Article Figures & Data
Tables
Practice Characteristic CPC Initiative Practices
(n = 496)National Benchmark Primary care or multispecialty practice: multispecialty, % 11.9 6.1 Ownership, % Owned by hospital, hospital system, academic institution, or HMO 43.8 10.5 Owned by physicians 54.4 89.5 Owned by government or other organization 1.8 NR Patient mix: African American patients, % 4.6 13.4 Patients per FTE physician in practice, average No. 1,475.5 NR Distribution of number of patients per FTE physicians in practice, % <500 6.0 NR 500–1,000 22.6 NR 1,000–1,499 36.7 NR 1,500–1,999 16.5 NR 2,000–2,499 9.1 NR ≥2,500 9.0 NR Primary care physicians attesting as meaningful users of electronic health records, % 67.8 17.8 Practice location, % Located in metropolitan area 84.7 NR Located in nonmetropolitan area 15.3 NR -
CPC = Comprehensive Primary Care; FTE = full-time equivalent; HMO = health maintenance organization; NR = not reported.
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Source: For CPC initiative practices, data for the percentage of African American patients per practice are from the Medicare Enrollment Data base; data on the number of patients per FTE physician per practice are from the patient roster; the other data are from the CPC initiative practice application. Metropolitan and nonmetropolitan areas are based on the US Census urban/rural continuum code as reported in the 2009 Area Resource File. National benchmarks for electronic health record meaningful use estimates are based on meaningful-use attestation data provided by CMS and reported by Wright et al.40 All other national benchmarks come from a survey fielded between July 2007 and March 2009 for the National Study of Small and Medium-Sized Physician Practices, a nationally representative, random sample of 1,325 practices with fewer than 20 physicians drawn from the IMS Healthcare Organization Services database. The survey had an overall response rate of 63.2%. Results were restricted to practices that had at least 33% primary care physicians. Unlike the CPC initiative sample, a practice was not restricted to clinicians who were practicing in the same physical location.
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- Table 2
Percentage of CPC Initiative Practices With Different Staff Types, by Practice Size
Staff Type ≤2 FTE Physicians >2–4 FTE Physicians >4–7 FTE Physicians >7–13 FTE Physicians >13 FTE Physicians All Practices Practice sample, No. (%) 216 (43.5) 148 (29.8) 92 (18.5) 31 (6.3) 9 (1.8) 496 (100.0) Practices with each staff type, % Administrative staffa 96.3 100.0 100.0 100.0 100.0 98.4 Medical assistants 79.2 95.9 96.7 93.5 88.9 88.5 NPs, PAs 52.8 48.6 48.9 74.2 100.0 53.0 LPNs, LVNs 40.3 42.6 56.5 67.7 88.9 46.6 RNs 29.2 29.1 43.5 77.4 88.9 35.9 Care managers/coordinators 17.6 23.0 31.5 48.4 33.3 24.0 Pharmacists 1.4 6.8 12.0 25.8 33.3 7.1 Social workers 0.9 4.1 8.7 22.6 22.2 5.0 Community service coordinators 4.2 3.4 4.3 9.7 11.1 4.4 Health educators 2.3 3.4 6.5 6.5 22.2 4.0 Nutritionists 1.9 4.1 5.4 6.5 33.3 4.0 -
CPC = Comprehensive Primary Care; LPN = licensed practical nurse; LVN = licensed vocational nurse; NP = nurse practitioner; PA = physician assistant; RN = registered nurse.
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Source: The CPC initiative practice survey, fielded October through December 2012.
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↵a Administrative staff include those managing reception, medical records, appointments, finance, etc.
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Staff Type PCMH Practicesa
(n = 204)Other Practices
(n = 292)Physicians 100.0 100.0 Administrative staffb 98.5 98.3 Medical assistants 93.1 85.3 NPs, PAs 53.4 52.7 LPNs, LVNs 40.2 51.0 RNs 41.2 32.2 Care managers/coordinator 41.7 11.6 Pharmacists 9.3 5.5 Social workers 7.4 3.4 Community service coordinators 5.9 3.4 Health educators 2.9 4.8 Nutritionists 5.9 2.7 -
CPC = Comprehensive Primary Care; FTE = full-time equivalent; LPN = licensed practical nurse; LVN = licensed vocational nurse; NP = nurse practitioner; PA = physician assistant; PCMH = patient-centered medical home; RN = registered nurse.
