AHRQ Study Proposes Staffing Levels for High-Quality, Comprehensive Primary Care

A primary care practice may need 37 team members, including eight primary care clinicians, to provide high-quality, comprehensive care for a panel of 10,000 adult patients, according to a new study by a team that included AHRQ researchers. The study in the Journal of General Internal Medicine identified specific functions that comprise high-quality primary care and then estimated the resources necessary to provide it. The total costs for the practice to deliver this care averages $45 per patient per month. Researchers also estimated requirements for high-quality primary care in specific care environments:

For 10,000 adults with a high proportion of older patients: 52 staff, including 12 primary care clinicians, at $64 per patient per month
For 10,000 patients with high social needs: 50 staff, including 10 primary care clinicians, at $56 per patient per month
For 5,000 adults in a rural area: 22 staff, including four primary care clinicians, at $46 per patient per month

The research is aligned with AHRQ’s ongoing efforts to support quality improvement in primary care. Access the abstract.

2018 Jul 3. doi: 10.1007/s11606-018-4530-7. [Epub ahead of print]

Workforce Configurations to Provide High-Quality, Comprehensive Primary Care: a Mixed-Method Exploration of Staffing for Four Types of Primary Care Practices.

Meyers D1, LeRoy L2, Bailit M3, Schaefer J4, Wagner E4, Zhan C5.

Author information

Abstract

BACKGROUND:

Broad consensus exists about the value and principles of primary care; however, little is known about the workforce configurations required to deliver it.

OBJECTIVE:

The aim of this study was to explore the team configurations and associated costs required to deliver high-quality, comprehensive primary care.

METHODS:

We used a mixed-method and consensus-building process to develop staffing models based on data from 73 exemplary practices, findings from 8 site visits, and input from an expert panel. We first defined high-quality, comprehensive primary care and explicated the specific functions needed to deliver it. We translated the functions into full-time-equivalent staffing requirements for a practice serving a panel of 10,000 adults and then revised the models to reflect the divergent needs of practices serving older adults, patients with higher social needs, and a rural community. Finally, we estimated the labor and overhead costs associated with each model.

RESULTS:

A primary care practice needs a mix of 37 team members, including 8 primary care providers (PCPs), at a cost of $45 per patient per month (PPPM), to provide comprehensive primary care to a panel of 10,000 actively managed adults. A practice requires a team of 52 staff (including 12 PCPs) at $64 PPPM to care for a panel of 10,000 adults with a high proportion of older patients, and 50 staff (with 10 PCPs) at $56 PPPM for a panel of 10,000 with high social needs. In rural areas, a practice needs 22 team members (with 4 PCPs) at $46 PPPM to serve a panel of 5000 adults.

CONCLUSIONS:

Our estimates provide health care decision-makers with needed guideposts for considering primary care staffing and financing and inform broader discussions on primary care innovations and the necessary resources to provide high-quality, comprehensive primary care in the USA.