Article Title

Estimating the Human Resource Costs of Developing and Implementing Shared Medical Appointments in Primary Care

Publication Date



primary care, activity-based costing


Background/Aims: Shared medical appointments (SMAs) or group visits have been shown to improve access, but there is no research to date on the costs of developing and implementing SMAs. We estimate the human resource costs of developing and implementing an administrative program to support SMAs and an additional SMA on cancer survivorship.

Methods: Activity-based costing was used to analyze the human resource costs for completed tasks, personnel involved and time to complete tasks. The study occurred in one division of a nonprofit, multispecialty group practice in northern California that serves 126,000 patients. We conducted in-depth, key-informant interviews with stakeholders involved in SMAs –– clinicians, coordinator, and operations manager –– from different levels of the organization. National median wages were calculated from the 2013 Bureau of Labor Statistics.

Results: We estimate that the human resource cost to develop and implement a program to support SMAs was $62,874. The employee who spent the most time (1,255 hours) was the SMA coordinator and the activity that required the most time (1,211 hours, $52,945) was for research tasks including establishing workflow and logistics of a SMA program. Once the SMA program was established, the cancer survivorship SMA cost $7,271 to develop and implement. The physician who ran the cancer survivorship SMA spent the most time and provided the most expensive labor (72.5 hours, $6,513) and the most time-consuming and costly activity was the development of materials (44 hours, $3,768).

Discussion: Developing and implementing a program to support SMAs took the SMA coordinator about 8 months. Introducing new providers or a new type of SMA may require a relatively modest incremental commitment of organizational resources and provider time (less than 6% of the time and less than 14% of the finances required to start the initial SMA). It is possible that the total time and cost could be further decreased by leveraging relevant materials from existing SMAs.