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Ask MGMA: How to Right-Size Patient Panels Without Burning Out Your Providers

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Daniel Williams:

Hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. We are back with another of our very popular ask MGMA podcast with cohost Christy Good, who's a senior adviser with MGMA and worked many years at practices, in labs, all kinds of things out there. So, Christy, welcome back to the show.

Cristy Good:

Thank you.

Daniel Williams:

All right. So today we're unpacking one of the most operationally complex and financially impactful issues facing medical group leaders, and that's panel size management. Panel size isn't just about assigning patients to a provider. It's about capacity planning, workforce utilization, care team strategy, burnout prevention, and access optimization. So, we're going to talk about this a lot because through Ask MGMA, Christy has received questions about panel size management.

Daniel Williams:

So talk about panel management and what's going on right now.

Cristy Good:

Sure. I think most people think of panel management or panel size, and we know there's a calculation for it. The right size panel equals the days worked per year times the visits per day, and you divide that by visit rate. But panel size is also affected by rising patient demand, staffing shortage, and a greater push for value based care just to keep it all encompassed. So what's changing is the complexity of patients and the expectation around access and the pressure on the providers.

Cristy Good:

It isn't that static calculation that I mentioned really anymore. It's very dynamic. It has to flex based on staffing and FTA changes, burnout levels and patient acuity. So many practices really should be focusing on an infrastructure to monitor and adjust those real, almost like real time, as best as possible.

Daniel Williams:

Yeah. Thanks so much for sharing that and defining it. We were talking offline about a checklist. So one of the first checklist items is panel attribution. What are the most efficient ways practice leaders can operationalize attribution across teams?

Cristy Good:

Standardization is key. So use a clear attribution model, like patients seen within the past twelve to eighteen months, and automate those processes using your EHR logic or your population health platform, whichever one you're using, and then validate that list regularly. So you want to take out those that are deceased, those that are inactive, or any duplicate patients. We know it happens. It's not great to have duplicates, but it happens.

Cristy Good:

And then run this review quarterly and involve operations, IT, and clinical leads. You really need to make sure that everyone from front desk, schedulers, really understand this process so that they know what's working and they can bring up anything that might not be working well or what they see if there's any problems.

Daniel Williams:

Okay. One of the other aspects of this, as you were explaining to me offline, is rightsizing with those risk and resources. Popular ranges for primary care, twelve hundred to 2,000 patients. But let's be honest, every admin wants to know where's my provider on that spectrum. Do you want to share about that?

Cristy Good:

The great thing is MGMA has data dive benchmarks for panel size for many practices, specialties, and primary care. So if you are interested in something like that, we do have that, and you can reach out to our survey team and get that data, or our customer service, and we can help you figure out what that looks like. But in the meantime, though, there are many things that you have to remember. That's where data stratification comes in. And so using HCC scores, chronic condition counts, and age data to get a patient complexity index is helpful.

Cristy Good:

Then you factor in your staffing ratio. Does provider have access to RNs or PAs or NPs, a behavioral health consultant, a care coordinator? So without team support, you're gonna skew towards the lower end with a robust group of staffing and standing orders in place. You can confidently stretch that upper range, But access metrics, time to their next available appointments, should also be something to consider and look at.

Daniel Williams:

Okay. So how can practices then most effectively distribute panel related workload across those care teams?

Cristy Good:

Yeah. So you want to make sure that you look at your scope of practice, your MAs, your RNs, your PAs, your NPs. Make sure that they're working at the top of their license. And if they're not, you're missing opportunities. Standing orders for screenings, vaccination protocols, and chronic care workflows help redistribute tasks.

Cristy Good:

Risk stratification is another piece you just don't want to treat the panel as a flat list, So identifying rising risk patients and delegate outreach is really important and helpful. So make sure you have team huddles and you have ways to communicate with each other and circle around so everyone's on the same page and find out where you can help each other. There's definitely ways that you can align daily work and catch capacity issues and prevent overload by just doing simple things like that.

Daniel Williams:

Okay. Part of that, if we just drill down then, scheduling is just so important to making sure this is run efficiently. So what's working well in terms of optimizing schedules so you can support panel management?

