Access intervention in an integrated, prepaid group practice: effects on primary care physician productivity.
OBJECTIVE
To estimate the joint effect of a multifaceted access intervention on primary care physician (PCP) productivity in a large, integrated prepaid group practice.


METHODS
Administrative records of physician characteristics, compensation and full-time equivalent (FTE) data, linked to enrollee utilization and cost information.


METHODS
Dependent measures per quarter per FTE were office visits, work relative value units (WRVUs), WRVUs per visit, panel size, and total cost per member per quarter (PMPQ), for PCPs employed >0.25 FTE. General estimating equation regression models were included provider and enrollee characteristics.


RESULTS
Panel size and RVUs per visit rose, while visits per FTE and PMPQ cost declined significantly between baseline and full implementation. Panel size rose and visits per FTE declined from baseline through rollout and full implementation. RVUs per visit and RVUs per FTE first declined, and then increased, for a significant net increase of RVUs per visit and an insignificant rise in RVUs per FTE between baseline and full implementation. PMPQ cost rose between baseline and rollout and then declined, for a significant overall decline between baseline and full implementation.


CONCLUSIONS
This organization-wide access intervention was associated with improvements in several dimensions in PCP productivity and gains in clinical efficiency.
Conrad
Douglas
D
Department of Health Services, University of Washington, Box 357660, Suite H660C, Seattle, WA 98195-7660, USA. dconrad@u.washington.edu
Fishman
Paul
P
Grembowski
David
D
Ralston
James
J
Reid
Robert
R
Martin
Diane
D
Larson
Eric
E
Anderson
Melissa
M
D000555:Ambulatory Care Information Systems; D019033:Delivery of Health Care, Integrated; D003953:Diagnosis-Related Groups; D004526:Efficiency; D005260:Female; D006125:Group Practice, Prepaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007061:Idaho; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D017146:Models, Organizational; D009042:Motivation; D009819:Office Visits; D018802:Patient-Centered Care; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D015397:Program Evaluation; D012044:Regression Analysis; D015895:Relative Value Scales; D014861:Washington