Association of Specialty Professors Division Chiefs Symposium March 3, 00 Managing Faculty Performance and Productivity Sara M. Larch, FACMPE VP, Physician Services Inova Health System Overview Measuring performance and setting expectations tti Discuss performance measures Division Chief s role Measuring performance and productivity in your practice
Measuring Performance What are the 00 goals for your Division? Define performance expectations in key areas that will support the Division s goals, for example: Clinical Academic Research Leadership Community Determine if this expectation will be measured at the individual, division, department, or School level Define Expectations Clinical Academic Financial Research Leadership Community Who is providing oversight? Faculty Dept of Practice School of Job Description Annual Performance Goals Examples Division Medicine Plan Medicine Hospital Inpatient Increase new outpatient practice patient visits X X Outpatient Achieve RVU target X X X Evening/Weekends Reduce LOS X X Students Present Grand Rounds /year X X X Residents Student evaluation scores at least X X X X Fellows Revenue Cycle Submit charges faster to reduce lag time X X X Expense Management Research? Define Mentor resident research project X X X Submit an R0 grant application to NIH X X X Committees Member of physician managed care committee X X X Governance External Activities Participate in community fund raising event X X X
Title: Medical Critical Care Service Physician Operating Unit: Inova Health System, Inova Fairfax Hospital MCCS (medical critical care service) is a clinical service that provides hospital based 4/7 critical care service to critically ill adult medical patients in IFH. MCCS physicians are board-certified intensivists who, during their scheduled time on the MCCS roster, do not have other competing clinical responsibilities other than the management of critically ill patients. MCCS physicians will cover the service in -hour shifts and will be expected to remain in the hospital for the entire duration of hours. PRINCIPAL DUTIES AND RESPONSIBILITIES:. Clinical responsibilities: a. Provide direct ICU care as primary intensivists when requested by the attending physicians or other services. b. Provide all necessary medical treatment to all ICU patients in the event of life threatening emergencies or when the primary intensivists are not available. c. Provide initial ICU care and management when other primary intensivists request such care as their proxy. d. Intervene with management and diagnostic plans to insure the best clinical outcome /decrease length of ICU and ventilator days utilizing evidence based medicine. e. Provide ongoing evaluation and management to ICU patients throughout the day. This requires multiple visits to patient s bedside. f. When given the authority to manage the patients on behalf of the private intensivist, MCCS physician is expected to initiate appropriate and timely diagnostic and therapeutic interventions during the morning rounds with the housestaff. g. There may be consults specifically requested to be provided by MCCS physician in house. In these situations, the patients will be remaining on MCCS, and will be managed by the subsequent MCCS physicians.. Teaching responsibilities: a. Conduct multidisciplinary morning rounds with the house staff, registered nurses, and other allied health care team on all patients in the ICU. b. The multidisciplinary morning rounds are expected to occur daily including Saturdays, Sundays, and holidays. 3/5/00 What is the Bonus? Base compensation versus bonus compensation Base Compensation Inova Health System JOB DESCRIPTION Bonus Compensation job description & job expectations incentivized behaviors or performance Examples: Group/individual meets base wrvu target Attend or participate in meetings, conferences, and training (i.e., Grand Rounds) required for position Timeliness of charge capture Participate in call schedule + Examples: Group/individual surpasses base wrvu target by X% Program growth increase number of cases or patient visits by X% over base threshold System or department wide financial goal reached (operating margin over x%, etc.) = Total Comp Host fellows for rotation Patient Satisfaction scores exceed IHS base %tile by X% Reduce Serious Safety Events (SSE) Patient Satisfaction scores at expected IHS base %tile Medical records documentation (zero suspensions) What is the Bonus? Each criteria must: Be objective Be measureable Be tracked (by current systems) Have scoring goals defined (all or none, partial award) Should these goals be Group or Individual? Productivity RVUs Expense Management Growth Quality Service Academics Research 3
