Time and Activities for the HealthTexas Corporate Patient-Centered Medical Home (PCMH) Team for Initial National Committee for Quality Assurance PCMH Accreditation (2008 Criteria)
| Role | Activities | Time | Annualized FTE* | Mean Hourly Wage ($)† | Total Cost ($) |
|---|---|---|---|---|---|
| PCMH director | • Assemble program structure and write first application | 0.50–0.60 FTE (first 6 months, January to June 2010) | 0.28 | 79.00 | 45,185 |
| • Work with practice administrators and operations managers to get the guidelines/protocols/processes in place and the documentation needed for the application | 0.10–0.15 FTE (July 2010–June 2012) | 0.25 | 41,077 | ||
| • Develop standard practices and templates for the applications, put together a handbook to guide practices through the process; write applications; build and categorize the library of documents required for the application; write guidelines and protocols required by the standards, shepherding them through the approval process; teach leaders about PCMH | ∼0.40 FTE (July 2010 to June 2012)‡ | 0.80 | 131,448 | ||
| PCMH specialists | • Learn about PCMHs; learn the NCQA online tool through which applications are submitted; upload the first practice application; communicate with NCQA regarding inconsistencies or ambiguities in their instructions | 1.0 FTE (first 6 months, January to June 2010) | 0.50 | 28.38 | 29,512 |
| • Work with practice administrators and operations managers to put together the documentation for the practice applications; write the applications | 2 FTE (July 2010 to June 2012) + ∼0.1 FTE for 8 months + 0.2 FTE for 4 months‡ | 4.13 | 243,968 | ||
| Physician executive leader | • Obtain board approval for HealthTexas-wide PCMH endeavor; get primary care physicians aligned and motivated; lead the physician champions; promote/hire administrative leaders and staff for the PCMH initiative | 0.1–0.15 FTE for 12–18 months | 0.17 | 146.40 | 51,386 |
| • Interpret NCQA PCMH criteria | |||||
| • Work with the decision support group to get the reports needed for PCMH accreditation | |||||
| • Work with physicians to write up the information for the 3 target conditions (diabetes, asthma, heart failure) and the evidence-based guidelines for those, and pull together patient education for those conditions | |||||
| • Work with the disease management group to build templates in the EMR; create physician checklists for patient visits involving the target conditions | |||||
| • Audit and review the applications (especially first, which was his practice, and other early ones); maybe 2 hours spent on this | |||||
| Physician champions | • Engage and train primary care physicians, educating them on what PCMH is, what getting accreditation involves, and what they would need to do | 0.6 FTE (a half day/week for each of 6 MDs) for ∼12 months | 0.60 | 146.40 | 51,386 |
| • Review the required 36 charts per practice for compliance with the criteria on the clinical side | 1.0 FTE for July 2010 to June 2012 (20 h/week for 1 physician, 3–4 h/week for 5 physicians) | 2.00 | 609,024 | ||
| Informatics and disease management | • Coordinate changes in the EMR to facilitate PCMH (add/change content, change wordings, tag things so reports could be created; add more structured data to capture of all requirements as they related to the 3 PCMH target conditions); chair the clinical committee reviewing all protocols for the PCMH initiative | Physician: 0.2 FTE (first 6 months, January to June 2010) | 0.10 | 130.65 | 27,175 |
| • Perform administrative and leadership tasks | Physician: 0.1 FTE (July 2010 to June 2012) | 0.20 | 54,350 | ||
| • Program the changes in the EMR | Staff: 0.2 FTE (Jan 2010 to June 2012) | 0.40 | 60.70 | 50,498 | |
| HealthTexas director of clinical informatics | • Spend supervisory time related to PCMH reporting work | 0.25 FTE for 12 months | 0.25 | 84.38 | 43,875 |
| Programming time:
| 0.16 | 27,338 | ||
| Negligible human time | 0.00 | 0 | 0 | ||
| 1.5 FTE for all helpdesk services; during application periods, ∼10% of queries are related to PCMH reports | 0.15 | 24.29 | 7,579 | ||
| Care coordination resource | • Identify and confirm gaps in preventive and chronic disease care, and schedule appointments to address these Note: We chose to focus on preventive services that can be billed for, ensuring that the care coordination resource pays for itself (under the FFS model) | 8 FTE medical assistants‖ | 8.00 | 18.75 | 312,023 |
| 1 FTE manager‖ | 1.00 | 37.87 | 78,767 |
↵* Number of full-time equivalents (FTEs) (eg, 1 FTE) multiplied by the number of months (eg, 24 months) over which those FTEs were sustained, divided by 12 months = the annualized FTE (eg, 2 FTEs).
↵† The mean hourly wage included a 22% fringe rate to account for the cost of employee benefits.
↵‡ This included 3 weeks spent putting together the corporate application (0.20 FTE for the PCMH director [with an associated cost of $1,896] + 2 FTE PCMH specialists [with an associated cost of $6,811]). The corporate application captured 44.25 of the 100 points required for accreditation; the remaining 55.75 had to come from individual practice applications.
↵§ HealthTexas had existing reports for 2 of the 3 priority conditions and was able to revise these to incorporate the PCMH criteria; for the calculation of time and cost, however, we assumed creation of 3 novel reports.
↵‖ Ongoing expense.
EMR, electronic medical record; FFS, fee-for-service; NCQA, National Committee for Quality Assurance.