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Source: The CPC initiative practice survey, fielded October through December 2012.
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↵a Practices were classified as a PCMH if they reported they had received PCMH recognition, accreditation, or certification from 1 or more of the following: The Accreditation Association of Ambulatory Healthcare, The Joint Commission, the National Committee for Quality Assurance, the Utilization Review Accreditation Association, or a state- or insurance plan–based recognition program.
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↵b Administrative staff include those managing reception, medical records, appointments, finance, etc.
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- Table 4
Mean Number of FTE Staff per FTE Physician—Among CPC Initiative Practices With Staff Type—by Practice Size
Staff Type ≤2 FTE Physicians
(n = 216)>2–4 FTE Physicians
(n = 148)>4–7 FTE Physicians
(n = 92)>7 FTE Physicians
(n = 40)All Practices
(n = 496)Administrative staffa 2.42 1.76 1.70 1.98 2.05 Medical assistants 1.76 1.31 1.23 1.11 1.45 NPs, PAs 0.97 0.49 0.38 0.20 0.65 LPNs, LVNs 1.38 0.78 0.66 0.53 0.95 RNs 1.04 0.54 0.38 0.31 0.64 Care managers/coordinators 0.77 0.46 0.24 0.23 0.47 Pharmacists 0.75 0.42 0.15 0.29 0.32 Social workers 0.75 0.22 0.13 0.12 0.20 Community service coordinators 0.86 0.26 0.17 0.20 0.48 Health educators 1.00 0.37 0.19 0.10 0.42 Nutritionists 0.58 0.38 0.08 0.07 0.27 -
CPC = Comprehensive Primary Care; FTE = full-time equivalent; LPN = licensed practical nurse; LVN = licensed vocational nurse; NP = nurse practitioner; PA = physician assistant; RN = registered nurse.
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Source: The CPC practice survey, fielded October through December 2012.
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Note: Practice size is defined by the number of FTE physicians.
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↵a Administrative staff include those managing reception, medical records, appointments, finance, etc.
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Staff Type Practice Size PCMH Status All Practices ≤2 FTE Physicians >2–4 FTE Physicians >4–7 FTE Physicians >7–13 FTE Physicians >13 FTE Physicians PCMH Practices Other Practices Ratio of FTE nonphysician staff to FTE physician All nonphysician staffa 5.32 3.92 3.73 4.23 3.35 4.40 4.57 4.50 All nonadministrative staff 2.99 2.16 2.04 2.21 1.52 2.50 2.48 2.49 Administrative staff 2.33 1.76 1.70 2.02 1.83 1.90 2.09 2.01 FTE physicians Average number of FTE physicians 1.4 3.4 5.5 9.4 27.7 4.3 3.4 3.7 Median number of FTE physicians 1.0 3.0 5.0 9.0 15.6 3.0 2.9 3.0 -
CPC = Comprehensive Primary Care; FTE = full-time equivalent; LPN = licensed practical nurse; LVN = licensed vocational nurse; NP = nurse practitioner; PA = physician assistant; PCMH = patient-centered medical home; RN = registered nurse.
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Source: The CPC initiative practice survey, fielded October through December 2012.
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Note: Practice size is defined by the number of FTE physicians. Practice status is based on whether a practice reported it had received PCMH recognition, accreditation, or certification from 1 or more of the following: The Accreditation Association of Ambulatory Healthcare, The Joint Commission, the National Committee for Quality Assurance, the Utilization Review Accreditation Association, or a state- or insurance plan–based recognition program.
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↵a Administrative staff include those managing reception, medical records, appointments, finance, etc. Nonadministrative staff include medical assistants, NPs/PAs, LPNs/ LVNs, RNs, care managers/coordinators, pharmacists, social workers, community service coordinators, health educators, and nutritionists.
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Additional Files
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.
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