Measuring Contributions to the Clinical Mission of Medical Schools and Teaching Hospitals

Abstract

This is the final report of a panel convened as part of the Association of American Medical College's (AAMC's) Mission-based Management Program to examine the use of metrics (i.e., measures) in assessing faculty and departmental contributions to the clinical mission. The authors begin by focusing on methods employed to estimate clinical effort and calculate a "clinical full-time equivalent," a prerequisite to comparing productivity among faculty members and departments. They then identify commonly used metrics, including relative-value units, total patient-care gross charges, total net patient fee-for-service revenue, total volume per CPT (current procedural terminologies) code by service category and number of patients per physician, discussing their advantages and disadvantages. These measures reflect the "twin pillars" of measurement criteria, those based on financial or revenue information, and those based on measured activity. In addition, the authors urge that the assessment of quality of care become more highly developed and integrated into an institution's measurement criteria. The authors acknowledge the various ways users of clinical metrics can develop standards against which to benchmark performance. They identify organizations that are sources of information about external national standards, acknowledge various factors that confound the interpretation of productivity data, and urge schools to identify and measure secondary service indicators to assist with interpretation and provide a fuller picture of performance. Finally, they discuss other, non-patient-care, activities that contribute to the clinical mission, information about which should be incorporated into the overall assessment. In summary, the authors encourage the use of clinical productivity metrics as an integral part of a comprehensive evaluation process based upon clearly articulated and agreed-upon goals and objectives. When carefully designed, these measurement systems can provide critical information that will enable institutional leaders to recognize and reward faculty and departmental performance in fulfillment of the clinical mission.

Compensating the Transplant Professional: Time for a Model Change

“…In response many organizations have created their own academic RVU (aRVU) (14)(15)(16)(17)(18). Currently most academic medical centers as well as large group practices and newer Accountable Care Organizations (ACOs) tend to incorporate various metrics to calculate and compensate physician clinical productivity (wRVU), academic/education activities (aRVU), quality initiatives (incentive bonus for pay-for-performance payments), etc.…”

The role of remuneration in clinical productivity of paediatric physicians

“…of PaediatriC PhysiCians There are generally two types of clinical productivity measures: those based on financial data (for example, fee-forservice earnings per physician) and those based on clinical activity (for example, the number and length of patient visits) (Table 1) (1,2). Neither of these measures account for the quality of patient care.…”

“…Neither of these measures account for the quality of patient care. It is thus prudent to examine the underlying clinical circumstances (including the context) of practice when evaluating clinical productivity, especially in academic clinical settings where many factors are beyond the control of individual clinicians (1).…”

“…The most commonly reported measure has been the resource-based relative value scale (RBRVS), which was developed to assign resource values to various services provided by physicians. The RBRVS has designated relative value units (RVUs) for more than 7000 services and encompasses physician work, practice expenses and cost of malpractice expenses (1,3). RVUs are used extensively in the United States Medicare system.…”

“…Remuneration models for physicians often begin by assigning relative time or effort to each area of responsibility, and then measure productivity in each of these areas (22,23). For example, research productivity may be measured through the number of publications and research grants; productivity in teaching may be measured by the number of medical residents supervised and hours of classroom time (23,24).…”