The HealthCare Connection
PROVIDER PERFORMANCE EVALUATION
RATING SCALE OUTLINE
Rating Numerical ValueDefinition
Far exceeds job requirements5Exceptional;often exceeds requirements – Meets stretch goals
Exceeds job requirements4Above average; usually exceeds job requirements
Meets job requirements3Competent dependable; meets all relevant rqmts – Meets goals
Meets some job requirements2Improvement needed; meets some requirements
Unacceptable1Unsatisfactory; fails to meet requirements – Does not meet goals
Evaluate the provider’s work performance in relation to their position. The appraiser should assign a rating in relation to the individual work activities listed based upon chart audits and other supporting information. Provide comments for all areas rated.
A. Provider Productivity35%
Meet visits per hour goal based upon national benchmark data54321
Meet annual visits goal based upon national benchmark data54321
______Provider Productivity
Comments:
______
B. Performance / Quality35%
Pediatrics: 3=met goal; 1=did not meet goal
Vaccination rates for all pediatric patients who had one office visit in past year54321
Hearing screen completed at age 554321
Vision screen completed at age 554321
Lead screen completed54321
Adults: 3=met goal; 1=did not meet goal
1 HBA1C completed for all diabetic patients who had one office visit in past year54321
Pneumovax completed for diabetics54321
Chlamydia screen females age <2554321
Screening mammogram females age >5054321
______Performance / Quality
Comments:
C. Administrative Compliance15%
Attendance at required provider meetings54321
Participation in committees54321
Make contribution to provider education initiative54321
Adherence to office policies and procedures (medication lists, drug contracts)54321
Timely chart completion54321
Chart audit to ensure conformity of establish office practices and policies54321
Registry oversight (HDC, Pap)54321
______Administrative Compliance
Comments:
D. Patient Satisfaction10%
Letters of support received from patients54321
Patient survey results related to the provider54321
______Overall Patient Satisfaction
Comments:
E. Mission / Core Values 5%
Daily actions and communication are in support of organization’s mission54321
Adherence and understanding of the organization’s core values54321
______Overall Mission / Core Values
Comments:
OVERALL EVALUATION
A. Provider Productivity______x 35% =______
B. Performance / Quality______x 35%=______
C. Administrative Compliance______x 15% =______
D. Patient Satisfaction______x 10%=______
E. Mission / Core Values______x 5%=______
______
Overall Score 0 to 1 = Unacceptable
Overall Score 2.1 to 3 = Meets job requirements
Overall Score 3.1 to 4 = Exceeds job requirements
Overall Score 4.1 to 5 = Far exceeds job requirements
V. COMMENTS
Employee Comments.
______
Appraiser Comments.
______
My performance has been discussed with me and I have read this document
Provider’s Signature Date
Appraiser's Signature Date
CEO Signature Date
Copy To: Personnel File (Original): ______Employee: ______Supervisor: ______
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