview.com/state-rankings/average-rent-by-state\n\nNational Averages by apartment size\nhttps://www.statista.com/statistics/1063502/average-monthly-apartment-rent-usa/\n\nWorking with a local apartment complex to provide safe, secure housing may also give your health center the opportunity to lease an apartment for locum tenens staff at a reduced rate. "]
[null,"HR/Business Office Hourly Rate plus benefits","$42 /hr\n20 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts\n\nFor detailed salary calculations, see HR/Business Office calculations above (A-1)","$42/hr x 20 hrs\n\nOnboarding of locum tenens employee, including negotiations with locum agency or freelance employee, credentialing, other basic onboarding, etc. ","The amount of time needed to onboard temporary staff will depend on several factors, including any contracting company the health center works with (as opposed to hiring a freelance locum physician) and what administrative burdens the contractor covers versus the health center (insurance, housing, travel, etc). There will be significant time saved as most locum tenens employees will not be receiving benefits through the health center like insurance, retirement, etc. Activities like license verification will likely still be required, however. "]
[null,"Leaving Provider Total Salary and Benefits for Length of Vacancy",77000,"Phys Assistant salary report - Medscape 2022\nhttps://www.medscape.com/slideshow/2022-compensation-physician-assist-6015298\n\nAPRN salary report - Medscape 2021\nhttps://www.medscape.com/slideshow/2021-aprn-comp-report-6014632\n\nBureau of Labor Statistics March 2022 Compensation Report (pg 5) https://www.bls.gov/news.release/pdf/ecec.pdf","Medscape APRN Salary Report: Average for 2019 and 2020 NP income for non-hospital and community health clinic settings: $111,000/yr \n\nMedscape PA Salary Report: $121,000 (Family Medicine 2021)\n\nEmployer overhead and benefits: 32%\n\nAverage NP + PA /2 + 32%  = $153,000\n\nEstimated length of vacancy: 120 working days (6 months) = $77,000","Remember to factor in any bonuses or incentives that would add to this number. "]
[null,"Total Locum Tenens Expense",null,null,"Sum Locum Expenses - Leaving Provider Expenses"]
["3. Malpractice tail coverage costs, if any ","Malpractice Tail Costs (if any)",3000,"American Academy of Physician Associates\n\nhttps://www.aapa.org/news-central/2020/12/what-pas-need-to-know-about-malpractice-insurance/","PA malpractice insurance costs are usually higher than NP premiums, but annual premiums for both types of providers can range from under $1000 per year to over $8000 per year depending on specialty. $3000 is likely a hiigher end of the family medicine range. \nhttps://www.aapa.org/news-central/2020/12/what-pas-need-to-know-about-malpractice-insurance/","If there are other NPs or PAs already working at your Health Center, a more precise figure for your health center's costs for these provider's malpractice premiums can likely be easily obtained. "]
["A. Total Termination Costs",null,null,null,"Sum of A-1, -2, & -3"]
["B. Replacement Costs"]
["4. Advertising Costs","Advertising Costs",14550,"UHC Solutions, quoting a Merritt Hawkins whitepaper = $25,000 for \"Agency or in-house recruiter\" + $3000 for marketing and incidentals\nhttps://www.uhcsolutions.com/whats-the-average-cost-per-hire-for-physicians/\nhttps://www.merritthawkins.com/uploadedFiles/merritthawkins_physicianvacancy_whitepaper_2018.pdf\n\nIdealist.org rates\nhttps://www.idealist.org/en/help/how-much-does-it-cost-to-post-listings-on-your-site\n\nGlassdoor summary of major online job posting platform costs\nhttps://www.glassdoor.com/employers/blog/how-much-it-costs-to-post-a-job-online/\n\nBreakdown on ad spending, including radio and TV media options\nhttps://hubbardchicago.com/how-much-should-you-spend-on-recruitment-ads/","Based on Glassdoor cost estimates for largest hiring sites (https://www.glassdoor.com/employers/blog/how-much-it-costs-to-post-a-job-online/):\nZip Recruiter = $250/month\nIdealist = $105-195/month\nWorkable = $100/month\nCraigslist = $75/month\nCareerBuilder = $300/month\nMonster = $250/month\nIndeed/Glassdoor = \"pay per click\" rates ($.10 - $5 per click)\nLinkedIn = \"pay per click rates\"\nEstimated $250/month budget for LinkedIn and Indeed each\nTotal = $1675/month x6 months = $10,050\n\nAdded additional budget for specific ads in professional publications and on occupation-specific recruiting sites (3 publication or recruiting sites at $500/month each x 3 months ea = $4500\n\nTotal = $14550","Tracking results from different job posting and recruitment platforms (cost, time to receive applications, number of interviews/hires from each outlet) is invaluable and over time will help you reduce recruiting costs by tailoring your postings to only those sites that generate candidates that move to the interview process. \n\nAlso remember that a well-written job posting (clear, accurate, listing salary ranges and the benefits of working at your health center, and mission-forward) is worth any amount of staff time involved in writing, editing, and perfecting. The job posting itself is probably more important than any one outlet it might be posted to or printed in. "]
["5. Pre-Interview Staff Time -  to arrange advertising; accept, sort and document applications (written and electronic);  respond to telephone and written inquiries, arrange visits including logistics (hotel, travel, recruitment dinner), schedule telephone interviews and meetings with medical director, other staff involved in the decision process.","Pre-Interview Staff Time"]
