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Research ArticleOriginal Research

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

Deborah N. Peikes, Robert J. Reid, Timothy J. Day, Derekh D. F. Cornwell, Stacy B. Dale, Richard J. Baron, Randall S. Brown and Rachel J. Shapiro
The Annals of Family Medicine March 2014, 12 (2) 142-149; DOI: https://doi.org/10.1370/afm.1626
Deborah N. Peikes
1Mathematica Policy Research, Princeton, New Jersey
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  • For correspondence: dpeikes@mathematica-mpr.com
Robert J. Reid
2Group Health Research Institute, Seattle, Washington
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Timothy J. Day
3Centers for Medicare and Medicaid Services, Baltimore, Maryland
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Derekh D. F. Cornwell
1Mathematica Policy Research, Princeton, New Jersey
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Stacy B. Dale
1Mathematica Policy Research, Princeton, New Jersey
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Richard J. Baron
4American Board of Internal Medicine, Philadelphia, Pennsylvania
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Randall S. Brown
1Mathematica Policy Research, Princeton, New Jersey
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Rachel J. Shapiro
1Mathematica Policy Research, Princeton, New Jersey
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Abstract

PURPOSE Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative.

METHODS We undertook a descriptive analysis of CPC initiative practices’ baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis.

RESULTS Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators—all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician.

CONCLUSIONS At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost.

  • primary care
  • staffing
  • patient-centered medical home
  • team-based care
  • Received for publication June 14, 2013.
  • Revision received December 16, 2013.
  • Accepted for publication January 6, 2014.
  • © 2014 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 12 (2)
The Annals of Family Medicine
Vol. 12, Issue 2
March/April 2014
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Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative
Deborah N. Peikes, Robert J. Reid, Timothy J. Day, Derekh D. F. Cornwell, Stacy B. Dale, Richard J. Baron, Randall S. Brown, Rachel J. Shapiro
The Annals of Family Medicine Mar 2014, 12 (2) 142-149; DOI: 10.1370/afm.1626

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Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative
Deborah N. Peikes, Robert J. Reid, Timothy J. Day, Derekh D. F. Cornwell, Stacy B. Dale, Richard J. Baron, Randall S. Brown, Rachel J. Shapiro
The Annals of Family Medicine Mar 2014, 12 (2) 142-149; DOI: 10.1370/afm.1626
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