RT Journal Article
SR Electronic
T1 Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 142
OP 149
DO 10.1370/afm.1626
VO 12
IS 2
A1 Deborah N. Peikes
A1 Robert J. Reid
A1 Timothy J. Day
A1 Derekh D. F. Cornwell
A1 Stacy B. Dale
A1 Richard J. Baron
A1 Randall S. Brown
A1 Rachel J. Shapiro
YR 2014
UL http://www.annfammed.org/content/12/2/142.abstract
AB 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.