Instructions for completing the Input data sheet
We suggest you print this sheet to have it available when completing the input data sheet.
1. Enrolled population
Enter the breakdown (by age and gender) for your enrolled population, according to the most recent capitation
quarterly PHO report. You should split the total by non-HUHC and HUHC card holders.
2. Practice cost data
Enter your practice overhead costs in the two cells shown. If you find it difficult to distinguish the two amounts
(admin overheads versus other overheads) then enter the total in one cell and set the other to 0.
3. Personnel cost data
Enter in the relevant cells the average number of paid leave hours per Full Time Equivalent GP & Nurse per year.
Include special leave or other leave in the sick leave total.
If your GPs are not paid leave (i.e. are on an hourly rate contract) then enter 0 in those cells.
Enter the average hourly wage rate for doctors and nurses. If you have staff on different rates (e.g. mix of locums
and permanent) then enter the approximate average rate.
4. Time (minutes per day) on non-billable activity
The purpose of this section is to estimate the amount of time spent on activities that are not billable; i.e. are not
part of a consultation or other billable activity.
You may find it easiest to estimate this by looking at the appointments for a typical week and estimating how much
time is reserved for non-consultation work, including meetings, telephone calls, filing results, writing referrals, etc?
This figure is likely to vary for nurses according to role. Please enter the average non-billable time across all
nursing roles.
The breakdown between the two categories (i.e. clinical and admin) is not essential - you can enter the total value
in one cell and "0" in the other if this is easier to work out.
As a guide, a recent survey found that nurses spent 32% of their time on administrative work (including telephone
calls) and GPs spent 20%.
5. Capitation data
If your practice is Very Low Cost Access then enter 'y", if not enter "n".
If you participate in the free under 6 policy enter "y", if not enter 'n'.
Enter your average clawback from capitation (resulting from your patients using other practices) as a percentage
of total monthly capitation payments. Capitation rates are those applying as at 1 July 2010.
6. Service activity data
6.1 Episodes / year
Enter the number of episodes of care (i.e. attendance/visits) per enrolled person for each service type. The model
differentiates general consults for those aged under 6, and those over 6; for all other service lines the rate should
be an average for all age groups. The sheet will use this rate to calculate the total number of visits. If you know
the total number of visits (e.g. for ACC) but not the rate per capita, then the model allows you to adjust the per
person rate until the total figure is correct.
The "Other Service Line" categories are there for you to use if you have important sources of activity based
revenue not listed. This might include, for instance, cellulitis contracts, sexual health consults or mental health
consults.
6.2 Activity Revenue
The activity revenue cells require an average total fee earned per episode calculation. Hence for ACC, as an
example, enter the total of the amount you would receive from ACC per visit plus the amount you would receive
from the patient.
The sheet automatically assumes a 10% average discount on the fee you put in the cell. The discount percentage
is adjustable.
Enter the fee for service amount excluding GST.
The "Both" column means the fee payable when the patient sees both the doctor and the nurse in one visit.
6.3 Activity allocation
For each type of service, estimate the proportion of the visits where the patient would see the nurse only, the
doctor only, or the nurse and the doctor. For repeat scripts enter the percentage of the time the script request
would be managed by the doctor alone and the percentage of the time the script request would be managed by
both the nurse (e.g. to prepare the script) and the doctor (to check and sign). The total must add to 100% across
the row, and the 'both' column must be greater than 0.
6.4 Time per episode (minutes)
Estimate the average minutes per consult/activity for each service line for GP consults, nurse consults and 'both'
consults.
6.5 Substitution impacts
These cells allow you to change the maximum number of consults that could possibly be managed by a nurse,
and the proportion of nurse consults that are likely to require doctor input (i.e. that turn into a 'both' consult). You
may wish to leave these at the default values.
Disclaimer
This model is intended to stimulate 'what if' scenario thinking among practice owners and primary care clinicians.
Like all models, it is a simplified version of reality. Hence the model outputs should not be relied upon solely to
make financial investment decisions or resource allocations decisions. You should seek professional advice
before making major decisions. LECG and the Ministry of Health accepts no liability for any losses or costs
incurred as result of decisions taken based on this model. We are happy to provide more in-depth assistance if
you wish to a more detailed options analysis.
For further information contact Martin Hefford, 0272949132, mhefford@lecg.com.
Notes
VLC = very low cost
MECA = Multi employment Collective agreement
HUHC = high use health card
Capitation = payment per capita
The password to unlock sheets is "oliver".
This sheet does not include rural roster subsidies, PHO performance programme payments or SIA or health
promotion revenue.
Maternity is assumed to be included in 'other'.
Further notes
These notes are intended to provide further guidance in the use of the financial model.
Non-billable activity: the minutes attributed to non-billable activity will have a major influence on your FTE
requirements and on the resulting profit/loss. You may only have a broad estimate of these parameters, and so we
suggest you adjust these values until the FTE and profit reflects your current actuals. GPs and other staff may be
doing additional non-paid hours in the evenings to catch up on paper work and filing results, etc. If you put in the
actual hours worked on average (including nonpaid admin hours), then the model will generate an FTE
requirement in excess of your current paid FTEs.
