Clinic Management, Productivity, and Cost: Results from Selected Navy Clinics

The Deputy Chief BUMED, Resource Management/Comptroller, asked CNA to examine the delivery of primary care to beneficiaries at a selected set of Navy clinics. We examined six primary care clinics and two family practice clinics within naval hospitals engaged in the graduate medical education of interns and residents. We explored several issues, including understanding clinic management practices, developing measures of productivity and costs associated with clinic visits, and the implications of other influences, such as the incentives on managing demand associated with the managed care support contracts. We found that the sites were generally productive, whether the unit of measure was based simply on the number of encounters with the provider or the complexity of the service provided to the beneficiary. We found that the average costs of the services varied across the clinics and were higher than the costs of primary care services to many of the same beneficiaries when obtained in civilian health care facilities. We also offered several recommendations based on our analysis, including improving the accuracy of the staffing data and developing reliable cost measures to allow comparisons of DOD and civilian costs.