COMPENSATION AND INCENTIVE PLAN Base Salary Base salary is set by the School of Medicine, in consultation with practice plan, based on University performance standards. Incentive Opportunity Minimum qualifying performance standards must be met to be eligible for participation in the incentive plan. These standards define acceptable performance to maintain the operational and financial integrity of the department, faculty practice plan and the School of Medicine as a whole. Performance incentives are department specific and reflect the departments objectives for the year. Adapted from University Physician, Inc., Baltimore, MD Minimum Qualifying Performance Standards. Manage the finances of the department/program to the all funds bottom line approved. Acceptable performance is: revenue greater than expense, or expense greater than revenue by % or less of the FAAC approved budget. Acceptable performance in the areas of academic, (e.g., faculty recruitment t and appointment process), and research ( e.g. research support to faculty and compliance with IRB and IACUC rules), administration determined by the dean s office 3. No university account deficits by fiscal year end 4. All department clinical long-term operational targets at C or better at fiscal year- end 5. Acceptable audit performance as determined by: Finance and Audit Committee for internal and external audit SOM for university and state audits 4
3 3/5/00 Incentive If minimum qualifying performance standard targets are met; is eligible for an incentive of 0% of base salary calculated as follows: 60% Of the incentive opportunity is based on achievement of departmental specific objectives related to the academic, research and clinical mission defined by chair and administrator and approved by Dean s office (3 5 measurable objectives). Examples: Strengthen department research infrastructure Develop new service at affiliate hospital Reduce administrative cost by Y% All objectives must be measurable 30% Of the incentive opportunity is based on achieving departmental clinical performance targets at 6/30/XX 0% Institutional contribution. This is a measure of the individual s contribution to further the School s education, research and clinical mission, including institutional spirit, citizenship, and support of the School s overall objectives. Determined by SOM/Practice Plan Measuring Clinical Productivity: RVU Performance (Sample) Total FTE Clin FTE N-Clin FTE Survey Specialty Actual to 008 Target Total Oct 09 Nov 09 Dec 09 009 YTD.00 0.90 0.0 IM: Hospitalist ###.00 0.90 0.0 IM: Hospitalist ###.00 0.90 0.0 IM: Hospitalist ###.00 0.67 0.33 IM: Hospitalist ###.00 0.90 0.0 IM: Hospitalist ### 0.80 0.30 0.50 IM: Hospitalist.00 0.90 0.0 IM: Hospitalist ###.00 0.90 0.0 IM: Hospitalist ###.80 8. 3.58 ### 3,5 34 98 365 3,906,478 0 5 34 3,09 N/A 34 65 55,408 3,07 68 67 0,340 3,49 09 39 43 3,57 807 7 5 38, 46 07 8 338 3,847,047 363 3 53 4,7 8,3 5,6,636 7,500 59,8 00.00 090 0.90 00 0.0 CitC Crit Care:Intensivist ii t ### N/A 460 49 937 857,857.00 0.90 0.0 Crit Care:Intensivist ### 4,90 50 45 54 5,50.00 0.50 0.50 Crit Care:Intensivist ### 4,435 68 5 37 4,586 0.50 0.45 0.05 Crit Care:Intensivist ###,036 444 9 676 3,93.00 0.90 0.0 Crit Care:Intensivist ### 3,75 444 43 49 3,636 0.75 0.68 0.08 Crit Care:Intensivist ### 865 6 54 99 4,78 8.75 7.48.3 ### 5,997 0,40,45 5,85 8,93 Note: Columns don t sum Adapted from Inova Health System 5
Cost & Productivity RVUs Models (goal set by Specialty Group) Bucket (Example) Linear (Example) $/RVU over a set RVU target (examples from readings) Where should the RVU target be set (compared to benchmarks)? How much ramp up time for new physicians? AreNon Physician Providers (NPPs ) RVUs includedin the measure? How is the target adjusted? Are you creating a system where RVU expectations may be different by MD within the group goal? Service & Quality What service & quality goals can be set at the physician, division, department level? Are they: Specific to the division s physicians? Measurable? Able to be tracked through current IT systems? 6