[null,"HR Staff Salary and Benefits per hour","$42 /hr \n60 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts\n\nFor detailed salary calculations, see HR/Business Office calculations above (A-1)","$42/hr (HR management staff rate + benefits) x 60 hours for staff time arranging and tracking advertising; accepting, sorting, and tracking applications; arranging candidate interview logistics, including visits (hotel, travel, etc); coordinating with other personnel involved in recruitment process (CEO, medical director, etc). \n"]
[null,"Support Staff Salary and Benefits per hour","$29 /hr\n40 hours","Office support staff\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000","$29/hr (HR Support staff + benefits) x 40 hours supporting HR staff activities invovled with recruitment, processing applications, and arranging interview logistics. \n\nOffice support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\nHR Assistants $21.94 + 31% benefits/overhead = $28.74"]
[null,"CEO Salary and Benefits per hour","$78 /hr\n10 hours","Salary: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n\nTimeframe: JSI and ACU subject matter experts","$78/hr x 10 hours developing position advertising materials, job descriptions, phone interviews.\n\nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77"]
[null,"CMO Salary and Benefits per hour","$182 /hr\n24 hours","Salary: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n\nTimeframe: ACU and JSI subject matter experts","$182/hr x 24 hours developing position advertising materials, job descriptions, phone interviews.\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Total Pre-Interview Staff Time",null,null,"Sum B5"]
["6. Professional Recruiting Service Expenses","Recruiting Service Cost",8700,"Recruiting Service cost estimate:\nhttps://eddy.com/hr-encyclopedia/recruitment-fees/","15% x average non-physician provider salary (per month) x 6 months of recruiting work by recruiting company. ","Note, various outside recruiters have different fee structures, including some that only pay when a candidate is interviewed or hired. Carefully select one if you plan to use external recruiters, and be sure to choose a fee structure that is beneficial to your health center. "]
["7. Interview Staff Expenses","Interview Staff Expenses"]
[null,"HR Staff Salary and Benefits per hour","$42 /hr \n80 hours","Salary:\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTime estimate: JSI and ACU subject matter experts","$42/hr x 80 hours\nFour in-person interviews at 20 hours per interview","The amount of interview preparation and review, as well as number of HR staff and other staff involved, will greatly affect these costs. "]
[null,"Support Staff Salary and Benefits per hour","$29 /hr\n40 hours","Office support staff salary estimates:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\n\nTime estimate: JSI and ACU subject matter experts","$29/hr (HR Support staff + benefits) x 40 hours supporting HR staff activities invovled with arranging and carrying out four in-person interviews. \n\nOffice support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\nHR Assistants $21.94 + 31% benefits/overhead = $28.74"]
[null,"CEO Salary and Benefits per hour","$78 /hr\n32 hours","Salary: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n\nTimeframe: JSI and ACU subject matter experts ","$78/hr x 32 hours supporting and taking part in in-person interviews, interview meals, etc.\n\nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77"]
[null,"CMO Salary and Benefits per hour","$182 /hr\n48 hours","Salary: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n\nTimeframe: ACU and JSI subject matter experts ","$182/hr x 48 hours supporting and taking part in in-person interviews, crafting interview questions and activities, hosting interview meals, etc..\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Total Interview Staff Expenses",null,null,"Sum B7"]
["8. Interview Direct Costs (on-site face-to-face interview visits)","Interview Direct Costs (Non-staff)"]
[null,"Travel Expense per interview","$330 per interview","USDOT https://www.transtats.bts.gov/averagefare/","3 candidate face-to-face interviews; 1 repeat interview for final candidate; Total of 4 on-site interviews\n\nNational average for cost of a domestic round-trip ticket as of Q1 2022\nhttps://www.transtats.bts.gov/averagefare/","This number may increase if you opt to pay for a spouse to accompany the candidate or if there are no major airports located near your health center (flights into smaller local or regional airports are often more costly); it may decrease if the candidate lives within driving distance. "]
[null,"Hotel Expense per night","$220 per night x 2 nights per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","Average between all 12 months listed for lodging rates for Washington, DC on US General Services Administration site (for US fiscal year 2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=\n\n2 nights per interview for 3 candidate face-to-face interviews; 1 repeat interview for final candidate; Total of 4 on-site interviews","Rates will vary depending on time of year, hotel options available, and general cost profile in your part of the country."]
