ASSET INVESTMENT MANAGEMENT SYSTEM:

“ No one ever said it would be easy…”

Charles Paidas

Financial Oversight Committee

August 15, 2007

The AIMS CouncilThe AIMS CouncilCo-Chairs

Bruce Lindsey Chuck Paidas Joann Strobbe Basic Sciences Clinical Sciences Finance & Administration

Members

Michael Barber, Past Pres Faculty Council Jim McKenzie, USF Health IT

Robert Belsole, Clinical Affairs Vicky Mastorides, Dean’s Office

Eric Bennett, Molecular Pharmacology & Physiology Jean Nixon, Business Office H. James Brownlee, Family Medicine Robert Nelson, PediatricsKaren Burdash, Clinical Finance John Curran, Fac/Acad. AffairsDuane Eichler, Molecular Medicine William Quillen, Physical TherapyPeter Fabri, GME Abdul Rao, ResearchFrank Fernandez, Psychiatry Paul Wallach, EducationHarvey Greenberg, DIO Lynn Wecker, ResearchJoseph Jackson, USFPG Paula Knaus, Dean’s Office

AIMS: OBJECTIVES

To support College of Medicine Mission, Goals, and Strategic Plan by:

1) Aligning resources with missions: The All Source Funding Model

2) Implementing a salary program that links assignment and performance to pay.

Kickoff = March 9, 2005

Meaningful Links

Assignment Performance

Performance Pay

The AIMS Council

Phase 1

COM Basic Science and Clinical Ranked Faculty

• Implement an All Source Funding Model

• Pilot College wide Performance Expectations

• Create The Data Warehouse/dashboard

• Revise the Annual Assignment and Evaluation Forms

The AIMS Council

Summary of Accomplishments - 1

• Established COM minimum percentages of effort per assignment category for ranked faculty with substantial input from Vice Deans (5-5-3-2)

• Identified measurable College performance expectations for ranked faculty

• Created a plan to develop additional measurable Department-specific performance expectations for Clinical faculty

The AIMS Council

Summary of Accomplishments - 2

• Created Data warehouse and Dashboard-Health Analysis Reporting Tracking (HART)

• Implemented Pilot Program of Draft of College wide and Departmental performance criteria

• Established web site for transparency- http://www.hsc.usf.edu/medicine/aims/index.html

The AIMS Council

Future Phases

Performance expectations and evaluation of:

• Chairs

• Staff

• Administration

KEY CONCEPTS

• Faculty driven process

• Let’s learn from the pilot data

• 360° Transparency of data

• First we need to understand what we do. What is our definition of work?

- Practice plan- Basic Science

• We have yet to arrive at an evaluation component.

• Productivity not allocation

• Strategic cost assessment- What is the cost of doing business must

be preceded by knowing the business.

•How we stack up - internally - nationwide

KEY CONCEPTS

Pilot Departments:Pilot Departments: 2006-20072006-2007

• Psychiatry

• Pediatrics

• Family Medicine

• Basic Sciences

• Physical Therapy

• OBGYN

CATEGORYCATEGORY COLLEGE - WIDECOLLEGE - WIDE

Instruction 5%

Scholarly Activity 5%

Service/Governance 3%

Clinical Care *

Other (Professional Development or Leave of Absence with Pay)

2%

NOTE: The minimum required workweek for 1.00 FTE Faculty is 40 hours; faculty are expected to work the number of hours necessary to accomplish their assigned responsibilities. The minimum work year is 46 weeks or 1840 hours. *Not applicable to Basic Science faculty. Clinical Faculty assignment will include patient care with and without students or house staff and will be benchmarked.

College of Medicine Minimum Percentages of Effort for Ranked Faculty (Revised by Council 3/30/06)

AIMS and College Criteria

AIMS Criteria

$ 350K

BaseIncentive /

BonusTotal

Compensation

Promotion – Assistant Associate Full Professor

Cost of living adjustment

New Administrative Permanent Assignment.

If Grant is eliminated, non- tenure salary eliminated.

ASF can decrease if clinical earnings are not sufficient or department is in deficit.

Does not meet 5/5/3/2 (after PILOT)

Eligibility Meets 5/5/3/2 minimum expectations

Plus - Research / Scholarly Activity Criteria - Education Criteria - Clinical Criteria

Not eligible if 5/5/3/2 not met

Pilot: Total Compensation For Ranked Faculty

SQMC Service and Clinical Metrics

Metric

Definition

Standards

Department

Division

Individual

USFPG

1. Patient satisfaction

2. Patient complaints

3. Patient complaints regarding providers

4. Discharges of patients from USFGP

5. Physician cancellations of patients’ appointments

6. Appointment availability

7. USFPG Consultations

8. Patient waiting time at visit

9. Clinical measures

Systems and QualityManagement Committee (SQMC)

Clinical Quality Indicators

• TGH Quality Indicators– Discharge times– Operative reports

Performance Criteria for Basic Scientist and Clinical Faculty

(Handouts)

• Instruction

• Scholarly Activity

• Service/Governance

• Professional Development

AIMS Metrics (Pulmonary Division Level)

Metric Definition Base Incentive Bonus

Work RVU’sNo. of Providers x pro

rata assignment75th perc. 80th perc. 85th perc.

