Article Figures & Data
Tables
Staff Type CPC Practices,a % Comparison Practices in 2016, %
(N = 358)Difference CPC vs Comparison Practices in 2016b 2012
(N = 461)2014
(N = 454)2016
(N = 460)Changec Primary care cliniciansd 100 100 100 0 NA NA Physicians 100 NA NA NA NA NA Primary care physicians (MDs or DOs) NA 100 99 –1 98 1 Specialty physicians NA 12 12 0 18 –6e NPs and PAs 53 NA NA NA NA NA Do bill under own NPI NA 44 50 5 57 –7e Do not bill under own NPI NA 21 19 –2 16 3 RNs, excluding RN care managers 35 45 43 8e 40 3 Nutritionists 4 11 13 9f 10 4 Behavioral health professionals, clinical psychologists, or social workers NA 19 29 10f 12 17f Health educators 4 9 9 5f 5 4e Care managers/care coordinators who coordinate care for patients in the practice with other providers 24 85 84 60f 36 48f Community services coordinators who link patients in the practice with available services and resources in the community 4 5 4 0 4 0 Medical assistants 90 88 90 0 87 3 LPNs/LVNs 47 50 52 5 49 3 Pharmacists 8 14 18 10f 4 14f Practice supervisors or practice managers NA 91 93 2 87 6f Quality improvement specialists NA 11 18 7f 12 6e Physical or respiratory therapists NA 3 3 0 9 –6f Laboratory or radiology technicians NA 31 33 2 38 –5 Health information technologists or EHR specialists NA 16 18 2 11 7f Administrative staff (reception, medical records, appointment, finance, etc.) 99 NA NA NA NA NA Receptionists NA 95 96 0 92 4e Accountants or financial managers NA 13 17 4g 19 –1 Staff who work in billing, coding, administrative assistance, medical records, payroll, data entry or analysis, or network administration NA 51 53 2 56 –3 Other NA 21 22 1 10 12f CMS = Centers for Medicare & Medicaid Services; CPC = Comprehensive Primary Care; DO = Doctor of Osteopathic Medicine; EHR = electronic health record; LPN = licensed practical nurse; LVN = licensed vocational nurse; MD = Doctor of Medicine; NA = not applicable because survey did not ask about that staff type; NP = nurse practitioner; NPI = National Provider Identifier; PA = physician assistant; RN = registered nurse.
Notes: Sample is restricted to the 461 CPC practices that responded to the 2012, 2014, and 2016 surveys. Data are from CPC practice surveys administered October through December 2012, April through July 2014, and April through August 2016.
↵a Sample restricted to the 461 CPC practices that responded to each survey wave; because not all practices answered each question, sample size varies over time.
↵b Difference between CPC and comparison practices in percentage points, calculated using regression models that controlled for multiple factors and applied weights to comparison practices that were equal to the product of a matching weight and a nonresponse weight. See Methods for details.
↵c Difference between 2012 (or 2014) and 2016 in percentage points.
↵d Includes primary care physicians, nurse practitioners, and physician assistants who can bill under their own NPI as reported on roster files to CMS. Practices reported this information to CMS each month; numbers for this analysis come from the roster files reported in November of the corresponding year.
↵e Change over time was statistically different from zero at the P =.05 level, 2-tailed t test.
↵f Change over time was statistically different from zero at the P =.01 level, 2-tailed t test.
↵g Change over time was statistically different from zero at the P =.10 level, 2-tailed t test.
Characteristic All Practicesa
(N = 460)Practices Without a Care Manager
(n = 74)Practices With a Care Manager(s)
(n = 386)Number of primary care clinicians at baseline (2012),b % 1 clinician 15 24 14 2-3 clinicians 34 45 32 4-5 clinicians 24 20 24 6-10 clinicians 20 8 23 >10 clinicians 7 3 8 Practice affiliation with a system, % Yes 37 23 40 No 63 77 60 Percent of practice county that was urban 78 72 79 CPC = Comprehensive Primary Care.
↵a In the 2016 survey, 1 practice did not answer the question asking about practice staffing, resulting in a sample of 460 practices.
↵b Practice size was determined using practice-provided rosters of the primary care physicians, nurse practitioners, and physician assistants who bill under their own National Provider Identifier. The roster files were collected in November 2012 and reported the number of these clinicians at the practice site in October 2012, the first month of CPC.
