As the nation's focus on health care quality increases, clinicians and practices are being called upon to report on the health of their patients and the quality of care they provide. Their reports, in turn, are used in data-based quality improvement (QI) programs. Up until now, participation in such programs has been voluntary, but that likely will change in the not-too-distant future, resulting in financial and staff challenges related to data collection and reporting.
Researchers led by Jacqueline R. Halladay, M.D., M.P.H., of the University of North Carolina at Chapel Hill, studied eight demographically diverse primary care practices in North Carolina to determine the costs they incurred in implementing and maintaining quality reporting programs. Each of the practices participated in at least one of four quality reporting programs. The practices varied by size, ownership, specialty, location, and medical record format; four were not-for-profit practices, three were nonprofit practices, and one was a teaching practice.
The major expenses incurred by the practices were associated with planning, staff training, modification of electronic systems, visit coding, data gathering and entry, and maintenance of the data registry. Costs per full-time equivalent physician ranged from less than $1,000 to more than $11,000 during QI program implementation and from less than $100 to more than $4,000 annually during the maintenance phase. Practice costs also varied widely among the four reporting programs, underscoring the considerable challenges to QI work in primary care. Small practices appeared to be particularly affected by program participation costs. Cost variations among the practices were due principally to lack of interoperability among information technology systems, the amount of work done by QI program staff, and differences in the way data elements were defined, gathered, and transmitted. The researchers conclude that participation in quality reporting programs can be costly, and programs seeking to engage primary care physicians should choose measures with great care. They suggest that financial and nonfinancial incentives may help improve physician acceptance. This research was supported by the Agency for Healthcare Research and Quality (Contract No. 290-07-10014).
Details are in "Cost to primary care practices of responding to payer requests for quality and performance data," by Dr. Halladay, Sally C. Stearns, Ph.D., Thomas Wroth, M.D., M.P.H., and others in the November/December 2009 Annals of Family Medicine 7(6), pp. 495-503.