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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 **.

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Access Initiative Impacts on Primary Care Provider Productivity

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  1. 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**

  2. Timeline of Group Health Cooperative Access Initiative and Initiative Components

  3. 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

  4. 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)

  5. 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

  6. 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)

  7. 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)

  8. 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

  9. Visits per FTE Productivity over Initiative Time (adjusted)

  10. RVU per Visit Levels over Initiative Time (adjusted)

  11. RVU per FTE Productivity over Initiative Time (adjusted)

  12. Cost per Panel Member (PMPQ) over Initiative Time (adjusted) Note: Raw Post-Full Costs ~ $650/qtr versus ~ $800/qtr during Rollout

  13. 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

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