Start-Up and Incremental Practice Expenses for Behavior Change Interventions in Primary Care

Background: 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 component of establishing appropriate payment and was the objective of this study. Methods: In-practice expenditure data were collected for ten different interventions, using a standardized instrument in 29 practices nested in ten practice-based research networks across the U.S. during 2006-2007. The data were analyzed using standard templates to create credible estimates of the expenses incurred for both the start-up period and the implementation phase of the interventions. Results: Average monthly start-up expenses were $1860 per practice (SE=$455). Most start-up expenditures were for staff training. Average monthly incremental costs were $58 ($15 for provision of direct care [SE=$5]; $43 in overhead [SE=$17]) per patient participant. Tile bulk of the intervention expenditures was spent on the recruitment and screening of patient participants. Conclusions: Primary care practices must spend money to address their patients' unhealthy behaviors-at least $1860 to initiate systematic approaches and $58 monthly per participating patient to implement the approaches routinely. Until primary care payment systerns incorporate these expenses, it is unlikely that these services will be readily available.