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Estimating the Costs of Primary Care Transformation: A Practical Guide and Synthesis Report

Appendix B. Example Data Collection Tools (continued)

Example 5. Cost Dimensions Tool

Principal Investigator: Michael Magill
Institution: University of Utah, School of Medicine
Contact Information: michael.magill@hsc.utah.edu

The screenshots below are extracts of the cost dimensions tool developed by Magill et al. This tool was based on NCQA 2011 PCMH recognition criteria to assess the line item costs to practices associated with activities to sustain PCMH services. The tool includes three worksheets: Costs, Personnel, and PCMH Functions. Staff used to support each NCQA Standard, Element, and Factor were identified, including the number of FTEs in various staff positions (e.g., nurse, clinical care manager) and hours worked per month to deliver PCMH services (cost worksheet). An hourly rate was calculated for every staff position (salary or hourly rate adjusted for the cost of benefits) and referenced to produce the line item cost attributed to each PCMH service.

2011 NCQA PCMH

Resources and Systems unique to mature PCMH 2011 Level III practices (i.e., not found in traditional, high performing, primary care practices) (Development and implementation NOT bolded.)

Table showing the first part of the cost dimensions tool developed by Magill and colleagues based on the NCQA 2011 recognition criteria. The user enters information on the practice’s resources and systems unique to mature PCMH 2011 Level III practices such as “staffing for 5 hours on a Sat. AM” in order to meet the “After Hours Access” criteria.

Table showing Part II of the cost dimensions tool which is used to assess staffing information. Users enter position titles, hourly rates and salary, average hours per week, and other details on practice staffing.

Table showing Part III of the cost dimensions tool which is used to generate a functional assessment of the practice. Users review a list of elements and factors based on NCQA recognition criteria and enter which are relevant to their practice in order to determine those requiring additional costs to the practice.

Example 6. Cost Capture Template

Principal Investigator: Arturo Vargas-Bustamante
Institution: University of California, Los Angeles
Contact Information: avb@ucla.edu

The screenshots below are of the structured cost tool developed by Vargas-Bustamante et al. This tool is a short, easy-to-understand cost capture template (CCT) that was completed by key program administrators to report on the costs of senior wellness care redesign. The CCT structure was based on the Prescription for Health (P4H) framework (developed in collaboration between the Robert Wood Johnson Foundation and AHRQ), which outlines various categories of startup and incremental expenses. To customize the CCT, appropriate job descriptions were added to the template based on labor resources used for the transformation. Screen shots of the original P4H tool have also been included in this Practice Guide.

Overview: The cost capture template is designed to collect costs for the Comprehensive Wellness Visit (CWV).

Regions: The upper section includes costs for all regions together. Below that, the regions are listed separately. While the regions are now broken into North and South; however, the former region names are used to indicate the historical regions.

  • Region 1 is ______________________
  • Region 2 presents ________________
  • Region 3/4 are ___________________

Time periods: The template includes columns for each year from 2008–2012.

  • Please include both startup and incremental costs. If the program was not implemented in a year, please indicate this in the comments. For example, if there were no costs in 2008 ($0 in 2009), startup costs in 2009 ($X in 2009), and early pilot testing in 2010 ($Y in 2010), please indicate each costs in the appropriate year with the comments indicating which costs are entered in each year.
  • Please also indicate the number of clinics operating the program in each year (in the green section, to the right of the blue costs section). For example, there could be 0 clinics in 2008, 0 clinics in 2009, and X clinics in 2010.

I. Methods to calculate costs:

Since there may be multiple methods used to estimate the costs for each category, please provide:

  • Comments or supporting documentation to facilitate review and support of the cost identified.
  • A detailed description of the allocation method used to distribute total provider costs.

This table is a structured cost tool developed to collect cost information for comprehensive wellness visits. The table details cost line items for training (creating and updating), staff (attending trainings, contracting patients, incidental costs, and patient visit time), and equipment (medical and office). Users can enter information on all regions together or separately.

