Access initiative impacts on primary care provider productivity
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Access Initiative Impacts on Primary Care Provider Productivity. Douglas A. Conrad, PhD* Paul Fishman, PhD** University of Washington, Department of Health Services * , and Group Health Cooperative, Center for Health Studies **.

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Access initiative impacts on primary care provider productivity

Access Initiative Impacts on Primary Care Provider Productivity

Douglas A. Conrad, PhD*

Paul Fishman, PhD**

University of Washington, Department of Health Services*, and Group Health Cooperative, Center for Health Studies**



Productivity hypotheses
Productivity Hypotheses Initiative Components

Postulated Principally Positive Effects of Access Initiative on Productivity

However, Anticipated Some Short-Run Decrements in PCP Productivity, Potentially in Adjusting to:

  • New Systems

  • New Incentives

  • New Clinical Management Routines


Overview of study design
Overview of Study Design Initiative Components

  • Productivity Analysis Embedded within Overall Evaluation of the Initiative Intervention

  • Analysis Period: 1998 – 2005

  • Unit of Observation: PCP in any of 32 Quarters, at least .25 FTE, practicing within the Integrated Group Practice (IGP) in Western Washington

    • 147 unique physicians (49%, or 72, of eligible PCPs present in all 32 quarters)


Study design continued
Study Design (continued) Initiative Components

Dependent Variables in Productivity Analyses included: (at PCP-Quarter level)

  • Mean Work RVUs per FTE

  • Mean Visits per FTE

  • Mean Work RVUs per Visit (“Intensity”)

    Also, examined the “Dual” of Productivity:

  • System Cost of Care per PCP empanelled Enrollee


Independent variables in productivity analyses general estimating equation models
Independent Variables in Productivity Analyses (General Estimating Equation Models)

  • Initiative Time

  • Primary Care Clinic (“fixed effects”)

  • Interactions: Initiative Time*Clinic

  • PCP Years in the IGP

  • PCP Gender

  • Case Mix (Expected Resource Intensity) of Individual PCP’s “Panel” (prospective)


Description of study sample pcps and enrolled panel
Description of Study Sample (PCPs and Enrolled Panel) Estimating Equation Models)

  • 70% of PCPs were Male

  • 41% of PCP-Quarters had 1.0 FTE

  • Mean Panel Size: 1455 (SD = 557)

  • 84% in Commercial Market Segment

  • Mean Age of Panel Enrollees: 43 years

  • 51% of Panel Enrollees are Women

  • Mean Per Member Per Quarter Cost: $744 (SD = $407)


Primary care productivity patterns over initiative time
Primary Care Productivity Patterns over Initiative Time Estimating Equation Models)

Relative to Pre-Initiative Levels:

RVU/FTE Rose during Rollout, Rose Further during Full Implementation

RVU/Visit Intensity Rose Modestly during Rollout, More Dramatically Post-Initiative

Costs per Panel Member Rose during Rollout, Declined below Pre-Initiative Levels during Full Implementation





Cost per panel member pmpq over initiative time adjusted
Cost per Panel Member (PMPQ) over Initiative Time (adjusted) Estimating Equation Models)

Note: Raw Post-Full Costs ~ $650/qtr

versus ~ $800/qtr during Rollout


Implications
Implications Estimating Equation Models)

  • Comprehensive Access Initiative Was Associated with Increased PCP Productivity and Reduced PMPQ Cost for Primary Care Providers

  • System Adjustments Appeared to Mitigate Potential Decrements

  • Enhanced Productivity Occurred in Parallel with declining, then flat FTE, respectively, during Rollout, Post-Full Implementation


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