Cost Estimates for Operating a Primary Care Practice Facilitation Program

Steven D. Culler; Michael L. Parchman; Raquel Lozano-Romero; Polly H. Noel; Holly J. Lanham; Luci K. Leykum; John E. Zeber

doi:10.1370/afm.1496

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Costly but worth it
William E. Hogg

Published on: 09 July 2013
Response to question from James Mold
Steven D. Culler

Published on: 08 July 2013
Cost of Practice Facilitation
Jim Mold

Published on: 01 July 2013

Published on: (9 July 2013)
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Costly but worth it
William E. Hogg, family physician
Congratulations to Steven Culler and colleagues for a practical contribution to the literature about facilitation as a method to improve the quality of care delivered in community based primary care. As many programs are opening in jurisdictions across North America and beyond it is helpful to have costs from a real life program.
Less expensive attempts to improve practice by distributing guidelines or throug...
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Congratulations to Steven Culler and colleagues for a practical contribution to the literature about facilitation as a method to improve the quality of care delivered in community based primary care. As many programs are opening in jurisdictions across North America and beyond it is helpful to have costs from a real life program.
Less expensive attempts to improve practice by distributing guidelines or through traditional continuing professional development don't work. The costs of facilitation are high but there is good evidence of its effectiveness and reasonable evidence that the improvements are sustained long after the intervention is finished. a cost consequences analysis of a program to improve the delivery of preventive services in Ontario, Canada showed all costs were recovered in the first year with a positive return on investment of 40% from the perspective of the provincial government(1).
The finding that a large portion of the costs are for facilitator training, baseline chart audits and report preparation is interesting. While it is clear that facilitation can improve practice patterns it is also known that an intensive intervention is needed for the approach to work. It is important that the facilitator can visit the practices often. The relatively small cost of visiting the practices should discourage program managers from diluting the intervention to the point it loses its effectiveness. (1) Hogg W, Baskerville N, Lemelin J. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost- consequences analysis. BMC Health Serv Res. 2005;5(1):20.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (8 July 2013)
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Response to question from James Mold
Steven D. Culler, Professor
Other Contributors:
Jim,
Thank you for your interest in our cost estimates. While I am not sure what facilitation activities are included in your study, I suspect that our costs estimates are higher than your estimates because of the relatively extensive baseline evaluation that was conducted on each practice. The purpose of this baseline evaluation is to obtain descriptive information and background necessary for facilitating...
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Jim,
Thank you for your interest in our cost estimates. While I am not sure what facilitation activities are included in your study, I suspect that our costs estimates are higher than your estimates because of the relatively extensive baseline evaluation that was conducted on each practice. The purpose of this baseline evaluation is to obtain descriptive information and background necessary for facilitating improvement activities in the practice: such as the staffs' impression concerning the strengths and weakness of practice management, clinical information concerning the baseline quality and outcomes of diabetes care, and patient satisfaction with the care provided in the practice. We believe that this type of information is essential if primary care practices are going to engage in any sustainable quality improvement efforts. We estimated that these activities accounted for about $4,500 of the $7,600 of direct variable cost per practice (excluding the cost of food and travel). Over half of the total cost of the baseline evaluation was attributable to the chart audit and data analysis to produce the customized baseline feedback report associated with quality of diabetic care. Because of the low penetration of any type of electronic medical record among the practices that participated in our study, it was very time consuming to identify diabetic patients, pull their medical charts and collect the desired clinical information. Hopefully, the current trend toward increasing adoption of electronic medical records in primary care practices will lower the cost of clinical performance measurement and feedback to practices in the future.
In general, if one eliminates both the baseline report and the follow -up monitoring report from our study, then our median estimated of the cost of 6 practice facilitation sessions is approximately $2.500. This is in line with your estimates if one extrapolates out to 24 visits over 12 months.
Hopefully this helps explain the estimated cost differences between our studies.
Steve
Competing interests: None declared
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Competing Interests: None declared.
Published on: (1 July 2013)
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Cost of Practice Facilitation
Jim Mold, Research Director
I applaud this attempt to document the cost of practice facilitation, given the effectiveness and increasing popularity of this component of implementation strategies in primary care. We had previously estimated a cost of around $5,000 per practice with 24 visits per practice per year (1/2 day weekly for 6 months) and including the cost of supervision and travel. This estimate was based upon facilitation of 8 practices p...
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I applaud this attempt to document the cost of practice facilitation, given the effectiveness and increasing popularity of this component of implementation strategies in primary care. We had previously estimated a cost of around $5,000 per practice with 24 visits per practice per year (1/2 day weekly for 6 months) and including the cost of supervision and travel. This estimate was based upon facilitation of 8 practices per 6 months or 16 practices per year, a facilitator salary of $45,000 per year plus 30% fringe benefits, a travel budget of $4,000 per year, and supervision costs of $12,000 per year. I can't figure out why there is such a difference between our estimate and those reported here. It is also important to point out that the cost of facilitation is dependent upon both travel time/mileage and the time it takes to establish a relationship with a practice. These costs can probably be reduced substantially by embedding facilitators in communities of practice (i.e. primary care extension).
Competing interests: None declared
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Competing Interests: None declared.