Researchers examine staffing patterns among nearly 500 technologically advanced primary care practices selected to participate in the Centers for Medicare and Medicaid Services Comprehensive Primary Care Initiative and find a significant gap between where the practices are and where policy makers expect them to be in order to implement new models of care.
Analyzing the practices' staffing composition before the start of the initiative, researchers found while most practices reported having administrative staff (98 percent) and medical assistants (89 percent), most did not have dedicated staff integral to providing team-based primary care - staff who provide health education, care coordination, behavioral health care, nutrition counseling and medication adherence and reconciliation.
Specifically, 53 percent reported having nurse practitioners or physician assistants; 47 percent reported having licensed practical or vocational nurses; 36 percent reported having registered nurses; 24 percent reported having care managers and/or coordinators; and 7 percent or fewer reported having pharmacists, social workers, community service coordinators, health educators or nutritionists.
The authors note that this restricted staff composition is not surprising given the current fee-for-service payment environment, which does not provide incentives for the delivery of comprehensive coordinated care. They conclude that without access to such staff - and payment for their services - practices are unlikely to deliver comprehensive, coordinated and accessible care to patients at a sustainable cost. They call for future research to understand what functions are optimally performed by which staff and what changes in staff size and composition improve outcomes for different types of practices and patients.
By Deborah N. Peikes, PhD, MPA Mathematica Policy Research Inc., Princeton, N.J.