Time per episode: GP appointments are routinely scheduled for 15 minute slots, but people will often complete a
few extra consults during the day. If you tend to do one extra consult per hour then the actual average time per
consult is 12 minutes. If you wish to use GPs for many brief consultations to support an expanded nursing role, we
suggest setting the GP duration for 'both' to 5 minutes.
SIA & health promotion: these are not included because they are paid to the PHO, and may not be passed on to
the practice.
Commentary tab: this provides a summary analysis of where task substitution could be financially profitable.
Outputs will change if inputs change.
Population, practice, wage and activity data inputs
1. Enrolled population 2. Practice cost data Summary practice statistics
High Use Health Card Practice admin & support wages $200,000
Age Group Gender No Yes Non-wage practice overhead costs $200,000 Estimated Practice Profit & Loss
00-04 F 200 0 Revenue Total Per 1000
00-04 M 200 0 3. Personel cost data GP Nurse Capitation revenue 736,896 133,833
05-14 F 400 0 Sick leave hours /year/FTE 24 32 Activity revenue 771,078 140,041
05-14 M 400 0 Annual Leave hours /year/FTE 240 160 Total revenue 1,507,973 273,873
15-24 F 400 0 Continuing Education hours /year/FTE 80 24
15-24 M 400 0 MECA protected time hours /year/FTE 0 0 Expenditure
25-44 F 800 0 Statutory holidays hours /year/FTE 80 80 Nonwage overheads 200,000 36,323
25-44 M 800 0 Total paid nonpractice time per FTE 424 296 Admin personnel 200,000 36,323
45-64 F 600 1 Hourly rate $85.00 $29.50 Medical personnel 662,674 120,353
45-64 M 600 1 Wage cost increment CME/ACC/super 105% Nursing personnel 152,903 27,770
65+ F 400 2 Total costs 1,215,576 220,769
65+ M 300 2 4. Time (minutes/day) on non-billable activity
Total 5,500 6 Ave minutes by GP/nurse per day for GP Nurse Net profit (loss) 292,397 53,104
Total under 6 480 0 Clinical activity - nonbillable 60 100 Clinical staffing
Total 6 + 5,020 6 Practice managment & admin 30 60 GP Nurse
FTEs required 3.6 2.4
5. Capitation data
VLC access y/n? n
Free < 6 y/n? y
Capitation clawback % 2.50%
6. Service activity data 6.1 Episodes / year 6.2 Activity Revenue 6.3 Activity allocation 6.4 Time per episode (minutes) 6.5 Substitution impacts
Average income per episode % of time managed by Ratio of Nurse Maximum
Nurse Both - consults that require proportion of nurse
Service type total Per capita GP Nurse Both GP only Both GP only Nurse only Both - GP
only nurse GP input consults
General <6 consults <6 2,160 4.5 $0.00 $0.00 $0.00 80% 20% 0% 12.5 16.0 12.0 20.0 20% 50%
General 6+ consults 6+ 12,048 2.4 $30.00 $10.00 $30.00 80% 10% 10% 14.0 17.0 12.0 20.0 20% 50%
ACC all ages 2,750 0.5 $62.00 $25.00 $62.00 80% 20% 0% 14.0 16.0 12.0 20.0 20% 50%
Immunisations all ages 2,161 0.4 $18.80 $18.80 $18.80 0% 100% 0% 14.0 14.0 0% 100%
Casual all ages 1,650 0.3 $50.00 $10.00 $50.00 80% 10% 0% 14.0 14.0 14 14 20% 50%
CCM/careplus all ages 825 0.2 $50.00 $50.00 $50.00 80% 10% 10% 16.0 25.0 16.0 25.0 20% 60%
Scripts all ages 2,750 0.5 $10.00 $10.00 $10.00 80% 0% 20% 5.0 2.0 5.0 99% 80%
Other service line #1 all ages 6 0.001 $30.00 $10.00 $10.00 95% 5% 0% 14.0 17.0 14.0 17.0 20% 50%
Other service line #2 all ages 6 0.001 $30.00 $10.00 $10.00 95% 5% 0% 14.0 17.0 14.0 17.0 20% 50%
Other service line #3 all ages 6 0.001 $30.00 $10.00 $10.00 95% 5% 0% 14.0 17.0 14.0 17.0 20% 50%
Other service line #4 all ages 6 0.001 $30.00 $10.00 $10.00 95% 5% 0% 14.0 17.0 14.0 17.0 20% 50%
Other service line #5 all ages 6 0.001 $30.00 $10.00 $10.00 95% 5% 0% 14.0 17.0 14.0 17.0 20% 50%
Other all ages 2,551 0.5 $50.00 $10.00 $50.00 80% 20% 0% 14.0 20.0 14.0 20.0 20% 50%
Total visits / yr all ages 26,922 4.9 Discount avg/visit 10%
Activity, revenue and FTE summary information
Nurse
Visits Revenue GP % GP Nurse % Nurse GP FTE FTE
Activity summary year (GST excl) minutes time minutes time needed needed
General <6 consults 2,160 - 21,600 4.8% 6,912 2.3% 0.22 0.06
