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

摘要 背景：以病人为中心的医疗之家（PCMH）是实现“三重目标”的一种有前途的模式， 改善患者的护理体验，改善人口健康，降低人均医疗保健成本。 保险公司正在鼓励初级保健做法，通过金融转型为PCMH 激励措施或直接合同要求。考虑PCMH转换和识别的实践 过程需要关于他们将产生的成本的信息，以权衡这些与预期的收益， 患者的结果和可用的经济激励措施，并做出充分知情的决定。 目的：量化与初级保健相关的时间、精力、资金以及总直接和间接成本 实践的转变，并持续承认为PCMH，根据60初级保健的经验， HealthTexas Provider Network（HTPN）是一家大型门诊医疗集团， 贝勒医疗保健系统（Baylor Health Care System，BHCS）位于德克萨斯州北部。实践取得了PCMH 2010-2011年获得国家质量保证委员会（NCQA）的认可。 目的：目的1：估计初级保健实践的初始PCMH转型和应用的成本， 根据2008年NCQA标准获得正式认可。目标2：估计更新PCMH确认的成本 根据2011年NCQA标准，最初根据2008年标准认可的PCMH 方法：将进行结构化访谈，以获得与以下方面相关的数据：1）活动的时间和努力 与PCMH改造和NCQA认证申请有关; 2）额外的基础设施或设备 购买相关的改造和申请NCQA认可;和3）在何种程度上，实践 在转型期间，工作人员将从事创收活动， 应用活动。企业资源领导者、医生、中层供应商、医疗助理，以及 将对来自6个HTPN初级保健实践的代表性样本的办公室经理进行访谈。直接 成本将根据以下方法估算：1）按工作类别划分的活动所需时间和精力乘以平均值 薪工单系统中职务类别每小时费率; 2）总分类账中观察到的支出，或 其他资金来源。对于医生，平均工资将使用报销估计 收取的平均办公室访问减去非医生的做法费用，转换为小时工资 这一数字是根据个人实践记录中的数据得出的。这些做法的间接费用将根据 按个人的时间和努力乘以该业务为一个 平均办公室访问和个人的努力的百分比去偿还活动。 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转型的资源。结果也将是有用的，在确定的大小和结构， 需要向初级保健实践提供财政激励措施，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.