The Article in Brief
Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative
Deborah N. Peikes , and colleagues
Background Team-based care is a cornerstone of new care models designed to deliver high-quality, comprehensive care efficiently, but little is known about appropriate staffing composition for team-based primary care. This report describes the size and staffing composition of 496 technologically-advanced practices in the Centers for Medicare and Medicaid Services Comprehensive Primary Care Initiative.
What This Study Found There is a significant gap between where practices are and where policy makers expect them to be in order to implement new models of care. While most practices reported having administrative staff (98%) and medical assistants (89%), most did not have dedicated staff integral to providing team-based primary care ? staff who provide health education, care coordination, behavioral health care, nutrition counseling and medication adherence and reconciliation. Fifty-three percent reported having nurse practitioners or physicians assistants; 47% reported having licensed practical or vocational nurses; 36% reported having registered nurses; 24% reported having care managers and/or coordinators; and 7% or fewer reported having pharmacists, social workers, community service coordinators, health educators, or nutritionists.
Implications
- Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated and accessible care to patients at a sustainable cost.
- The restricted staff composition found in this study may be a result of the current fee-for-service payment environment, which does not provide incentives for the delivery of comprehensive coordinated care.