General 6+ consults 12,048 337,344 149,395 33.5% 44,578 15.1% 1.50 0.42
ACC 2,750 135,135 30,800 6.9% 8,800 3.0% 0.31 0.08
Immunisations 2,161 40,621 - 0.0% 30,250 10.2% - 0.28
CCM/careplus 825 41,250 11,880 2.7% 4,125 1.4% 0.12 0.04
Scripts 2,750 27,500 11,000 2.5% - 0.0% 0.11 -
Casual 1,650 60,885 18,480 4.1% 2,310 0.8% 0.19 0.02
Other service line #1 6 160 73 0.0% 5 0.0% 0.00 0.00
Other service line #4 6 160 73 0.0% 5 0.0% 0.00 0.00
Other service line #5 6 160 73 0.0% 5 0.0% 0.00 0.00
Other 2,551 127,545 28,570 6.4% 10,204 3.4% 0.29 0.10
Non chargeable time 82,592 18.5% 146,829 49.6% 0.83 1.37
Paid leave 90,812 20.4% 42,149 14.2% - -
Total 26,911 770,759 445,349 100% 296,170 100% 3.57 2.37
Nurse consult substitution opportunities
Summary Metrics
For the population of 5,506 patients, 3.57 GP FTEs and 2.37 Nurse FTEs are required with this
allocation of tasks.
Revenue of $1,507,973 comes from capitation ($736,896) and fees ($771,078).
Expenditure amounts to $1,215,576 resulting in a base profit/loss of $292,397.
Per 1000 enrolled patients, this converts to:
Revenue $273,873 per 1000
Expenditure $220,769 per 1000
Profit/(loss) $53,104 per 1000
Potential use of Nurse consults
Based on substituting GP consults with nurse consults where profitablility is enhanced:
192 GP hours could be freed up.
GP FTEs could reduce to 3.45 from 3.57.
The number of patients per GP would increase from 1,542 to 1,594
Alternatively, the number of enrolled patients able to be serviced by the 3.57 GP FTEs could
increase to 5,691
An extra 318 nurse hours would be added (0.18 FTEs).
Profitability would increase by up to $734
This represents a 0.06% increase in profitability.
General Consults, under 6
Per visit, GP consults result in a loss of -$30.44
Per visit, nurse consults result in a loss of -$22.82
Nurse visit delivers higher profit than GP visit
General Consults, over 6 years
Per visit, GP consults result in a loss of $4.10
Per visit, nurse consults result in a loss of $14.25
For breakeven using a nurse consult the fee would need to increase from $10.00 to $22.85
ACC
Per visit, GP consults result in a profit of $21.70
Per visit, nurse consults result in a loss of $0.32
For breakeven using a nurse consult the fee would need to increase from $22.50 to $44.85
(including the ACC payment)
Immunisations
Per visit, GP consults result in a loss of $15.30
Per visit, nurse consults result in a loss of $1.17
Nurse visit delivers higher profit than GP visit
CMM/CarePlus
Per visit, GP consults result in a profit of $11.03
Per visit, nurse consults result in a profit of $14.34
For breakeven using a nurse consult the fee would need to increase from $50.00 to $54.48
Other
Per visit, GP consults result in a profit of $15.90
Per visit, nurse consults result in a profit of $21.47
For breakeven using a nurse consult the fee would need to increase from $50.00 to $51.25
Nurse Hours per year
General <6 consults
2%
Paid leave
14%
General 6+ consults
15%
ACC
3%
Non chargeable time Immunisations CCM/careplus
50% 10% 1%
Scripts
Casual
0%
1%
Other service line #1
0%
Other service line #2
Other 0%
Other service
4% Other service line #3 Other service line #4
line #5 0%
0%
0%
GP Hours per year
General <6 consults
5%
General 6+ consults
34%
ACC
Paid leave 7%
20% Immunisations
0%
CCM/careplus
3%
Casual Scripts
4% 2% Other service line #1
0%
Other Other service line #2
Non chargeable time
6% 0%
19% Other service line #3
0%
Other service line #5 Other service line #4
0% 0%
Revenue
General 6+ consults ,
General <6 consults , $- $337,344
ACC, $135,135
Immunisations, $40,621
CCM/careplus, $41,250
Scripts, $27,500
Casual, $60,885
Other service line #1, $160
Other service line #2, $160
Capitation revenue = , Other, $127,545
$736,896 Other service line #3,
$160
Other service line
#4, $160
Other service line #5, $160
Costs
Nursing personnel,
$152,903, 13%
Medical personnel,
$662,674, 55%
Overheads - facility and
supply costs, etc,
$200,000, 16%
Admin personnel,
$200,000, 16%