[null,"Number of people included in interview dinner, per interview","10 people per interview","JSI subject matter expert","CEO couple, CMO couple, MD in same specialty couple, HR/in-house recruiter couple, Candidate couple","Offering to pay for child care during the interview activities--including dinner and other outings--could be a good incentive to interview if the candidate has children. "]
[null,"Interview Dinner Cost per person per interview, including tax and gratuity","$360 per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","GS per diem rate (dinner) for Washington, DC 2023 Fiscal Year https://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=\n\n$36 per person x 10 people per interview x 4 interviews","Remember to budget for tax and tip (usually 20% for parties of 6 or more). This suggested figure is an estimate inclusive of tax and tip based on US government per diem rates for Washington, DC for the 2023 fiscal year. "]
[null,"All Staff breakfast with candidate per interview","$360 per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","Estimate for cost of all-staff continental breakfast based on GSA 2023 per diem of $18 per person x 20 people x 4 interviews","A basic continental style breakfast will likely be more economical, though costs can quickly add up for large staff—but it is important for workplace solidarity and showing candidates a commitment to \"community\" to involve all staff in this process and allow them to meet candidates. "]
[null,"CMO lunch with candidate per interview","$60 per interview x 4 interviews","US GSA Per Diem Rates (2023)\nhttps://www.gsa.gov/travel/plan-book/per-diem-rates/per-diem-rates-results/?action=perdiems_report&state=DC&fiscal_year=2023&zip=&city=","GSA per diem (Lunch) for 2023 FY x 3 (candidate + 1 guest and CMO) x 4 interviews","Remember to budget for tax and tip. Bringing candidates to a \"local\" spot can be a good way to avoid more costly options and provide a candidate exposure to the community where they will be working/living. "]
[null,"Cost of other interview items, such as gift baskets, baby sitting service","$150 per interview x 4 interviews","JSI subject matter expert","Cost of other interview items, like gift basket and child care during interviews, etc","Gift baskets do not have to be expensive or elaborate, they can include branded items (like coffee mugs or other promotional items with your health center's logo) and/or some local items from community shops or attractions. Childcare during interview activities can be very expensive, and should be provided through a vetted and trusted provider. "]
[null,"Total  Direct Costs (Non-staff)",null,null,"Sum B8"]
["9. Post Interview Expenses - staff time for negotiation, other hiring expenses","Post-Interview Expenses"]
[null,"HR Staff Salary and Benefits per hour","$42 /hr \n16 hours","Pay rate: \nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)\n\nTimeframe: ACU HR subject matter expert","16 hours negotiation, contracts, processing signing bonus & relocation expenses","This cost could be much higher if consultation with staff legal counsel or special work for licensure verification or transfer is required. "]
[null,"CEO Salary and Benefits per hour","$78 /hr \n4 hours","Timeframe: JSI and ACU subject matter experts\n\nPay rate: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 ","4 hours negotiation and contracting + contract review and approval\n\nPay rate: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77"]
[null,"CMO Salary and Benefits per hour","$182 /hr \n4 hours","Timeframe: ACU and JSI subject matter experts\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm","4 hours Q&A + check-ins during onboarding (and preferably again during 30-, 60-, and 180-day onboarding and stay interviews). \n\nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Signing Bonus",7000,"Merritt Hawkins Incentive Review 2021\nhttps://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdf","Based on Nurse Practitioner average signing bonus reported by Merritt Hawkins Incentive Review 2021.\nMerritt Hawkins Incentive Review 2021\nhttps://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdf\nAverage Column By Specialty (pg 17)\nNurse Practitioner $6,939 \nFamily Medicine  $34,644 \nRadiology $23,235 \nPsychiatry $33,260 \nInternal Medicine $22,861 \n\nMedscape Annual Physician Compensation Report (2022) https://www.medscape.com/slideshow/2022-compensation-overview-6015043\nAverage Incentive Bonus (NO signing bonus statistics given) = $30k for Family Med; $28k Peds, $49k OBGYN\n","This is potentially a low estimate. Especially in the southern US and in more rural areas, signing bonuses for physicians and non-physician providers may be much higher due to competition, and may include additional annual incentives like CME compensation, and/or student loan repayment compensation. "]
