News From The Annals Of Family Medicine, May/June 2013

Much of the May/June 2013 issue of Annals of Family Medicine and the entirety of an accompanying supplement published in partnership with the U.S. Agency for Healthcare Research and Quality are about changing primary care practice. Practice transformation on a large scale toward the patient-centered medical home model of care is a cornerstone of health care reform efforts in the United States, and the research and commentary in this issue can serve as a roadmap to achieve practice transformation. Not only do the articles address the opportunities, challenges, costs, processes and determinants of such change, but importantly, many also consider contextual factors - information important to understanding what happened and why and factors that would be critical to others attempting to transport the findings to different times, settings or situations. The journal editors hope that by including these contextual factors, the important research findings detailed in this issue can be more readily translated into practice.

Median Cost of Practice Facilitation to Improve Chronic Illness Care About $10,000 for Small Primary Care Practice

Widely recognized as a promising method for achieving large-scale practice redesign, practice facilitation using outside consultants, researchers estimate, cost a small primary care practice between $9,670 and $15,098 per year, or the cost of two to three hospitalizations. Reporting on the direct costs of providing practice facilitation that focuses on improving chronic illness care to a sample of 19 small primary care clinics with one to four clinicians, the researchers found the median total variable costs of all practice facilitation intervention activities, including six meetings over a 12-month period from start-up through monitoring was $9,670 per practice (range = $8,050 to $15,682). These estimates do not include overhead costs to the practice for staff and systems. The authors note that because much of the cost of practice facilitation is devoted to start-up and practice assessment (47 percent), the costs of ongoing facilitation activities in subsequent years would likely be much lower.

Cost Estimates for Operating a Primary Care Practice Facilitation Program
By Steven D. Culler, PhD, et al
Emory University, Atlanta, Ga.

Editorial: Payers Should Bear the Cost of Practice Transformation and Clinicians Should be Held Accountable for Providing Value to Patients

Researchers address the opportunities as well as the challenges and costs of transforming practice toward the patient-centered medical home model of care in this editorial. The authors assert that primary care practices cannot bear the costs of transformation unless they are reimbursed for the costs they incur. For the needed changes to occur on a wide and sustainable basis, they argue that payers should fund the full cost to primary care practices, which is estimated at a minimum of $7-12 per patient per month in addition to usual fee-for-service reimbursement. They call for payment reform and cast a vision for an alternative system that fosters a shared sense of responsibility for cost, quality and service in which primary care physicians are held accountable for providing value to patients, and are compensated for the value they provide.