- Table 3
CPC Practice Staff per Primary Care Clinician in 2016, by Baseline (2012) Practice Size
Staff Type All Practices, Mean By Baseline Practice Size,a Mean 1
Clinician2-3
Clinicians4-5
Clinicians6-10
Clinicians>10
CliniciansStaff FTE per primary care clinician FTE 3.3 5.1 3.0 2.9 2.8 3.2 Non-administrative staff 2.0 2.9 1.9 1.8 1.7 2.1 Administrative staff 1.2 2.2 1.1 1.0 1.0 1.0 Individual staff type FTE per primary care clinician FTE Primary care cliniciansb (reference group) 1.0 1.0 1.0 1.0 1.0 1.0 Physicians Primary care physicians (MDs or DOs) 0.6 0.8 0.6 0.6 0.5 0.5 Specialty physicians 0.3 1.0 0.5 0.2 0.2 0.3 NPs and PAs Do bill under own NPI 0.3 0.5 0.3 0.2 0.2 0.2 Do not bill under own NPI 0.4 0.9 0.3 0.3 0.3 0.2 RNs, excluding RN care managers 0.3 0.9 0.3 0.3 0.2 0.2 Nutritionists 0.1 0.6 0.2 0.1 0.1 0.1 Behavioral health professionals, clinical psychologists, or social workers 0.2 0.5 0.2 0.1 0.1 0.1 Health educators 0.1 0.4 0.2 0.1 0.1 0.1 Care managers and care coordinatorsc 0.3 0.6 0.3 0.2 0.2 0.2 Community services coordinatorsd 0.2 0.5 0.5 0.2 0.1 0.1 Medical assistants 0.9 1.3 0.9 0.9 0.7 0.8 LPNs and LVNs 0.6 1.2 0.6 0.5 0.5 0.3 Pharmacists 0.2 0.4 0.2 0.2 0.1 0.1 Quality improvement specialists 0.1 0.2 0.2 0.1 0.1 0.1 Physical or respiratory therapists 0.2 0.3 0.1 0.5 0.1 0.2 Laboratory or radiology technicians 0.4 0.7 0.3 0.3 0.3 0.6 Health information technologists or EHR specialists 0.2 0.4 0.2 0.2 0.1 0.2 Administrative staff (reception, medical records, appointment, finance, etc) Receptionists 0.7 1.2 0.7 0.6 0.6 0.6 Accountants or financial managers 0.2 0.6 0.2 0.2 0.1 0.1 Staff who work in billing, coding, administrative assistance, medical records, payroll, data entry/analysis, or network administration 0.5 1.4 0.4 0.5 0.3 0.5 Practice supervisors or practice managers 0.3 0.6 0.3 0.2 0.1 0.1 Other 0.3 0.4 0.3 0.3 0.4 0.3 CPC = Comprehensive Primary Care; DO = Doctor of Osteopathic Medicine; EHR = electronic health record; FTE = full-time equivalent; LPN = licensed practical nurse; LVN = licensed vocational nurse; MD = Doctor of Medicine; NP = nurse practitioner; NPI = national provider identifier; PA = physician assistant; RN = registered nurse
Notes: In the survey, we asked for the number of full-time and part-time staff. We estimated that a part-time staff was equivalent to 0.5 FTE. For the denominator of each ratio, we used the number of FTE physicians reported in the November 2016 clinician roster files to CMS; the numerator is the FTE staff reported by practices in the survey. Source was the CPC practice surveys administered April through August 2016.
↵a Practice size was determined using practice-provided rosters of the primary care physicians and NPs and PAs who bill under their own NPI. The roster files were collected in November 2012 and report the number of these clinicians at the practice site in October 2012, the first month of CPC.
↵b The number of primary care clinicians includes primary care physicians, nurse practitioners, and physician assistants who can bill under their own NPI. Practices reported this information to Centers for Medicare & Medicaid Services each month; the numbers for this analysis come from the roster files reported November of the corresponding year.
c Coordinate care for patients in the practice with other providers.
↵d Link patients in the practice with available services and resources in the community.
Additional Files
Supplemental Appendix
Supplemental Appendix
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Primary Care Practice Transformation Introduces Different Staff Roles
Kaylyn E. Swankoski, and colleagues
Background The Comprehensive Primary Care initiative was launched in 2012 by the CMS Innovation Center as a four-year multi-payer initiative designed to strengthen primary care.
What This Study Found This study examines shifts in staffing patterns, from 2012 to 2016, at 461 primary care practices participating in the CPC transformation initiative with those at 358 non-CPC practices.Over the course of the study, CPC practices moved away from a traditional staffing model of physicians with medical assistants as they added a variety of new staff, most commonly care managers or coordinators and behavioral health staff, to support patients with comprehensive, team-based care. Non-CPC practices, by comparison, did not increase their diversity as much as CPC practices did. For example, in 2016, 84% of CPC practices had care managers or care coordinators, but only 36% of comparison practices had them.
Implications
- he authors suggest that future studies should: * Examine the effect of team-based care and staff composition on health care cost, service utilization, patient experience and the overall sustainability of new staffing models.
- * Address how practices make decisions about augmenting staff in response to patients' medical and social needs.