[null,"Relocation Costs",10000,"Merritt Hawkins Incentive Review 2021\nhttps://www.merritthawkins.com/uploadedFiles/physician-advanced-practitioner-incentive-review-2021.pdf","Average relocation allowance in 2020/2021"]
[null,"Total Post-Interview Expenses",null,null,"Sum B9"]
["B. Total Replacement Costs",null,null,null,"Sum of B-4, -5, -6, -7, -8, & -9"]
["C.Net Impact to Revenue"]
["10. Revenue Loss from Leaving Provider","Revenue Lost"]
[null,"Estimated length of vacancy","120 working days (~6 months)","Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx October 2015\n\nhttps://apploi.com/blog/hiring-tips/average-time-to-hire-in-healthcare/\n\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","120-280 days depending on specialty\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","Time-to-fill data is scarce for non-physician practitioners, so estimates are primarily based on the data for physicians. Much of the data available is from pre-Pandemic periods. There is also a large variation in average times between specialties (sometimes more than 100 days), and data are not usually broken down by state or region. Basing this timeframe off of your Health Center's prior time-to-fill durations will provide a much more accurate result."]
[null,"Average # patients per day by leaving provider","11 visits per day","UDS Data Table 5 (2021)\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","UDS Table 5 (2021) Staffing and Utilization Line 10a \"Total NPs, PAs, and CNMs (Lines 9a–10)\" \n**FTE and Patient Visit numbers for Certified Nurse Midwives were subtracted out since CNMs saw far fewer patients per FTE, likely because of increased time spent on patient counseling and other aspects specific to the OBGYN field, as well as far fewer virtual patient visits contributing to total patient load per FTE. [Average annual patient visits per day for CNMs in 2021 was 7.9]\n\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021\n\nTotal Clinic Visits + Virtual Visits divided by total FTEs = \n2507 patients per annual FTE divided by 230 working days per year (5 days per week x 48 work weeks - 10 holidays) = 11 patient visits per day. ","This number is a reflection of a national average, but average patient visits per provider per day vary widely by health center and even individual provider. For non-physician providers, the effect of a vacancy on patient visit counts and revenue will also depend on how the practice is arranged (ie: does the PA or NP practice largely independently or are they largely under the physician's direction?). "]
[null,"Average revenue/collections per visit with leaving provider","$205 per visit","UDS Data Tables, Community Health Centers, Expanded Summaries of UDS Data Tables 2021\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national","Average revenue per patient visit (virtual and in-clinic, all specialties) = $204\n(2021 UDS Table 9D: Patient Related Revenue, Collections, Line 14, total for \"Amount Collected This Period\" [total revenue collected = $25,345,338,569] divided by 2021 UDS Table 5: Staffing and Utilization, Personnel by Major Service Category, Line 34, total for \"Grand Total\" Clinic + Virtual visits [total patient visits = 124,211,391]. \nUDS Table 9D (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=9D&year=2021\nUDS Table 5 (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","This is an average based on the total national revenue of health centers (excluding lookalikes) divided by the total national patient visits for every health center (inclusive of all specialties and of patients who are unable to pay and are uninsured). This number might be significantly higher or lower for a specific provider type in your health center. For non-physician providers, as noted above, the impact of a vacancy to revenue will likely depend partly on how the practice is organized and the level of independent practice afforded to the leaving provider. "]
[null,"Total Revenue Lost",null,null,"Gross visits X Collections per visit \n($205 per visit x 11 visits per day x 120 working days)"]
["11. Revenue Recovered from Locum Tenens","Revenue Recovered"]