Adapted from Department of Medicine, University of Maryland Adapted from Department of Medicine, University of Maryland 7
New Bonus Model Draft Grouping for Bonus Models Version Possible System Level Goal(s)? Scorecards will have the same weights at the Category level Safety Net Physicians Hospital-Based Physicians Inova Medical Group Office-Based Physicians Quality and Service at Category and Sub Category Level Safety Net Intensivists Hospitalists Surgery Specialists Adult Specialists Pediatrics Specialists Primary Care Inova Cares for Women Med Intensivist Med Hospitalists Neurosurgery Psych Peds Endo Internal Medicine Inova Cares for Children Peds Intensivist Peds Hospitalists Ortho Trauma Transplant Non- Surgical Peds GI Family Practice Peds Hem/Onc Psych Hospitalists Transplant Surgery Urgent Care RVUs at Specialty Group Category Level Trauma Peds Infectious Disease Peds Nephrology Sub Category Level Peds Neurosurgery Peds Neurology Specialty Group Peds Psych Model Model Peds Rheum Adapted from Inova Health System Division Chief s Role Define leadership role in collaboration with Department tchair Daily, weekly, monthly measurement and oversight At least quarterly, performance coaching sessions High performers Low performers 8
KNOW HOW EACH CLINICAL DOLLAR IS SPENT Cost of Practice Expenses $0.64 Faculty Incentives $0.09 UPI $0.0 Department Developmental Fund $0.7 Medical School Enrichment Fund $0.075 Good Physician Partner Clinically sound Good communication skills Willing to learn Willing to teach Guardian of quality Active in community Peer coach Interests in academia Negotiator Politically astute Source: Thomas C. Royer, M.D. 9
Who controls your academic practice clinic site? Department/PA/Specialty/Division Practice Plan/Multispecialty Group School of Medicine Hospital Medical System/Center Phys & Other Clinical Prov's Staff Non - clinical Staff Space Appts Pre - Visit Clinical Check Service out Chg Capture Day to Day Accountability D Business Standards & Management Oversight M How are we structured? Phys & Other Non - Clinical clinical Pre - Clinical Check Chg Prov's Staff Staff Space Appts Visit Service out Capture Department/PA/Specialty/Division DM DM DM DM DM DM DM DM DM Practice Plan/Multispecialty Group M DM DM M DM M M School of Medicine M Hospital M M DM DM DM M DM Medical System/Center Day to Day Accountability D Business Standards & Management Oversight M 0
Reconstructing the Value Chain Patient Enters Check In Patient Intake $.04 $.33 $7.50 Provision Clinical of Care Follow $7.50 up $.33 Check Out $.04 Patient Exits Position Salary Benefits Total Cost per Minute Physician $ 50,000 $ 30,000 $ 80,000 $.50 Check-In $ 0,800 $ 4,60 $ 4,960 $ 0. Nurse $ 33,80 $ 6,656 $ 39,936 $ 0.33 Check-out $ 0,800 $ 4,60 $ 4,960 $ 0. 40 hours/week * 50 weeks/year * 60 minutes/hour = 0,000 Copyright 009 Larch/Walker/Woodcock Note: Data reported for 5-minute increments; salaries are provided as sample only; analysis for illustrative purposes only. Capacity Space Utilization by Day of Week Ambulatory Encounters 50 00 50 0 Monday Tuesday Wednesday Thursday Friday
Productivity requires efficient use of space Where do people p work? Reception/Registration Front Office How do you inform nurse/md of patient s arrival? Physicians Exam Room Layout matters Stocked Entertaining Usage: 3 per MD, -3 per Provider Nurse Nurses Station Others? MD s don t escort patients! Every unnecessary step is unproductive and unprofitable! What can you do? Communicate in Writing Charge tickets Message boards Numbers on exam rooms Patient flow sheet Co-locate Equipment/Resources to people People to people (teams) Technology E-mail Workflow module in practice mgmt system Cordless phones
Overview Measuring performance and setting expectations tti Discuss performance measures Division Chief s role Measuring performance and productivity in your practice Association of Specialty Professors Division Chiefs Symposium March 3, 00 Managing Faculty Performance and Productivity Sara M. Larch, FACMPE VP, Physician Services Inova Health System 3