Table 2.

Time and Activities for the HealthTexas Corporate Patient-Centered Medical Home (PCMH) Team for Initial National Committee for Quality Assurance PCMH Accreditation (2008 Criteria)

RoleActivitiesTimeAnnualized FTE*Mean Hourly Wage ($)Total Cost ($)
PCMH director• Assemble program structure and write first application0.50–0.60 FTE (first 6 months, January to June 2010)0.2879.0045,185
• Work with practice administrators and operations managers to get the guidelines/protocols/processes in place and the documentation needed for the application0.10–0.15 FTE (July 2010–June 2012)0.2541,077
• 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)0.80131,448
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 instructions1.0 FTE (first 6 months, January to June 2010)0.5028.3829,512
• Work with practice administrators and operations managers to put together the documentation for the practice applications; write the applications2 FTE (July 2010 to June 2012) + ∼0.1 FTE for 8 months + 0.2 FTE for 4 months4.13243,968
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 initiative0.1–0.15 FTE for 12–18 months0.17146.4051,386
• 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 do0.6 FTE (a half day/week for each of 6 MDs) for ∼12 months0.60146.4051,386
• Review the required 36 charts per practice for compliance with the criteria on the clinical side1.0 FTE for July 2010 to June 2012 (20 h/week for 1 physician, 3–4 h/week for 5 physicians)2.00609,024
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 initiativePhysician: 0.2 FTE (first 6 months, January to June 2010)0.10130.6527,175
• Perform administrative and leadership tasksPhysician: 0.1 FTE (July 2010 to June 2012)0.2054,350
• Program the changes in the EMRStaff: 0.2 FTE (Jan 2010 to June 2012)0.4060.7050,498
HealthTexas director of clinical informatics• Spend supervisory time related to PCMH reporting work0.25 FTE for 12 months0.2584.3843,875
  • Creating reports required to meet the PCMH criteria–both creation of new reports (eg, pre-visit planning), and tweaking existing reports so that they would include the necessary elements (eg, performance reports for asthma and diabetes)

    • Data sources: EHR, HealthTexas data warehouse

    • used SQL server reporting services

  • Produce the reports (automated)

  • Answer queries practices submit to the help desk regarding reports

Programming time:
  • Previsit planning: 60 hours

  • Demographics: 24 hours

  • Priority conditions: 60–100 hours each if no pre-existing report§

Negligible human time0.0000
1.5 FTE for all helpdesk services; during application periods, ∼10% of queries are related to PCMH reports0.1524.297,579
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 assistants8.0018.75312,023
1 FTE manager1.0037.8778,767
  • * 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.