PT  - JOURNAL ARTICLE
AU  - Sanjay Basu
AU  - Russell S. Phillips
AU  - Asaf Bitton
AU  - Zirui Song
AU  - Bruce E. Landon
TI  - Finance and Time Use Implications of Team Documentation for Primary Care: A Microsimulation
AID  - 10.1370/afm.2247
DP  - 2018 Jul 01
TA  - The Annals of Family Medicine
PG  - 308--313
VI  - 16
IP  - 4
4099  - http://www.annfammed.org/content/16/4/308.short
4100  - http://www.annfammed.org/content/16/4/308.full
SO  - Ann Fam Med2018 Jul 01; 16
AB  - PURPOSE To estimate the conditions under which team documentation—having a staff member enter history, place orders, and guide patients—would be financially viable at primary care practices, accounting for implementation costs.METHODS We applied a validated microsimulation model of practice costs, revenues, and time use to data from 643 US primary care practices. We estimated critical threshold values for time saved from routine visits that would need to be redirected to new visits to avoid net revenue losses under: (1) a clerical documentation assistant (CDA) strategy where a scribe assists with recordkeeping; and (2) an advanced team-based care (ATBC) strategy where medical assistants perform history, documentation, counseling, and order entry.RESULTS Using a fee-for-service model, we estimated that physicians would need to save 3.5 (95% CI, 3.3-3.7) minutes/encounter under a CDA strategy and 7.4 (95% CI, 4.3-10.5) minutes/encounter under an ATBC strategy to prevent net revenue losses. The redirected time would be expected to add 317 visit slots per year under CDA strategy, and 720 under ATBC strategy. Using a capitated payment model, physicians would need to empanel at least 127 (95% CI, 70-187) more patients under CDA and 227 (95% CI, 153-267) under ATBC to prevent revenue losses. Additional patient visits expected would be 279 (95% CI, 140-449) additional visit slots per year under CDA and 499 (95% CI, 454-641) under ATBC.CONCLUSIONS Financial viability of team documentation under fee-for-service payment may require more physician time to be reallocated to patient encounters than under a capitated payment model.