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Cost to Primary Care Practices of Responding to Payer Requests for Quality and Performance Data

¹ Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
² Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
³ Piedmont Health Services, Carrboro, North Carolina
⁴ Spragens & Associates, LLC, Durham, North Carolina
⁵ Cecil G. Sheps Center for Health Services Research and School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

CORRESPONDING AUTHOR: Jacqueline R. Halladay, MD, MPH Department of Family Medicine 590 Manning Drive, CB# 7595 Chapel Hill, NC 27599-7595 jacqueline_halladay{at}med.unc.edu

PURPOSE We wanted to determine how much it costs primary care practices to participate in programs that require them to gather and report data on care quality indicators.

METHODS Using mixed quantitative-qualitative methods, we gathered data from 8 practices in North Carolina that were selected purposively to be diverse by size, ownership, type, location, and medical records. Formal practice visits occurred between January 2008 and May 2008. Four quality-reporting programs were studied: Medicare’s Physician Quality Reporting Initiative (PQRI), Community Care of North Carolina (CCNC), Bridges to Excellence (BTE), and Improving Performance in Practice (IPIP). We estimated direct costs to the practice and on-site costs to the quality organization for implementation and maintenance phases of program participation.

RESULTS Major expenses included personnel time for planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems. Costs per full-time equivalent clinician ranged from less than $1,000 to $11,100 during program implementation phases and ranged from less than $100 to $4,300 annually during maintenance phases. Main sources of variation included program characteristics, amount of on-site assistance provided, experience and expertise of practice personnel, and the extent of data system problems encountered.

CONCLUSIONS The costs of a quality-reporting program vary greatly by program and are important to anticipate and understand when undertaking quality improvement work. Incentives that would likely improve practice participation include financial payment, quality improvement skills training, and technical assistance with electronic system troubleshooting.

Key Words: Costs and costs analysis • quality of health care • medical audit • primary care

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