Table 10.

Transition Costs and the New Model of Family Medicine

New Model CharacteristicsCapital, $New Staff, $Lost Productivity Staff, $ (%)Physician, $ (%)Totals, $ (%)Totals per MD/DO, $ (%)
MD/DO = medical doctor/doctor of osteopathy.
* Assumes the practice subscribes to a Web-based service that does not involve new software or hardware in the practice.
† Electronic health record (EHR) capital costs of $35,000 per MD/DO (Table 1) are already accounted for in the financial model.
‡ Sensitivity analysis measures loss in productivity at different percentages from 5% (minimum) to 20% (maximum) for 1 year (Source: Stello B, Charlton EM. Avoiding common pitfalls in selecting an EMR system. Fam Pract Manag. 1999;6:47–48); ($214,708 × indicated percentages) (rounded to nearest dollar).
§ Sensitivity analysis for loss in productivity for 1 year (as above) ($405,109 × indicated percentage × 5).
II $3,000 in capital costs (Table 1) for e-visits is already accounted for in the financial model.
¶ Table 1 indicates 1 registered nurse (RN) would be needed per 200 patients and that 2% of a practice’s patients would benefit from chronic disease management. It is fair to assume a 5-physician practice would have at least 10,000 patients (200 is 2% of 10,000) and could thus employ an RN for this purpose. The practice would have to recruit 1 new RN. The cost of recruiting is approximately 10% of base pay for position; annual compensation for RN is approximately $52,000, according to US Bureau of Labor Statistics data.
# Assumes practice uses AAFP service that provides Web site for free.
** Assumes that the EHR will contain embedded clinical decision support tools (guidelines) and therefore that clinical practice guidelines software is not a separate capital cost.
Open-access scheduling000000
Online appointment0*00000
Electronic health records0010,735 ( 5)101,277 (5)§112,012 (5)22,402 (5)
21,471 (10)202,555 (10)224,026 (10)44,805 (10)
32,206 (15)303,832 (15)336,038 (15)67,208 (15)
42,942 (20)405,109 (20)448,051 (20)89,610 (20)
Group visits000000
E-visits0II00000
Chronic disease management05,200005,2001,040
Web-based information0#00000
Team approach (leveraging staff)000000
Clinical practice guideline software0**00000
Outcomes analysis000000
Totals05,20010,735 (5)101,277 (5)$117,212 (5)23,442 (5)
21,471 (10)202,555 (10)$229,226 (10)45,845 (10)
32,206 (15)303,832 (15)$341,238 (15)68,248 (15)
42,942 (20)405,109 (20)$453,251 (20)90,650 (20)