Panel Size Is Just a Number: A Rubric for Opening and Closing Panels
Deciding whether primary care doctors have the capacity to take on more patients requires accounting for things like productivity, as well as panel size.
Fam Pract Manag. 2020 Mar-Apr;27(2):7-10.
Author disclosures: no relevant financial affiliations disclosed.
The ideal panel size is the holy grail of primary care redesign. If we could cap our panels at just the right number, we would provide better care for our patients and have more joy in our work, or so the conventional wisdom goes. But in leading the empanelment effort in our health care system of more than 20 sites and 130 primary care clinicians, we came to realize that panel size alone should not determine if a primary care clinician can accept new patients.
Having done the work of formalizing our empanelment process,1 attributing patients to each clinician, and finding that some panels were larger than others, we were left with an important question: Which panels should be closed to new patients? To determine this, we developed a rubric based on an adjusted panel size, plus each clinician's upcoming openings and productivity. Here's how it works.
Deciding whether a physician's panel should be open or closed depends on more than just determining the number of patients the physician is already seeing.
This rubric accounts for variables like how often the physician sees patients in clinic, how backlogged the physician's schedule is, and how productive the physician is.
The rubric categorizes physicians' panels as “low,” “medium,” or “high,” depending on statistical ranges that can be modified to meet the needs of individual practices.
THREE OBJECTIVE VARIABLES
To begin, we needed to understand the consequences of a panel that is the wrong size. If clinicians take care of too many patients, their patients will struggle to get timely follow-up appointments and quality of care will suffer.2 If clinicians cap their panel sizes too low, the primary care workforce shortage will be exacerbated and a larger percentage of the population will not have a primary care clinician.3 Furthermore, clinicians with panel sizes that are too small will not fill their schedules.
But just knowing the raw number of patients in a panel without context is not enough to determine whether that panel is the right size. Every group of patients has different needs and every clinician works at a different pace. 4 A clinician who cares for thousands of patients but ends each day with unused appointment slots can take new patients. Conversely, a clinician who has a panel of only a few hundred patients but no available appointments for three months should not accept new patients.
We were tempted to adjust panel size for the age, gender, or morbidity of patients, but we concluded these calculations would not help determine if a specific panel size is the right number for a certain clinician. The purpose of adjusting panel sizes by those measures is to promote fairness – e.g., my panel size might be smaller than yours, but my patients are sicker. However, one patient panel might skew older, while another has more c
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2. Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Ann Fam Med. 2012;10(5):396–400.
3. Margolius D, Bodenheimer T. Transforming primary care: from past practice to the practice of the future. Health Aff (Millwood). 2010;29(5):779–784.
4. Weber R, Murray M. The right-sized patient panel: a practical way to make adjustments for acuity and complexity. Fam Pract Manag. 2019;26(6):23–29.
5. Murray M, Berwick DM. Advanced access: reducing waiting and delays in primary care. JAMA. 2003;289(8):1035–1040.
6. Medical Group Management Association. MGMA DataDive provider compensation data. https://www.mgma.com/data/benchmarking-data/provider-compensation-data. Accessed Feb. 5, 2020.
7. Association of American Medical Colleges. AAMC faculty salary report FY19. https://store.aamc.org/aamc-faculty-salary-report-fy19-online.html. Accessed Feb. 5, 2020.
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