Overview: The cost capture template is designed to collect costs for the Senior Wellness Visit (SWV).

Regions: The upper section includes costs for all regions together. Below that, the regions are listed separately. While the regions are now broken into North and South; however, the former region names are used to indicate the historical regions.

  • Region 1 is ______________________
  • Region 2 presents ________________
  • Region 3 / 4 are __________________

Time periods: The template includes columns for each year from 2008–2012.

  • Please include both startup and incremental costs. If the program was not implemented in a year, please indicate this in the comments. For example, if there were no costs in 2008 ($0 in 2009), startup costs in 2009 ($X in 2009), and early pilot testing in 2010 ($Y in 2010), please indicate each costs in the appropriate year with the comments indicating which costs are entered in each year.
  • Please also indicate the number of clinics operating the program in each year (in the green section, to the right of the blue costs section). For example, there could be 0 clinics in 2008, 0 clinics in 2009, and X clinics in 2010.

I. Methods to calculate costs:

Since there may be multiple methods used to estimate the costs for each category, please provide:

  • Comments or supporting documentation to facilitate review and support of the cost identified.
  • A detailed description of the allocation method used to distribute total provider costs.

This table is a structured cost tool developed to collect cost information for senior wellness visits. The table details cost line items for training (creating and updating), staff (attending trainings, contracting patients, incidental costs, and patient visit time), equipment (medical and office) and patients (transportation and incentives). Users can enter information on all regions together or separately.

Example 7. Prescription for Health (P4H) Toolkit: Templates for Collecting and Calculating Expenditure Data in Primary Care Interventions

Web Site: http://www.prescriptionforhealth.org/results/toolkit.html
Contact Person: Maribel Cifuentes
Institution: University of Colorado Health Sciences Center
Contact Information: Maribel.cifuentes@uchsc.edu

The screenshots below contain images taken from the original P4H templates for collecting and calculating expenditure data in primary care interventions, developed in collaboration between the Robert Wood Johnson Foundation and AHRQ. This set of standardized tools was created for the collection of expenditure data in primary care practices during three phases of a behavioral change intervention (baseline, steady state midpoint, and steady state endpoint). The user’s guide provides step-by-step instructions on the use of these tools. The tools were developed to arrive at credible estimates of startup and incremental expenses incurred by practices to implement their Prescription for Health interventions. The tools were not developed to be used as data collection/calculation instruments to undertake a full-fledged cost-benefit or cost-effectiveness study. The screenshots included in this Practice Guide are for the baseline intervention only; the steady state midpoint and steady state endpoint tools were similar.

Collecting intervention expenses data

Figure 1 - Participant Flow Diagram

This graphic is the participant flow diagram for the P4H baseline intervention tool template. Users complete this figure to track and report the number of patients participating in all and any of the different phases of the intervention.

Collecting intervention expenses data
Table 3 - Basic Operating Expenditures

This is Table 3 of the P4H baseline intervention tool template. Users complete this table to track and collect any and all expenses such as recurrent expenditures, non-recurrent expenditures, overhead, and other expenditures. Staff time is included.

Calculating intervention expenses
Table for Calculating - Gross Direct Patient Expenses

This table from the P4H baseline intervention tool template is for calculating gross direct patient expenses. This spreadsheet uses the information entered in the first figure of the tool and Table 3 of the tool to determine gross direct patient expenses.

Calculating intervention expenses
Table for Calculating - Overhead Gross Expenses

This table from the P4H baseline intervention tool template is for calculating overhead gross expenses. This spreadsheet uses the information entered in the first figure of the tool and Table 3 of the tool to determine gross overhead expenses.

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Page last reviewed February 2017
Page originally created February 2017

Internet Citation: Appendix B. Example Data Collection Tools (continued). Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/ncepcr/reports/cost-guide/collection-tools2.html

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