The GW HWRC’s research agenda focuses on emerging workforce topics relating to Title VII of the Public Health Service Act (PHSA). We produce multiple research studies per year, as well as several short turnaround policy briefs on topics of interest to HRSA.
1. Can Medicare Public Use File Data Identify NPs/PAs That Bill “Incident to” Physicians
This study will explore a new method for identifying nurse practitioners (NPs) and physician assistants (PAs) that bill “incident to” physicians, as opposed to billing Medicare directly for their services. Research questions include:
- How many NPs and PAs bill “incident to” physicians versus billing Medicare directly for their services?
- Does the rate of NP/PA “incident to” billing vary in states with more or less restrictive scope of practice laws?
- Is the rate of “incident to” billing changing over time?
2. Does NHSC Clinician Presence Affect the Use of Temporary Personnel and Overall Costs of Medical
Staff in FQHCs?
Staff in FQHCs?
This study will focus on measuring the relationship between the increased use of NHSC participants and the use of temporary personnel, as well as, lower overall costs of medical staff in federally qualified health centers (FQHCs). Research questions include:
- Does NHSC participation affect the use of temporary personnel in FQHCs?
- Does NHSC participation affect the overall costs of medical staff in FQHCs?
3. Predicting use of Telehealth in Community Health Centers
This study will examine site and state specific factors that can influence the use of telehealth services in CHCs, such as:
- rural/urban location
- size of the CHC
- PCMH status
- participation in an ACO
- CHC affiliation with other provider networks
- state policies that restrict use of telehealth services
4. THE IMPRINTING OF PROVIDING LOW COST CARE WITHIN FAMILY MEDICINE RESIDENCY PROGRAM
In this study we are interested in understanding the effects of participating in the National Health Services Corp (NHSC) Loan Repayment Program. Research questions include:
- Whether NHSC participants have higher-cost or lower cost practice patterns 4-5 years after participation, than peers.
- Whether there is a difference in cost practice patterns between NHSC participants who remain in “safety net” setting than those do not.
- Whether there are changes over time among NHSC family medicine residents in practice patterns. That is, does the imprinting fade with time?
5. WHY DOES NURSE PRACTITIONER (NP) AND PHYSICIAN ASSISTANT (PA) PRODUCTIVITY VARY ACROSS COMMUNITY
HEALTH CENTERS (CHCS)?
HEALTH CENTERS (CHCS)?
This study explores the question of how and why NP and PA productivity varies across CHCs. The growing shortage of primary care physicians, combined with the surge in new NP and PAs, has meant that many organizations are expanding their use of nurse practitioners (NPs) and physician assistants (PAs). Sample interview questions include:
- How is the NP or PA used in a team, i.e., do they have their own panel, their own schedules, do they have less complex patients than physicians, and why?
- How much time is each profession allotted for a visit and whether this differs from physicians and why? How many patients are seen by each type of professional per day?
- Is support staff is available to the NP/PA, e.g., RN, LPN, MAs, scribes, registration clerks?
- Park J, Wu X, Frogner B, Pittman P. 2018. Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers? Medical Care. doi: 10.1097/MLR.0000000000000965
- Frogner B, Wu X, Park J, Pittman P. 2017. The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers. Health Services Research, 52(S1): 407-421.
- Frogner B, Wu X, Ku L, Pittman P, Masselink L. 2017. Do Years of Experience With Electronic Health Records Matter for Productivity in Community Health Centers? Journal of Ambulatory Care Management, 40(1): 36–47.
- Li S, Pittman P, Han X, Lowe T. 2017. Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels. Health Services Research, 52(S1): 422-436.
- Malcarney M, Pittman P, Quigley L, Horton K, Seiler N. 2017. The Changing Roles of Community Health Workers. Health Services Research, 52(S1): 360-382
- Pittman P, Li S, Han X, Lowe T. 2017. Clinical nonlicensed personnel in U.S. hospitals: Job trends from 2010 to 2015. Nursing Outlook, 66(1): 35-45.
- Pittman P, Masselink L, Bade L, Frogner B, Ku L. 2016. Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives. Journal of Healthcare Management, 61(5): 364-377.
- Pittman P, Scully-Russ E. 2016. Workforce Planning and Development in Times of Delivery System Transformation. Human Resources for Health, 14: 56.
- Ku L, Frogner B, Steinmetz E, Pittman P. 2015. Community Health Centers Employ Diverse Staffing Patterns, Which Can Provide Productivity Lessons for Medical Practices. Health Affairs, 34(1): 95-103.
These projects were supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U81HP26493. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.