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)

Role	Activities	Time	Annualized 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 applications^{^‡}	53.3 h/practice^{^‡}	1.44	28.38	85,018
PCMH specialists	• 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^{^§}	0.04		2,384
Physician executive leader	• Develop mechanism to identify high-risk patients	12 hours	0.01	146.40	1,757
Physician executive leader	• Lead development of new guidelines (depression) and metrics (to be built into EMR)	12 hours	0.01		1,757
Physician champions	• Educate primary care physicians about changes under the 2011 criteria	1–2 h/practice^{^§}	0.04	146.40	12,298
Physician champions	• 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)	0.18		55,486
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 FTE	0.08	130.65	20.381
Informatics and disease management	• Program the changes in the EMR	Staff: 0.1 FTE	0.10	60.70	12,625
HealthTexas director of clinical informatics	• Spend supervisory time related to PCMH reporting work	0.25 FTE	0.25	84.38	43,875
	• Create reports required to meet the PCMH criteria	Programming time: Depression: 60 hours Audit tool: 80 hours	0.07		11,813
	• Produce the reports (automated)	Negligible human time	0.00	0	0
	• Answer queries practices submit to the help desk regarding reports	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, 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 assistants^{^‖}	8.00	18.75	312,023
Care coordination resource		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.
↵‡ 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.