Costs of Transforming Established Primary Care Practices to Patient-Centered Medi

摘要 背景：以患者为中心的医疗之家(PCMH)是一种很有前途的模式，可以实现 改善患者护理体验，改善人群健康，降低人均医疗费用。 保险公司正在鼓励初级保健做法通过财务手段向初级保健机构转型 奖励或直接合同要求。关于PCMH转换和识别的实践 流程需要有关它们将产生的成本的信息，以权衡这些成本与预期的收益 患者的结果和可用的经济激励措施，并做出完全知情的决定。 目标：量化与初级保健相关的时间、精力、资本以及总的直接和间接成本 基于60个初级保健经验的实践向PCMH的转变和持续认可 在大型门诊护理医疗集团诊所HealthTexas Provider Network(HTPN)内的实践 隶属于北德克萨斯州的贝勒医疗保健系统(BHCS)。实践获得了PCMH 2010-2011年获得国家质量保证委员会(NCQA)的认可。 目标：目标1：估算初级保健诊所的初始PCMH改造和应用成本 2008年NCQA标准下的正式认可。目标2：评估更新PCMH认可的成本 根据2011年NCQA标准，根据2008年标准初步认可的PCMH 方法：进行结构化访谈，以获得与以下方面有关的数据：1)活动的时间和精力 与PCMH改造和NCQA认证申请有关；2)额外的基础设施或设备 与NCQA认可转化和应用有关的采购；3)实践的程度 员工将在转型和转型期间从事创收活动 申请活动。企业资源主管、医生、中层提供者、医疗助理和 来自6个HTPN初级保健实践的代表性样本中的办公室经理将被采访。直接 成本的估算依据是：1)按工作类别划分的活动所需的时间和工作量乘以平均值 薪金系统中该职务类别每小时费率；和2)总分类账或 其他资金来源。对于医生，将使用报销来估计平均工资 收取的平均就诊次数减去非医生执业费用，折算为小时工资 该图基于来自个人实践记录的数据。实践的间接成本将根据以下因素进行估计 关于个人的时间和努力乘以执业所赚取的平均报销 平均办公室访问次数和个人用于有偿活动的努力百分比。 意义：拟议研究的结果将为初级保健提供者投资实践的决定提供信息 PCMH转型中的资源。结果也将有助于确定大小和结构 需要向初级保健实践提供的财政激励措施，以鼓励PCMH转型。

ABSTRACT Background: The patient-centered medical home (PCMH) is a promising model to achieve the "triple aim" of improving patients' experience of care, improving population health, and reducing per capita health care costs. Insurance companies are encouraging primary care practices to transform to PCMHs through financial incentives or direct contractual requirements. Practices considering the PCMH transformation and recognition process need information regarding the costs they will incur, to weigh these against the anticipated benefits for patient outcomes and the available financial incentives and make a fully informed decision. Objective: To quantify the time, effort, capital, and total direct and indirect costs associated with primary care practices' transformation to and sustained recognition as PCMHs, based on the experience of 60 primary care practices within HealthTexas Provider Network (HTPN), a large ambulatory care medical group practice affiliated with the Baylor Health Care System (BHCS) in North Texas. The practices obtained PCMH recognition from the National Committee for Quality Assurance (NCQA) in 2010-2011. Aims: Aim 1: To estimate the costs of a primary care practice's initial PCMH transformation and application for formal recognition under the 2008 NCQA criteria. Aim 2: To estimate the costs of renewing PCMH recognition under the 2011 NCQA criteria for a PCMH initially recognized under the 2008 criteria Methods: Structured interviews will be conducted to obtain data related to: 1) time and effort of activities related to PCMH transformation and application for NCQA recognition; 2) additional infrastructure or equipment purchased related to transformation and application for NCQA recognition; and 3) the extent to which practice staff would have been engaged in revenue-generating activities during the time spent on transformation and application activities. Corporate resource leaders, and physicians, midlevel providers, medical assistants, and office managers from a representative sample of 6 HTPN primary care practices will be interviewed. Direct costs will be estimated based on: 1) the time and effort for activities by job category multiplied by the average hourly rate for that job category in the payroll system; and 2) observed expenditures in the general ledger or other financial sources. For physicians, the average wage will be estimated using the reimbursements collected for an average office visit minus non-physician practice expenses, converted to an hourly wage figure, based on data from individual practice records. Indirect costs for the practices will be estimated based on the time and effort of individuals multiplied by the average reimbursements earned by the practice for an average office visit and the individual's percentage of effort going toward reimbursable activities. Significance: Results from the proposed study will inform primary care providers' decisions to invest practice resources in PCMH transformation. Results will also be useful in determining the size and structure of the financial incentives that need to be offered to primary care practices to encourage PCMH transformation.