Table 3.

Time and Activities for HealthTexas Corporate Patient-Centered Medical Home (PCMH) Team for renewal of National Committee for Quality Assurance PCMH accreditations (2011 or 2014 criteria)

RoleActivitiesTimeAnnualized FTE*Mean Hourly Wage ($)Total Cost ($)
PCMH specialists• Work with practice administrators and office managers to put together the documentation for the practice applications; write the applications53.3 h/practice1.4428.3885,018
• Conduct training on documentation in the EMR related to new standards (mostly related to replacing heart failure with depression as one of the priority conditions [required to have 1 related to mental health])1–2 h/practice§0.042,384
Physician executive leader• Develop mechanism to identify high-risk patients12 hours0.01146.401,757
• Lead development of new guidelines (depression) and metrics (to be built into EMR)12 hours0.011,757
Physician champions• Educate primary care physicians about changes under the 2011 criteria1–2 h/practice§0.04146.4012,298
• Perform required chart reviews (under 2011 criteria, 48 patient charts per practice; under 2014 criteria, 30 charts per practice)§10 min/chart (2011 criteria); 15 min/chart (2014 criteria)0.1855,486
Informatics and disease management• Develop mechanism to identify high-risk patients; coordinate changes in the EMR related to the need to collect structured data for new metrics (mostly around depression, the new priority condition)Physician: 0.05–0.1 FTE0.08130.6520.381
• Program the changes in the EMRStaff: 0.1 FTE0.1060.7012,625
HealthTexas director of clinical informatics• Spend supervisory time related to PCMH reporting work0.25 FTE0.2584.3843,875
• Create reports required to meet the PCMH criteriaProgramming time:
  • Depression: 60 hours

  • Audit tool: 80 hours

• Produce the reports (automated)Negligible human time0.0000
• Answer queries practices submit to the help desk regarding reports1.5 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, scheduling 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.

  • Unlike the initial recognition process, HealthTexas did not complete a corporate application for the renewals; an individual renewal application was completed for each practice.

  • § By May 2016, 56 PCMHs that obtained initial recognition under the 2008 National Committee for Quality Assurance criteria had renewed (33 under the 2011 criteria, 23 under the 2014 criteria).

  • Ongoing expense.

  • EMR, electronic medical record; FFS, fee-for-service.