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.
Today's health care environment requires medical schools and teaching hospitals to respond to changing institutional mandates and external demands for accountability. Faced with less predictable resources, academic medical centers must also improve their management processes while continuing to ensure the quality of the education, research, and clinical care they provide. To help medical schools and teaching hospitals meet these challenges, the Association of American Medical Colleges (AAMC) is facilitating the adoption of processes and procedures for tracking and managing resources on a mission-specific basis. This approach, mission-based management (MBM), integrates an institution's financial performance indicators with faculty and departmental productivity data and encourages it to use these data in restructured decision-making processes to support critical academic missions. Through improved measuring and accounting systems, MBM enables medical school deans and department chairs to plan for the future, allocate resources efficiently, and make more informed decisions.
In response to the need for guidance on appropriately measuring faculty productivity and contributions, the AAMC, as a part of its Mission-based Management Program, convened panels of experts in the areas of education, research, and clinical services. The panels' mandate was twofold: (1) to identify the appropriate metric (i.e., measurement) systems that would account for faculty and departmental contributions to each mission, and (2) to provide guidance on the development and use of improved quantitative data to inform management and institution-specific resource allocation decisions. This report reflects our work as members of the Clinical Panel.