Sanjay Basu1,2, Russell S Phillips2,3, Asaf Bitton2,4,5,6, Zirui Song2,4,7, Bruce E Landon2,3,4. 1. Center for Primary Care and Outcomes Research and Center for Population Health Sciences, Departments of Medicine and of Health Research and Policy, Stanford University, Stanford, California basus@stanford.edu. 2. Center for Primary Care, Harvard Medical School, Boston, Massachusetts. 3. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. 5. Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 6. Ariadne Labs, Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts. 7. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
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.
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.
Authors: Tait D Shanafelt; Michelle Mungo; Jaime Schmitgen; Kristin A Storz; David Reeves; Sharonne N Hayes; Jeff A Sloan; Stephen J Swensen; Steven J Buskirk Journal: Mayo Clin Proc Date: 2016-04 Impact factor: 7.616
Authors: Christine Sinsky; Lacey Colligan; Ling Li; Mirela Prgomet; Sam Reynolds; Lindsey Goeders; Johanna Westbrook; Michael Tutty; George Blike Journal: Ann Intern Med Date: 2016-09-06 Impact factor: 25.391