ASSET INVESTMENT MANAGEMENT SYSTEM: “ No one ever said it would be easy…” Charles Paidas Financial Oversight Committee August 15, 2007

The AIMS Council Co-Chairs Bruce Lindsey Chuck Paidas Joann Strobbe Basic Sciences Clinical SciencesFinance & Administration Members Michael Barber, Past Pres Faculty CouncilJim McKenzie, USF Health IT Robert Belsole, Clinical AffairsVicky Mastorides, Dean’s Office Eric Bennett, Molecular Pharmacology & PhysiologyJean Nixon, Business Office H. James Brownlee, Family Medicine Robert Nelson, Pediatrics Karen Burdash, Clinical FinanceJohn Curran, Fac/Acad. Affairs Duane Eichler, Molecular MedicineWilliam Quillen, Physical Therapy Peter Fabri, GMEAbdul Rao, Research Frank Fernandez, PsychiatryPaul Wallach, Education Harvey Greenberg, DIOLynn Wecker, Research Joseph Jackson, USFPGPaula 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 ( ) 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 -

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: Psychiatry Pediatrics Family Medicine Basic Sciences Physical Therapy OBGYN

CATEGORY COLLEGE - WIDE Instruction5% Scholarly Activity5% Service/Governance3% 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 Base Incentive / Bonus Total 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 Systems and Quality Management 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) MetricDefinitionBaseIncentiveBonus Work RVU’s No. of Providers x pro rata assignment 75 th perc.80 th perc.85 th perc. Collected Revenue Annualized $’s$2.5M$2.7M$3.0M New Program Interventional Pulmonary initiated (at year end) --Yes Fellow Education Core Curriculum Lectures --? Fellow EducationFellow presentations Medical Student Education Simulator training for Year 1 Students --Yes Medical Student Education 4 th Year Critical Care Clerkship 35 hours60 hours150 hours

AIMS Metrics (Pulmonary Division Level) MetricDefinitionBaseIncentiveBonus Clinical Trials – Pulmonary Hypertension Number123 AbstractsNumber--4 Fellow Research Each 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 Tax7% Corporation 20.9% Department 10-14% Division ~ 30%

Education ClinicalResearch Mission

The Tipping Point AIMS Council 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 Process Criteria for Basic Science Ranked Faculty Clinician Ranked Faculty