Journal of Healthcare Management - March/April 2014 - (Page 99)

c osts and B enefits of transcripts and met to reach consensus on the final set of codes, code definitions, and use. Remaining transcripts were coded by two members of the study team. All coding was supported by ATLAS.ti qualitative data analysis software (Scientific Software Development, 2009). Throughout the process, the coding team met regularly to ensure coding consistency and to discuss emerging themes and subthemes. Themes and subthemes were defined when supported by evidence from multiple sites and agreement among coding team members. t ransfor Ming p riMary c are p ractices activities and (2) nonpersonnel resource costs of practice transformation. Personnel Time for TransformationRelated Activities The most commonly mentioned cost was of personnel time for transformation-related activities. One practice leader noted, "If I had to say anything, it's going to relate to [fulltime equivalent staff]. . . . Because [IPIP] certainly . . . did not add cost in terms of any kind of materials when I look at any capital outlay." Specific activities mentioned that took staff time included the following: R E S U LT S As shown in Table 2, the 12 practices specialized in either family/internal medicine (n = 8) or general pediatrics (n = 4). Most practices (66.7%) were owned by physicians or providers; two were owned by health systems; and the other two were publicly owned. The majority (75%) had an electronic health record system in place. On average, practices had seven providers (range = 1 to 32). The mean practice overhead rate was 78.86% (range = 55.73% to more than 100%). For each practice, we categorized interviewees' responses into themes identified among the 12 sites. Where appropriate, we further divided themes into subthemes to provide a more nuanced view. We discuss each theme and subtheme below. 1. Data management (e.g., managing the registry, reporting to IPIP, modifying the electronic health record, pulling chart data) 2. Development and maintenance of forms (e.g., visit planners) 3. Attendance at meetings (e.g., internal meetings to review data and redesign workflow, external meetings to share and learn from others' IPIP experiences) Despite the emphasis on personnel cost, none of the practices reported hiring staff or paying overtime for transformation activities; therefore, the costs mentioned above reflect opportunity costs. This finding was confirmed by our examination of practice overhead rates, which appeared stable over time for practices before and after NC IPIP participation (data not shown). Personnel costs were absorbed by practice staff, whose responsibilities increased during the workday, or by practice leaders, who worked unpaid overtime on nights Practice-Level Costs of Transformation Interviewee responses regarding practice-level transformation costs were categorized into two themes: (1) personnel time for transformation-related 99

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