Journal of Healthcare Management - March/April 2014 - (Page 101)

c osts and B enefits Because the reported personnel costs were opportunity costs, we asked practices to estimate the total personnel time required for IPIP activities, using a hypothetical case where all activities would be carried out by a single, new employee. These estimates were fairly consistent across the 12 practices. The most common response was a half-time licensed practical nurse or registered nurse. Most practices indicated that the person would need both a clinical background and information technology skills. A staff member at one practice suggested, "If you're going to work in a medical office, you've got to have some kind of medical terminology, medical experience, or it just doesn't work. And computer knowledge definitely is needed." A leader of another practice stated more specifically, "I think an RN is a good fit because of the background. But I think it has to be a master'sprepared RN. Because of the statistical background." The full range of estimated personnel needs is provided in Table 3. We applied national salary data (Bureau of Labor Statistics, 2011) to these estimates to arrive at personnel costs ranging from $4,474 to $69,110 per practice. The high end reflects the cost of a full-time registered nurse; however, most practices suggested that core NC IPIP requirements could be met with less than one FTE. Where practices provided a range, the high end reflects the costs of implementing quality improvement beyond NC IPIP; thus, we use the low end to calculate the average cost of transformation activities as $21,550, or $6,659 per provider FTE. All practices but one reported that costs were nontrivial, and of t ransfor Ming p riMary c are p ractices many suggested that they could engage more intensively with NC IPIP if they had more time and resources. Nonpersonnel Resource Costs of Practice Transformation Several practices reported incurring supply costs (e.g., the printing of forms and visit summaries) or information technology-related costs. However, many of these costs were related to daily practice operations and as such are not 100 percent attributable to participation in NC IPIP. Although these costs directly affected the practices' cash flow, they were reported to be minimal. Creative Strategies Employed to Control Costs Interviewees across the 12 sites reported using creative strategies to limit or offset the cost of practice transformation. These strategies fell into one of three categories. First, practices reported leveraging the practice coach to actually perform transformation-related activities. One practice leader commented, "Those practice coaches helped us as well to . . . find resources [and] develop these forms to prompt us. We didn't just make it up on our own because we're so smart." Practice coaches were paid by the NC IPIP program and not by the participating practices. Second, many practices reported using existing organizational resources to support transformation efforts. These most often took the form of an employee with information technology expertise or previous quality improvement (QI) experience. One practice leader summarized, "If you've got to go out and . . . get that statistician, 101

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014