The position of chief medical officer is relatively new to many individuals and organizations. Not surprisingly, the roles and responsibilities of CMOs vary considerably, making it difficult for physician leaders to adequately compare their performance with that of others in the same position.
David Shulkin, M.D., CMO at University of Pennsylvania Health System, has created an assessment guide that CMOs can use to gauge their performance as physician leaders or to assess the strategic planning and implementation success of the organizations they help lead. Following are questions that allow an individual assessment. Information about how to obtain questions for an organizational assessment is provided at the end of the questionnaire.
Answer each question yes, no or not applicable. Please refer to the scoring guidelines at the end of the text for instructions about determining your individual performance.
1. Have you established disease management programs for your top five ambulatory diagnoses?
2. Are more than 20% of your physicians utilizing your disease management programs?
3. Have you implemented a risk assessment tool for high-risk patient populations?
4. Has your board or senior management team recognized disease management as a strategic priority?
5. Do you track and encourage compliance with target dose ranges for ACE inhibitors in congestive heart failure patients?
6. Do your programs offer disease-specific feedback of outcomes data to primary-care physicians at least three times per year?
7. Do your physicians have incentives to utilize disease management programs?
8. Do more than 50% of your diabetes patients have a hemoglobin AIC measured four times per year with an average of less than 8.0?
9. Have you involved office staff (e.g. receptionists and office-based nurses) in implementing your disease management programs?
10. Do you have an active system of prompts and reminders for physicians (e.g. reminders to use ACE inhibitors in congestive heart failure patients)?
Clinical resource management
1. Are clinical pathways developed for 80% or more of conditions/procedures with more than 100 cases per year?
2. Are there clear criteria for whether a physician or service is complying with pathway use?
3. Is compliance with surgical pathways on average above 70%?
4. Is compliance with medical pathways on average above 50%?
5. Do you have resource management information systems in place (e.g. cost accounting or a system to track services ordered by diagnosis)?
6. Does your organization have incentives for physicians to share in clinical management savings?
7. Do you have a formal technology assessment process for new clinical capital expenditures?
8. Does your organization perform a formal cost-effective analysis on all requests for new drugs with an organizational impact of more than $50,000 to the pharmacy?
9. Have your clinical resource management efforts resulted in documented savings of $2 million or more in the past fiscal year?
1. Has your organization established annual goals for clinical quality improvement?
2. Have you identified your organization's core clinical processes on which you have prioritized improvement efforts?
3. Do your departments or clinical services receive outcomes/quality data at least four times per year?
4. Were you able to document improvement in at least five projects last year?
5. Do you have a readily accessible comparative database for outcomes benchmarking?
6. Do you use a severity adjustment or risk adjustment system when reporting outcomes data?
7. Are department managers, healthcare executives and physician leaders held accountable for quality improvement goals?
8. Does your organization link employee pay to clinical performance goals?
9. Do you have a standardized system to prevent administration of errors in dosing chemotherapy regimens?
1. Can you track cost/care by physician?
2. Can you report complication rates by service and doctor?
3. Do you display comparative data by physician so doctors can view their performance against their colleagues'?
4. Do you routinely report re-admission rates by condition?
5. Do you track economic data across the full episode of care?
Achieving standards of care
1. Do at least 90% of patients with post-hip surgery receive DVT (deep venous thrombosis) prophylaxis?
2. Have you implemented a standardized weight-based approach to administration of heparin?
3. Does your organization have a ratio of at least 1.5:1 of inhaled steroids to beta-agonists for asthmatics?
4. Are at least 80% of your post-myocardial infarction patients on beta-blockers?
1. Have you presented your work or ideas at a national or regional meeting in the past 12 months?
2. Are you an active participant in a formal network or consortium of other similar professionals or organizations?
3. Have you published at least two articles in a journal or trade publication in the past three years?
4. Has your organization been recognized by an external group for its work in quality or medical management in the past two years?
1. Has your organization delegated medical management or does it plan to do so in the next nine months?
2. Do you have or are you planning to have within 12 months the ability to handle full-risk contracts from managed-care organizations?
3. Do you have referral guidelines in place?
4. Are you running 200 bed days/1,000 commercial members or less?
5. Is your organization prepared for a specialty carve-out product with an organized group of specialists, now or within six months, if the need enters your market?
1. Do your case managers have a daily routine time to discuss cases with your physicians?
2. Are case managers held accountable for pathway compliance?
3. Have you developed disease-specific roles for your case managers?
4. Are your denial rates from all payers for inpatient care less than 2%?
1. Do you have a regular forum with all physician leaders/medical directors to prioritize and coordinate activities?
2. Do you have a formal training program for physicians in quality and/or clinical management issues?
3. Do you routinely share work plans with other physicians and administrative leaders in your organization?
4. Does your organization dedicate time at board meetings to assess clinical quality?
5. Are there at least two other people being trained in your organization to handle your responsibilities should the need arise in the next two years?
Total number of responses
To score yourself, take the total number of yes responses, divide it by the total number of responses (excluding N/A responses) and multiply by 100.
50% or less: Role still developing -- at very early stages
60% to 70%: Not a bad beginning -- still a way to go
70% to 80%: Average performance
80% to 90%: Commendable
90% or above: Top of your field -- ask for a raise
This is an abridged version of the CMO assessment guide. A full copy of the guide, along with guidelines for scoring your organization, can be obtained by writing to: David Shulkin, M.D., chief medical officer, University of Pennsylvania Health System, 21 Penn Tower, 3400 Spruce St., Philadelphia, PA 19104, or e-mailing: [email protected]