[null,"Estimated length of vacancy","120 working days (6 months)","Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx October 2015\n\nhttps://apploi.com/blog/hiring-tips/average-time-to-hire-in-healthcare/\n\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","120-280 days depending on specialty\nhttps://www.medicaleconomics.com/view/physician-hiring-how-long-it-takes-fill-positions-10-specialties?page=2","Time-to-fill data is scarce for non-physician practitioners, so estimates are primarily based on the data for physicians. Much of the data available is from pre-Pandemic periods. There is also a large variation in average times between specialties (sometimes more than 100 days), and data are not usually broken down by state or region. Basing this timeframe off of your Health Center's prior time-to-fill durations will provide a much more accurate result. "]
[null,"Visits per day by locum tenens","7  visits per day","JSI subject matter expert. \n\nBarton and Associates Discussion of Lcoum Tenens to Supplement Staff or fill vacancies to increase productivity\nhttps://www.bartonassociates.com/blog/improving-healthcare-staffing-roi-with-locum-tenens-providers/","JSI subject matter expert assumes 25% to 50% loss of productivity due to lack of patient familiarity with a locum tenens physician, as well as the temporary physician's lack of familiarity with the organization, staff, and processes. \n\nBarton and Associates Discussion of Lcoum Tenens to Supplement Staff or fill vacancies to increase productivity\nhttps://www.bartonassociates.com/blog/improving-healthcare-staffing-roi-with-locum-tenens-providers/","Bringing in temporary support may not be as productive in patient care or revenue generation as having a full-time permanent hire, but it can still reduce burnout and other detrimental effects from other staff having to take up the entire workload of a lost provider. "]
[null,"Average revenue/collections per visit with Locum Tenens","$205 per visit","UDS Data Tables, Community Health Centers, Expanded Summaries of UDS Data Tables 2021\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national","Average revenue per patient visit (virtual and in-clinic, all specialties) = $204\n(2021 UDS Table 9D: Patient Related Revenue, Collections, Line 14, total for \"Amount Collected This Period\" [total revenue collected = $25,345,338,569] divided by 2021 UDS Table 5: Staffing and Utilization, Personnel by Major Service Category, Line 34, total for \"Grand Total\" Clinic + Virtual visits [total patient visits = 124,211,391]. ","There may be a loss of revenue per patient visit due to a temporary provider being less likely to order labs or other procedures that add to revenue, but there is no current literature directly examining if this loss exists, and if so, how great a loss it is. Likely, in most out-patient clinics, the primary loss will be due to lower patient visit rates. "]
[null,"Total Revenue Recovered",null,null,"7 visits per day x $205 per visit average revenue x 120 working day vacancy"]
["C. Total Net Impact to Revenue [Recovered - Loss]",null,null,null,"Total Revenue Recovered - Total Revenue Lost"]
["D.  New Hire/Onboarding Costs"]
["12. Payroll startup, Benefit Enrollment, establish passwords,email account ","HR Hourly Rate plus benefits","$42 /hr\n4.5 hours","JSI subject matter expert","Hourly Salary/Benefit Rate X 4.5 hours","Payroll and benefit enrollment, email account and password setup"]
["13. Credentialing services cost (internal or Credentialing Verification Organization (CVO))","Business Office Hourly Rate plus benefits","$42 /hr\n16 hours","JSI and ACU HR subject matter experts\n\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)","Time estimate (based on input from HR professional subject matter expert): 16 hours\n\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 1, 11: employer benefits overhead = 38% for state/local government; 31% for civilian employees = 34.5% mean overhead. Healthcare and social assistance industry: Management, professional, and\nrelated occupations - $54.10 mean total hourly compensation cost (incl benefits). Sales and office occupations - $30.22. Office and administrative\nsupport occupations - $28.68. Estimate average HR hourly cost: $38.  \n_____\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resources Workers) mean hourly wage $34.24. Total employer cost = $34.24 + 34.5% overhead = $46/hr total cost. \n________\nFinal estimate: $42/hr average total cost for general HR/office activities","The time and cost of credential verification may vary; transfer of credentials from another state may increase the time and could incur additional expense depending on licensure requirements of your state for the provider license type. "]
