Panel size management has become one of the most complex yet financially important areas for individual medical practices. More than just assigning patients to a provider, panel size incorporates issues including capacity planning, workforce utilization, care team strategy and access optimization while also addressing burnout prevention for medical staff.
Senior editor Daniel Williams and senior industry advisor Cristy Good address many of the challenges related to panel size management in this episode of the Ask MGMA podcast. MGMA now offers a panel size checklist and a dashboard to help put many of the following strategies to work.
Working With an Outdated Formula
According to Good, panel size is traditionally calculated as the days worked per year, times visits per day, divided by the visit rate. But factors such as rising patient demand, ongoing staffing shortages and a push for value-based care mean that formula needs to be revised. Practices should be focusing more on infrastructure to monitor those factors in real time.
“What’s changing is the complexity of patients and the expectation around access, and the pressure on providers,” Good says. “It isn’t that static calculation anymore, it’s very dynamic. It has to flex based on staffing and FTE changes, burnout levels and patient acuity.”
Four-Cut Method
The Four-Cut Method for effective panel size management involves four key operational strategies to align workload, provider capacity, and patient needs:
- Attribution: Use a standardized model and automate attribution through EHR or population health tools.
- Right-sizing: Consider provider support and patient complexity to determine a realistic panel size, generally ranging from 1,200 to 2,000 for primary care.
- Workload Distribution: Maximize team performance by ensuring all care team members work at the top of their license.
- Schedule Optimization: Employ a hybrid scheduling model blending advanced access with predictive slot modeling.
Attribution and Accuracy
Good says that standardization is key to help modernize panel size calculations. A clear attribution model, such as patients seen within the last 12 to 18 months, can be used as a benchmark, which can then be automated using your EHR logic or your population health platform.
That list needs to be validated regularly, removing duplicated, inactive or deceased patients, and reviews need to be completed quarterly, involving operations, IT and clinical leads. The Four-Cut Method can further refine attribution by considering visit frequency, most recent visit, or last exam to identify the best provider match for each patient.
Right-Sizing Based on Risk and Resources
Across the country, popular panel size ranges in primary care are between 1,200 and 2,000 patients per 1.0 FTE, but Good says practices can access MGMA DataDive benchmarks for panel size for different specialties, as numbers can vary widely.
Using HCC scores, chronic condition counts and age data, practices should consider data stratification to get a better picture of patient complexity. Staffing ratios should also be considered along with access to clinical support. Access indicators like time to third next available appointment can also be important.
“Without team support, you’re going to skew towards the lower end,” Good explains. “But with a robust group of staffing and standing orders in place, you can confidently stretch that upper range.”
A Balanced Workload Across the Team
To deliver the best results, Good says it’s important to make sure that everyone in your scope of practice is working at the top of their individual licenses: MAs, RNs, NPs and PAs included. Standing orders for screenings and vaccination protocols and chronic care workflows can also help redistribute tasks among the team.
Risk stratification of patient panels is also fundamental, so attention should be given to rising-risk patients and outreach delegated appropriately.
Schedule Optimization Means Better Panel Management
Many practices report success in schedule optimization by using hybrid models, including a mix of advanced access and predictive slot modeling. These allow time for acute needs while safeguarding slots for chronic care follow-ups and preventative visits. Advanced access scheduling can significantly reduce wait times and improve care continuity.
Registry dashboards can help flag gaps ahead of time, while better integration of telehealth can build extra time in your schedule, especially for lower-complexity touchpoints such as med refills or lab reviews.
Aligning Compensation with Panel Size
Good says any transitions in panel size management require transparency with providers to avoid disrupting their trust. Providers need to understand how panel size ties to quality, satisfaction and career continuity, not just volume.
Rather than production-focused RVUs, panel size and quality measures can be introduced into provider compensation models, with steps such as rewarding maintenance of chronic care metrics, patient engagement rates or appropriate outreach.
“Make sure you’re watching to see if there’s burnout risk among your providers. If a provider hits 1,800-plus, the risk spikes, unless you have a strong team-based system in place,” Good advises.
Using Technology for Panel Management
Emerging medical tech such as registries can be used to track overdue screenings such as A1C and BP control, with dashboards tied to panels to spot care gaps at a glance. Predictive analytics and automated reminders and outreach triggers, using historical data, can also be integrated to help flag patients who are likely to escalate and help cut down on ER and urgent care visits.
Continuous Monitoring and Rebalancing
As these changes are implemented, managers should track metrics such as panel size per provider, third next available appointment, visit lag time, no-show rates, quality outcomes, patient satisfaction scores, and burnout indicators. Panels should also be reevaluated and redistributed during staffing changes or when new providers are onboarded.
Fostering Continuity and Communication
Support continuity of care by allowing patients to affirm or select their provider. Ensure that any reassignments are communicated clearly to avoid confusion. Team huddles can also be useful to identify overloaded clinicians or highlight patient-specific needs.
Resources:
- MGMA Article: Balancing Capacity with the Quadruple Aim - read here
- AAFP Panel Management Tool - visit here
- NACHC Empanelment Guide - visit here
- Elation Health on Panel Management - read here
Additional Resources:
Email us at dwilliams@mgma.com if you would like to appear on an episode. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts.
