Measuring contributions to the clinical mission of medical schools and teaching hospitals

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 exa mine the use of metrics (i.e., measures) in assessing faculty and departmen tal contributions to the clinical mission. The authors begin by focusing on methods employed to estimate clinical effort and calculate a "clinical ful l-time equivalent," a prerequisite to comparing productivity among faculty members and departments. They then identify commonly used metrics, includin g relative-value units, total patient-care gross charges, total net patient fee-for-service revenue, total volume per CPT (current procedural terminol ogies) code by service category and number of patients per physician, discu ssing their advantages and disadvantages. These measures reflect the "twin pillars" of measurement criteria, those based on financial or revenue infor mation, and those based on measured activity. In addition, the authors urge that the assessment of quality of care become more highly developed and in tegrated into an institution's measurement criteria. The authors acknowledge the various ways users of clinical metrics can deve lop standards against which to benchmark performance. They identify organiz ations that are sources of information about external national standards, a cknowledge various factors that confound the interpretation of productivity data, and urge schools to identify and measure secondary service indicator s 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 in to the overall assessment. In summary, the authors encourage the use of cli nical productivity metrics as an integral part of a comprehensive evaluatio n process based upon clearly articulated and agreed-upon goals and objectiv es. 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 missio n.