["14. Internal and external publicity announcements ","Publicity Cost",250,"JSI subject matter expert estimate",null,"This cost will vary widely depending on what type of publicity your health center engages in for a newly hired clinician. Simply an announcement on the health center website, for instance, will be a negligible expense, but an advertisement in one or more local newspapers may be more. "]
["15. Equipment and Uniform expense ","Cell phone and lab coat cost","$180 (two lab coats with embroidery)","Embroidery Cost for two lab coats = $40\nhttps://sayitinstitches.com/price-list/\n\nTwo lab coats = $140 total\nhttps://www.uniformadvantage.com/","$140 for uniforms/lab coats + $40 for embroidering with health center logo, practitioner name","This cost assumes recurring cost items—like a provider cell phone—are factored into employer overhead for benefits and pay. "]
["16. Orientation Costs","Orientation Costs"]
[null,"HR Hourly Rate plus benefits","$42 /hr \n8 hours","JSI and ACU HR subject matter experts\n\nBureau of Labor Statistics\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022 pg 1, 11\n\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resource Workers)","Time estimate (based on input from HR professional subject matter expert): 8 hours\n\nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 1, 11: employer benefits overhead = 38% for state/local government; 31% for civilian employees = 34.5% mean overhead. Healthcare and social assistance industry: Management, professional, and\nrelated occupations - $54.10 mean total hourly compensation cost (incl benefits). Sales and office occupations - $30.22. Office and administrative\nsupport occupations - $28.68. Estimate average HR hourly cost: $38.  \n_____\nhttps://www.bls.gov/oes/current/oes_nat.htm#13-0000\nOccupation Code: 13-1070 (Human Resources Workers) mean hourly wage $34.24. Total employer cost = $34.24 + 34.5% overhead = $46/hr total cost. \n________\nFinal estimate: $42/hr average total cost for general HR/office activities"]
[null,"IT Hourly Rate plus benefits","$38 /hr \n8 hours","Time estimate: JSI and ACU HR Subject matter experts\n\nSalary: \nhttps://www.bls.gov/oes/current/oes_nat.htm#15-0000\n15-1230 Computer Support Specialists\n\nBenefits Cost:\nhttps://www.bls.gov/news.release/pdf/ecec.pdf \n2022 pg 11","Time based on input from HR subject matter experts: 8 hours for onboarding and tech setup.\n\nSalary: $29.11/hr (mean hourly salary)\nhttps://www.bls.gov/oes/current/oes_nat.htm#15-0000\n15-1230 Computer Support Specialists\n\nBenefits Cost: 30%\nhttps://www.bls.gov/news.release/pdf/ecec.pdf \n2022 pg 11\n\nTotal Cost for employer: $37.84/hr"]
[null,"Other Providers Average Hourly Rate plus benefits","$74 /hr \n6 hours","Time estimate: JSI and ACU HR Subject matter experts\n\nPhys Assistant salary report - Medscape 2022\nhttps://www.medscape.com/slideshow/2022-compensation-physician-assist-6015298\n\nAPRN salary report - Medscape 2021\nhttps://www.medscape.com/slideshow/2021-aprn-comp-report-6014632\n\nBureau of Labor Statistics March 2022 Compensation Report (pg 5) https://www.bls.gov/news.release/pdf/ecec.pdf","6 hours assisting with orienting new hire and providing peer mentorship and support during onboarding process. \n\nMedscape APRN Salary Report: Average for 2019 and 2020 NP income for non-hospital and community health clinic settings: $111,000/yr \n\nMedscape PA Salary Report: $121,000 (Family Medicine 2021)\n\nEmployer overhead and benefits: 32%\n\nAverage NP + PA /2 + 32%  = $153,000\n\n$153,000 / 2080 hours (one FTE) = $74/hr cost incl benefits/overhead"]
[null,"Nurse/MA Hourly Rate plus benefits","$53 /hr \n20 hours","JSI and ACU HR Subject matter experts\n\nRegistered Nurse Hourly Rate: $40/hr\nhttps://www.bls.gov/oes/current/oes_nat.htm#29-0000\nLine 29-1141 (mean hourly salary)\n\nMedscape RN/LPN Salary Report 2021 = Avg $75,000/yr or $36/hr (for non-hospital clinic staff RNs)\nhttps://www.medscape.com/slideshow/2021-rn-lpn-compensation-report-6014514#9\n\nBenefits Overhead for Registered Nurses: \nhttps://www.bls.gov/news.release/pdf/ecec.pdf\n2022, pg 11","$40/hr + 33% benefits cost = $53/hr x 20 hours supporting orientation and onboarding of new hire\n\n","There may be multiple support staff at various licensure levels supporting the onboarding process of a new provider. This estimate is based on an approximation of the collective time spent amongst these staff. "]
