Transition Costs and the New Model of Family Medicine
| New Model Characteristics | Capital, $ | 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 scheduling | 0 | 0 | 0 | 0 | 0 | 0 |
| Online appointment | 0* | 0 | 0 | 0 | 0 | 0 |
| Electronic health records | 0† | 0 | 10,735 ( 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 visits | 0 | 0 | 0 | 0 | 0 | 0 |
| E-visits | 0II | 0 | 0 | 0 | 0 | 0 |
| Chronic disease management | 0 | 5,200¶ | 0 | 0 | 5,200 | 1,040 |
| Web-based information | 0# | 0 | 0 | 0 | 0 | 0 |
| Team approach (leveraging staff) | 0 | 0 | 0 | 0 | 0 | 0 |
| Clinical practice guideline software | 0** | 0 | 0 | 0 | 0 | 0 |
| Outcomes analysis | 0 | 0 | 0 | 0 | 0 | 0 |
| Totals | 0 | 5,200 | 10,735 (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) | |||