Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative

Transcription

1 Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative Timothy Day, MSPH; 1 Deborah Peikes, PhD; 2 Robert J. Reid, MD, PhD; 3 Derekh Cornwell, PhD; 2 Stacy Dale, MPA; 2 Richard J. Baron, MD, MACP; 1 Randall Brown, PhD; 2 Rachel Shapiro, MPP 2 1 CMS Innovation Center, 2 Mathematica Policy Research, 3 Group Health Research Institute AcademyHealth 2013 Annual Research Meeting

2 Team Based Primary Care Includes range of staff beyond physician: Existing staff in new and expanded roles New staff Cornerstone of new models of primary care Potential advantages: Add expertise (e.g., care management, quality improvement, patient engagement) Improve care quality and health Reduce total cost of care Help relieve physician shortages 1

3 Important to Understand Current Staffing of Primary Care Practices The literature suggests that team based care may have advantages. However, it is not known whether practices are staffed to support team based care. Study Aim: To describe the baseline staffing composition of nearly 500 practices in the Comprehensive Primary Care Initiative. 2

4 Comprehensive Primary Care Initiative Multi payer model convened by CMS 7selected geographic areas Testing: Enhanced, non visit based payment Quarterly data feedback Technical assistance for practice transformation 502 practice sites selected primarily based on EHR capabilities and proportion of revenue coming from participating payers 3

5 Data Sources and Analyses Linked 2 sources: Practice applications to CPC Practice survey Fielded Fall % response rate Analyzed composition Overall By subgroups Practice size Medical home recognition status 4

6 CPC Practices Compared to National Benchmark CPC (N=497) NSSMSPP 1 (N=497) Multispecialty practice 11.90% 6.10% Practice ownership Owned by hospital, hospital system, academic institution, or HMO 43.70% 10.50% Owned by physicians 53.30% 89.50% Owned by government or other organization 3.00% 0.00% Patient mix African American patients 4.70% 13.40% 1 National Study of Small and Medium Sized Physician Practices. Rittenhouse DR, Casalino LP, Shortell SM, et al. Small and medium-size physician practices use few patient-centered medical home processes. Health Aff. 2011;30(8):

7 Traditional Staff Common in All Practices, Nurses More Common In Larger Practices 100% 90% 80% 70% 60% 100% 100% 100% 100% 96% Percentage of Practices with a Given Staffing Category 2 FTE Physicians 2< FTE 4 Physicians 4< FTE 7 Physicians 7< FTE 13 Physicians >13 FTE Physicians N=216 N=149 N=92 N=31 N=9 79% 96% 97% 94% 89% 89% 89% 68% 77% 74% 100% 50% 40% 43% 40% 57% 44% 53% 49% 49% 30% 20% 29% 29% 10% 0% Administrative Staff Medical Assistants Licensed Practical or Vocational Nurses Registered Nurses Nurse Practitioners and Physician Assistants 6

8 Use of Other Clinical Staff Is Uncommon 100% Percentage of Practices with a Given Staffing Category 2 FTE Physicians 2< FTE 4 Physicians 4< FTE 7 Physicians 7< FTE 13 Physicians >13 FTE Physicians N=216 N=149 N=92 N=31 N=9 90% 80% 70% 60% 50% 48% 40% 30% 20% 10% 0% 18% 23% 32% Care Managers and Care Coordinators 33% 33% 7% 12% 26% 1% 1% 23% 22% 9% 10% 11% 7% 7% 4% 4% 3% 4% 2% 3% 4% 5% 7% 2% Pharmacists Social Workers Community Service Coordinators 22% Health Educators Nutritionists 33% 7

9 Larger Practices Use Fewer FTE Staff per FTE Physician Mean Number of FTE Staff per FTE Physician Among Practices that Use a Particular Type of Staff FTE Physicians 2< FTE 4 Physicians 4< FTE 7 Physicians FTE>7 Physicians N=216 N=149 N=92 N= Administrative Staff Medical Assistants Licensed Practical or Vocational Nurses Registered Nurses Nurse Practitioners and Physician Assistants 8

10 Smaller Practices Have More Traditional Staffing Structures 100% 90% 21% 20% 15% 5% 5% Physician + at least 1 of the following: Administrative Staff Medical Assistant 80% 70% 60% 50% 40% 30% 20% 10% 0% 7% 13% 14% 33% 17% 23% 19% 20% 18% 18% 22% 15% 16% 40% 13% 26% 8% 13% 2 FTE Physicians 2< FTE 4 Physicians 4< FTE 7 Physicians >7 FTE Physicians Above + NP or PA Above + LPN/LVN Above + RN Above + Care Coordinator/Manager All Other Staff At least 1 of the following: Social Worker Pharmacist Health Educator Nutritionist Community Service Coordinator N=216 N=149 N=92 N=40 9

11 PCMH Recognized Practices More Likely to Have Non Traditional Staff 100% 90% 16% 20% Physician + at least 1 of the following: Administrative Staff Medical Assistant 80% 70% 60% 50% 9% 8% 18% 13% 27% Above + NP or PA Above + LPN/LVN Above + RN 40% 30% 20% 10% 0% 26% 23% PCMH Practices 24% 7% 10% Other Practices Above + Care Coordinator/Manager All Other Staff At least 1 of the following: Social Worker Pharmacist Health Educator Nutritionist Community Service Coordinator N=204 N=293 10

12 Conclusions Most CPC practices report traditional staffing models Only 24% have care coordinators or care managers, which are concentrated among PCMH recognized and larger practices 7.5% report having pharmacist 5% report having health educator, social worker, nutritionist, or community service coordinator Smaller practices are more likely to report having traditional staffing model >75% of practices with 4 physician FTEs have only traditional staff In comparison, only 54% of practices with >4 physician FTEs have only traditional staff 11

13 Limitations Not designed to be nationally representative Did not have data on staff functions Medical home recognition not perfect proxy for medical home functionality 12

14 Policy Implications Changes in staffing composition to support team based care will likely require outside intervention Current fee for service environment may not provide adequate incentives for expanded staff Payers will need to consider alternative payment schemes (such as CPC) to achieve augmented staff Practices may need technical assistance to change workflow and incorporate new team members Smaller practices may need to share staff with other practices No consensus on ideal practice staff composition Work is needed to link staffing composition to outcomes 13

15 Closing Use this page for large charts. Thank You! Questions? 14