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Physician Productivity Linked to Adequate Space and Staffing.

Findings from a recent United Hospital Fund/New York University Ambulatory Care Provider Survey reveal that adequate space and staffing levels are essential to high physician productivity at New York City ambulatory care clinics. Two or more exam rooms per physician appear to nearly double physician productivity, and having adequate support staff seems to improve productivity by relieving physicians from time-consuming patient needs other staff can meet.

These findings, released in the Fund's publication Medicaid Managed Care Currents, indicate that having three or more support staff per physician--including registered nurses, licensed practical nurses, pharmacists, therapists, social workers, outreach workers, and case managers--was associated with an increase in physician productivity from 2.0 to 3.6 visits per hour.

"These findings clearly indicate that efforts to improve physician productivity at ambulatory care sites should focus on assuring adequate space and staffing levels," said James R. Tallon, Jr., president of the United Hospital Fund. "Contrary to conventional wisdom, it is these factors and not the growth in Medicaid managed care enrollments which appear to have the greatest impact on ambulatory care productivity."

At the sites surveyed, the presence of medical residents (physicians in training) does not appear to have a negative impact on physician productivity. Having residents present may even benefit physicians by keeping their skills honed and providing an added sense of professionalism by linking these community-based physicians to academia.

The spring issue of Currents also reports that the proportion of visits by uninsured patients to the clinics had no significant effect on productivity. The survey did show, however, that productivity steadily increased as the percentage of Medicaid visits increased. In addition, the survey found a lower rate of productivity associated with privately insured patients.

The new issue of Currents also includes an article that reveals that primary care providers, rather than the plans, appear to be bearing much of the financial risk associated with ambulatory care for Medicaid managed care beneficiaries. The article, based on findings from the 1997 United Hospital Fund survey of plans participating in New York City's Medicaid managed care program, reports that plan payments to providers rarely provide incentives to improve the quality of care.

Medicaid Managed Care Currents is a quarterly publication tracking developments in New York City's Medicaid managed care program. It is based on research and analytic work of the New York Consortium for Health Services Research, a collaborative undertaking of the United Hospital Fund, Columbia University, and New York University.

The United Hospital Fund is a health services research and philanthropic organization addressing issues affecting hospitals and health care in New York City. For more information, contact Eleanor Rorer at 212-494-0732.
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Publication:Health Care Financing Review
Date:Jun 22, 1999
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