Start up and incremental practice expenses for implementing behavior change interventions in primary care

Context: If behavior change services are to be offered routinely in primary care practices, providers must be appropriately compensated. Estimating what is spent by practices in providing such services is a critical prerequisite for establishing appropriate payment, , and is the objective of this study. There is very little published on such estimates in the U.S.

Objective: To obtain credible estimates of the start-up and incremental expenses required to plan and implement each of ten behavior change interventions targeting: lack of physical activity; unhealthy diet; tobacco use; and risky use of alcohol, in primary care practices.

Methods/Outcome measures: In-practice expenditure data were collected from each of 30 practices nested in 10 PBRN interventional studies across the U.S. during 2006/2007 using a standardized instrument. The data were analyzed and credible expense estimates were calculated for the startup period, and incremental estimates for the implementation phase of the interventions.

Results: Average startup expenses were $1860 per practice (s.e. = $455). Most startup expenditures were for staff training. Average monthly direct care intervention expenditures were $15 per patient participant (s.e. = $5). Average monthly overhead intervention expenditures were $43 per patient participant (s.e. = $17). Most intervention expenditures were under-estimates, and spent on recruitment and screening.

Conclusions: Primary care practices must spend money to address their patients' unhealthy behaviors, at least $1860 to initiate systematic approaches and $58 per participant/month to implement them routinely. Until primary care payment systems incorporate these expenses, it is unlikely these services will be readily available.