Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative

Abstract

PURPOSE Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODSWe undertook a descriptive analysis of CPC initiative practices' baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis.RESULTS Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators-all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician.CONCLUSIONS At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost. 2014;142-149. doi: 10.1370/afm.1626. Ann Fam Med INTRODUCTIONP ublic and private health care payers nationwide are testing whether making primary care more patient centered, accessible, coordinated, and comprehensive will improve health care quality, cost, and patient and clinician experiences. [1][2][3] Many are piloting versions of the patient-centered medical home (PCMH) model as defined by the primary care physician societies. 4 A cornerstone of these new care models is team-based care, in which staff work collaboratively with patients and their caregivers to achieve coordinated, high-quality care. [5][6][7][8][9][10][11][12] Traditional staff, such as medical assistants, often take on expanded roles, and new staff types may be added. The team is expected to collaborate to deliver high-quality, comprehensive care efficiently; however, we know little about the current or optimal practice team composition.Expanding staffing and shifting roles offers possible advantages. Expanded staffing could provide additional expertise and resources to support patient-centered, evidence-based primary care 13...

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