[null,"Support Staff  Hourly Rate plus benefits","$29 /hr\n10 hours","Office support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\n","$29/hr x 10 hours supporting logistics of new provider orientation and onboarding (ex: medical reception, medical records and billing, etc)\n\nOffice support staff salary estimate:\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000\nHR Assistants $21.94 + 31% benefits/overhead = $28.74","10 hours: Annual median Support Staff (Med Recept, Med Rec, Med Asst) salary of $40,271 plus 20% benefits for all tasks with 2080 hrs per year  = $23.23 per hour"]
[null,"CEO Salary and Benefits per hour","$78 /hr\n4 hours","Timeframe: JSI and ACU subject matter experts\n\nPay rate: \nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 ","$78/hr x 4 hours onboarding meetings and check-ins with new provider\n\nMedical and Health Services managers (11-9111)\nhttps://www.bls.gov/oes/current/oes_nat.htm#43-0000 \n$57.61 + 35% overhead = $77.77","4 hours: Annual median CEO salary of $94,500 plus 20% for benefits for all tasks with 2080 hrs per year = $54.52 per hour"]
[null,"CMO Salary and Benefits per hour","$182 /hr  \n10 hours","Timeframe: ACU and JSI subject matter experts\n\nPay rate: \nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm","$182/hr x 10 hours supporting onboarding and orientation of new provider, check-in meetings and mentoring or advising, etc. \n\nChief Medical Officer national average pay 2021\nhttps://www.glassdoor.com/Salaries/chief-medical-officer-salary-SRCH_KO0,21.htm\n$280,000/yr divided by 2080 hours per year = $135/hr + 35% benefits/overhead = $182/hr"]
[null,"Total Orientation Costs",null,null,"Sum"]
["17. Cost of Productivity lost to startup","Cost of Productivity lost to startup"]
[null,"Average # patients per day by leaving provider","11 visits per day","UDS Data Table 5 (2021)\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","UDS Table 5 (2021) Staffing and Utilization Line 10a \"Total NPs, PAs, and CNMs (Lines 9a–10)\" \n**FTE and Patient Visit numbers for Certified Nurse Midwives were subtracted out since CNMs saw far fewer patients per FTE, likely because of increased time spent on patient counseling and other aspects specific to the OBGYN field, as well as far fewer virtual patient visits contributing to total patient load per FTE. [Average annual patient visits per day for CNMs in 2021 was 7.9]\n\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021\n\nTotal Clinic Visits + Virtual Visits divided by total FTEs = \n2507 patients per annual FTE divided by 230 working days per year (5 days per week x 48 work weeks - 10 holidays) = 11 patient visits per day. ","This number is a reflection of a national average, but average patient visits per provider per day vary widely by health center and even individual provider. "]
[null,"Average revenue/collections per visit with leaving provider","$205 per visit","UDS Data Tables, Community Health Centers, Expanded Summaries of UDS Data Tables 2021\nhttps://data.hrsa.gov/tools/data-reporting/program-data/national","Average revenue per patient visit (virtual and in-clinic, all specialties) = $205\n(2021 UDS Table 9D: Patient Related Revenue, Collections, Line 14, total for \"Amount Collected This Period\" [total revenue collected = $25,345,338,569] divided by 2021 UDS Table 5: Staffing and Utilization, Personnel by Major Service Category, Line 34, total for \"Grand Total\" Clinic + Virtual visits [total patient visits = 124,211,391]. \nUDS Table 9D (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=9D&year=2021\nUDS Table 5 (2021) https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2021","You may be able to derrive these numbers (or already have them available) from your health center's billing data. "]
[null,"Month 1 reduction factor","75% Reduction (~3 patient visits per day)","Estimate from JSI subject matter expert","First month loss of revenue = average standard collections minus revenue generated by new provider.\n\nFirst month of work a new provider will likely be less productive in patient visits and revenue generation as they learn the systems, develop a routine, and take time to do trainings, attend meetings, and other onboarding/orientation activities.","These reduction factors for provider productivity will vary widely between providers. Those with significant previous experience may ramp up faster, or they may take longer time to get accustomed to a new system. Usually, it is estimated that new employees need about 6 months to fully onboard, and will not attain peak productivity for approximately the first year of employment. "]
[null,"Months 2 and 3 reduction factor","50% Reduction (~6 patient visits per day)","Estimate from JSI subject matter expert","Standard collections – new provider revenue = revenue loss to ramp up."]
