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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

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
  • 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)

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)
  • 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

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)

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

versus ~ $800/qtr during Rollout

implications
Implications
  • 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