TITLE: WHAT IS THE BEST WAY TO MEASURE CLINICAL PRODUCTIVITY OF INDIVIDUAL ANESTHESIOLOGISTS IN AN ACADEMIC ANESTHESIOLOGY DEPARTMENT?

AUTHORS: Amr E. Abouleish, MD, MBA, James J. Abate, MS, Mark H. Zornow, MD, Donald S. Prough, MD
AFFILIATION: University of Texas Medical Branch, Galveston, TX.

Mission-Based Management (MBM) has been used successfully in the business world and is now being implemented at several medical schools. (1) RVUs are the primary measure of clinical productivity. Since anesthesia services are not billed using RVU- based CPT codes, the way to measure productivity is unclear. Two methods Clinical Days and ASA Units, for measuring productivity were examined.
METHODS: 32 faculty anesthesiologists were measured. "Clinical Days" were calculated from the daily availability schedule for the year 1998. A faculty was credited with one day if he/she worked in a clinical setting or had an in-house call. An internal benchmark was used and calculated to be 227 days [= (5 days/week x 52 weeks) - (8 holidays + 5 weeks for vacation, meetings, sick leave)]. "ASA Units" were calculated by dividing total charges for year 1998 by the ASA unit charge. 75th percentile of external benchmarks were used for the ASA Units. (2,3) The clinical FTE was defined as percentage of time contracted to be clinical.
RESULTS: There was poor correlation between Clinical Days and ASA units (R-sq=13.6%).

DISCUSSION: Since staffing clinical sites is the major day-to- day responsibility of an academic anesthesiology department, Clinical Days measures the individual faculty contribution towards this clinical mission. Total ASA units is a measure of workload, but is inaccurate as a measure of clinical contribution, because ASA Units (a) are lower with slower surgeons, (b) do not measure clinical contribution in areas where charges are not billed (e.g., Preoperative Clinic), (c) vary greatly depending on daily caseload, and (d) do not capture work done in areas where RVU-based billing occurs (e.g., Pain Clinic).
CONCLUSION: For measuring individual contribution to the clinical mission of an academic department, Clinical Days worked is more accurate than ASA units. Total ASA units/FTE may be valuable for management decisions on a departmental level.
REFERENCES:

(1) Acad Med 74:627, 1999

(2) 1997 MGMA Productivity Report,

(3) 1997 AAMC/MGMA Productivity Report.