Collected Revenue

Annualized $’s $2.5M $2.7M $3.0M

New ProgramInterventional

Pulmonary initiated (at year end)

- - Yes

Fellow EducationCore Curriculum

Lectures- - ?

Fellow Education Fellow presentations 10 15 20

Medical Student Education

Simulator training for Year 1 Students

- - Yes

Medical Student Education

4th Year Critical Care Clerkship

35 hours 60 hours 150 hours

AIMS Metrics (Pulmonary Division Level)

Metric Definition Base Incentive Bonus

Clinical Trials – Pulmonary

HypertensionNumber 1 2 3

Abstracts Number - - 4

Fellow ResearchEach Year 2 or 3 Fellow

on Research Project- - Yes

Clinical Trial Revenue

Annual Dollars - - $50K

AIMS Salary Subcommitee: The realistic solution

• EXPENSESEXPENSES

for all Clinical departments:

range = 50 – 67%

Dean’s Tax 7%

Corporation 20.9%

Department 10-14%

Division ~ 30%

Education

Clinical Research

Mission

The Tipping Point

AIMSCouncil

Bognar

Belsole

Rao

AIMS: FAQ’s from Faculty• Everyone can be treated fairly but no one

can be treated the same! • All assignments are Pro rated based upon

FTE.– {0.8 vs 1.0 vs. 0.2 FTE} x {wRVU, Education} =

% performance effort

• If people are happy then leave them alone. • Academic medicine means something, what

exactly does it mean?

AIMS: FAQ’s clinical issues

• Must understand sources of money.

Hard money = TGH, Moffitt, Feds, State Contracts and State $

Soft Money = patient revenue

• In order to increase revenue we must either:

increase the contracts or decrease the expenses associated with soft money

Team Observations during the interviews:“…Hey no one said it would be easy”

• AIMS is an essential element of modern day academic health care fiduciary responsibility and academic solvency.

• Life is complex in an academic world when we begin talking about sources and uses of capital (The All Source Funding Model) and pay for performance.

• Paucity of working knowledge about COM throughout faculty

• Disparity of feelings. Psychosis/Fear people will loose jobs. Others ecstatic !

Key Survey Concepts • Faculty driven process• Let’s learn from the pilot data• First we need to understand what we do. What is

our definition of work?- Practice plan- Basic Science

• We have yet to arrive at an evaluation component.• Productivity not allocation• Strategic cost assessment• The cost of doing business must be preceded by

knowing the business.– How we stack up internally and nationwide– 360° Transparency of data

Team Observations

AIMS Summary SWOT Analysis

Strengths: Faculty and Chair Buy-In. Levels the playing field. Reward the Knowledge Worker. Enhance dialogue. Improves APT. LCME

Weaknesses: Talk is cheap. Don’t stop here. Will it control expenses? Self Reporting. Cross Subsidization. Unrealistic requirements. LCME

Opportunities: “Eat what you kill,” Align Sources and Uses of Capital. Expense Control. LCME.

Threats: Disintegration of academic spirit. Legal Woes. Enforce of non-Compliance. LCME

Personal Observations

• Behavior has changed already• Faculty beginning to become aware of

advantages to pay for performance• Misconceptions abound• The title is a privilege not a right• Repetition is key• The pilot will help align effort,

performance and pay • If we don’t get our house in order

someone else can easily do it.

Pilot Highlights updated August 2007

• Clinical Activity “How you will be paid”– Incentive and Bonus will be wRVU based not

dependent upon Education.– Appendix III and IIIa (examples)

• Instruction– Key phrase is educational programs = 40 hrs– Appendix I

Basic Science Bonus Model August, 2007

• Basic Science Faculty are eligible for a Bonus in the following circumstances:

• In addition to meeting the College-wide Base Pay performance requirements, must:

• meet the Bonus Pay performance requirements for Medical Student Instruction (Appendix I ); and,

• meet the Bonus Pay performance requirements for Graduate and Postdoc Instruction (Appendix II); and,

• meet the Bonus Pay performance requirements for Research/Scholarly Activity (Appendix IVb).

• If a faculty member does not meet all of the performance requirements for teaching, research and service, and performs at an outstanding level for two out of three of the performance requirements, an exception may be made to the above Bonus requirements with approval by the Chair and Vice Dean for Research.

Faculty Merit ProcessCriteria for 2006-2007

• Basic Science Ranked Faculty

• Clinician Ranked Faculty