[null,"Months 4 - 6 reduction factor","30% Reduction (8 patient visits per day)","Estimate from JSI subject matter expert","Standard collections – new provider revenue = revenue loss to ramp up."]
[null,"Months 7 - 12 reduction factor","20% Reduction (~9 patient visits per day)","Estimate from JSI subject matter expert","Standard collections – new provider revenue = revenue loss to ramp up."]
[null,"Cost of Lost Productivity - Month 1","11 x 20 x 205 x 0.75","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 75%"]
[null,"Cost of Lost Productivity - Months 2 and 3","11 x 40 x 205 x 0.5","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 50%"]
[null,"Cost of Lost Productivity - Months 4 - 6","11 x 60 x 205 x 0.3","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 30%"]
[null,"Cost of Lost Productivity - Months 7 - 12","11 x 120 x 205 x 0.2","Estimate from JSI subject matter expert","Visits/Day x Working Days x Revenue x 20%"]
[null,"Total Cost of Productivity lost to startup",null,null,"Sum D17 (Lost Productivity)"]
["D.  Total New Hire/Onboarding Costs",null,null,null,"Sum D-12, -13, -14, -15, -16, & -17"]

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[null,"Notes:\n\nThis tool was developed by John Snow, Inc. for the STAR2 Center. This tool was last updated by STAR2 Center staff December 2022.\n\nThe final tool builds upon the work conducted by Holton Healthcare Consulting, Raleigh, NC and the National Association of Community Health Centers (Calculating the Cost of Turnover in Your Health Center: A Guide).\n\nThe information provided in this worksheet is intended for making estimates of the costs related to the loss of an existing provider and the recruitment and onboarding of a new provider as a replacement.\n\nThe termination costs are for providers leaving of their own accord, not providers being terminated by the organization. Terminating a provider can incur a variety of costs and is difficult to estimate in a generalized way, but could include paying out some remaining portion of a contract, maintaining certain benefits for a period of time, or even legal fees depending on circumstances, local, state, and federal laws. These costs can be estimated by organizations on a case-by-case basis. \n\nNational estimates are provided for convenience and do not differentiate by region, provider specialty, or certain other variations. They are averages or estimates based on available national or other generalizable data.\n\nThe national estimates assume previously budgeted items—such as accrued vacation and final retirement contributions—are not additional costs, but have already been accounted for in the existing CHC budget. Additional benefit extensions negotiated as part of the separation are also not included in these calculations.\n\nSeveral of the national estimates are based solely on physician data and may or may not be significantly different for non-physician providers. These include length of vacancy and locum tenens cost, among others. Please be aware that there are likely differences in these national estimates as compared to actual figures for non-physician providers, but reliable data are sparse or nonexistent with respect to these provider types.\n\nThere are frequently intangible costs associated with the loss of a provider, such as the cost to have existing providers absorb patient visits while maintaining their own practice, which could decrease productivity. \n\nWhile staff time may already be included as part of the health center budget and does not appear to be an additional cost, frequent vacancies can increase the need for more staff, or require significant overtime input from current staff. In addition, there are opportunity costs: Using staff for recruiting means that they are not available for other job functions. Additional stress on staff can cause more turnover.\n\nUltimately, turnover costs are highly context dependent, but this tool will help with planning for foreseen and unforeseen turnover costs. \n"]
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[null,"A final note on calculating costs and adjusting for annual changes:\n\nWhile the STAR2 Center team updates this tool periodically, costs and salaries can fluctuate rapidly. References are listed for each cost estimate in the Physician and Non-Physician Details tabs; as many of these references as possible were drawn from materials that are updated annually, so users can fine tune their own cost estimates if these data are not available directly from their health center's records. Estimates can also simply be given approximate annual updates using annual inflation measures. \n\nInflation can be calculated here: \nhttps://www.usinflationcalculator.com/\n\nThe above calculator uses the Consumer Price Index data, available here: \nhttps://www.bls.gov/cpi/\n\nFor more information on calculating Cost per Hire, see: \nhttps://www.shrm.org/resourcesandtools/business-solutions/documents/shrm_ansi_cph_standard.pdf\n\n\n\n\n\n"]