A SSET I NVESTMENT M ANAGEMENT S YSTEM: “ No one ever said it would be easy…”

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

2. The AIMS Council Co-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, Pediatrics Karen Burdash, Clinical Finance John Curran, Fac/Acad. Affairs Duane Eichler, Molecular Medicine William Quillen, Physical Therapy Peter Fabri, GME Abdul Rao, Research Frank Fernandez, Psychiatry Paul Wallach, Education Harvey Greenberg, DIO Lynn Wecker, Research Joseph Jackson, USFPG Paula Knaus, Dean’s Office

3. 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

4. Meaningful Links AssignmentPerformance PerformancePay

5. 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

6. 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

7. 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

8. The AIMS Council Future Phases Performance expectations and evaluation of: • Chairs • Staff • Administration

9. 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.

10. KEY CONCEPTS • 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

11. Pilot Departments: 2006-2007 • Psychiatry • Pediatrics • Family Medicine • Basic Sciences • Physical Therapy • OBGYN

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

13. AIMS and College Criteria AIMS Criteria $ 350K Incentive / Bonus Total Compensation Base 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

14. SQMC Service and Clinical Metrics Systems and QualityManagement Committee (SQMC)

15. Clinical Quality Indicators • TGH Quality Indicators • Discharge times • Operative reports

16. Performance Criteria for Basic Scientist and Clinical Faculty (Handouts) • Instruction • Scholarly Activity • Service/Governance • Professional Development

17. AIMS Metrics (Pulmonary Division Level)

18. AIMS Metrics (Pulmonary Division Level)

19. AIMS Salary Subcommitee: The realistic solution • EXPENSES for all Clinical departments: range = 50 – 67% Dean’s Tax 7% Corporation 20.9% Department 10-14% Division ~ 30%

20. Mission

21. The Tipping Point Rao AIMS Council Bognar Belsole

22. 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?

23. 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

24. 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 !

25. Team Observations 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

26. 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

27. 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.

28. 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

29. 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.

30. Faculty Merit ProcessCriteria for 2006-2007 • Basic Science Ranked Faculty • Clinician Ranked Faculty