Cristy Good:

I think most practices have seen success in using hybrid models. So having a mix of advanced access and predictive slot modeling, that means carving out time for those acute needs while still safeguarding slots for chronic care follow ups and preventative visits. That's where having some emergency or urgent visits in your time slots are important. Another interesting thing that I think people don't think about are registry dashboards to help flag gaps ahead of time, and telehealth integration adds some extra room in your schedule, especially for those lower complexity touch points like med refills or lab reviews.

Daniel Williams:

Okay. Now, you've noted in the checklist that was put together that aligning compensation with panel size, not just those RVUs, is essential. So how do practices transition without disrupting provider trust?

Cristy Good:

The big thing with working with any provider is always transparency. So your providers need to understand how panel size ties to quality, satisfaction, and career continuity, not just volume. So I know many people are on work RVUs with productivities. Many are adding those quality measures as well to their compensation models, and panel size is one of those points that they often look at. So you can introduce panel size with those RVU models very easily, such as rewarding maintenance of chronic care metrics, patient engagement rates, or appropriate outreach, and then make sure you're watching to see if there's burnout risk among your provider.

Cristy Good:

If your provider hits a 800 plus, the rise spikes unless you have a strong team based system in place. And that's for you'll wanna look at that 1,800 or you'll wanna change it based on your specialty because it might be lower or it could be higher. But just keeping an eye on what that kind of sweet spot is for your panel size, and then how are you doing, and is there burnout?

Daniel Williams:

Okay. So you and I have talked about this, and we've talked about this on all of our MGMA podcast. Technology is playing a huge role in so much of health care right now. We've got things like registries. We've got predictive analytics.

Daniel Williams:

So let's just get real for a moment. What is going on right now? And then good gracious, get out the crystal ball. What's coming down the pike?

Cristy Good:

Right now, the most effective practices are using registries to track overdue screenings. And I think many people forget that. Your a one c's, your BP controls, things you can act on quickly, they're like the easy fruit. They're building dashboards tied to panels so that you can know your care gaps at a glance, and predictive analytics is the next layer. So using historical data to flag who's likely to escalate is really important.

Cristy Good:

Combine that with outreach triggers or automated reminders, and you can catch issues before they require urgent care or ED visits. So keeping people healthy, keeping people home, catching them so they're not running to the ER, I think is very important, especially for our primary care and our specialty practices.

Daniel Williams:

Okay. Last question then. Let's say we make that transition, we get the new panel management process put in place, but we want to measure it. We want to monitor it to make sure things are going well. So you mentioned earlier that panel size isn't static.

Daniel Williams:

What are some of the key metrics and checkpoints practice leaders should be tracking?

Cristy Good:

Sure. So you want to look at your panel size per provider, of course, but overlay it with access data like third next available, which we mentioned, visit lag time and no show rates. And we do have a couple of those benchmarks part of Data Dive. And pair those with patient satisfaction scores and provider wellness data is also helpful. And anytime you have a provider go part time, retire, or you're onboarding a new clinician, use those as triggers to reassess and redistribute panels.

Cristy Good:

This should be part of your quarterly business review process, not something you scramble to fix during a crisis.

Daniel Williams:

Okay. Last thought then. I know that was the last question, but anything else I didn't ask you about panels that you wanna share? You think we covered everything here?

Cristy Good:

Well, we always have more to cover, but I do hope to have that checklist as well as a dashboard out here soon so people can keep an eye out for it once we get it linked on our website. That could be helpful for those that have more questions. And then, of course, like I said, we have a lot of benchmarks to help with this panel size and right sizing and other access to care questions that they might need data for. So just keep us in mind and reach out anytime.

Daniel Williams:

Okay. Christie, thank you so much for joining us again for ask MGMA.

Cristy Good:

Thank you.

Daniel Williams:

Alright, everybody. That is gonna do it for this episode. For our listeners, you can download the panel size management checklist in the show notes. We're gonna drop other links in the episode show notes as well. And please, as always, head over to mgma.com for more resources, benchmarks, and templates to help you operationalize what we've been talking about today.

Daniel Williams:

And thanks for listening to Ask MGMA. Until next time, I'm Daniel Williams. Thank you so much for listening.

Ask MGMA: How to Right-Size Patient Panels Without Burning Out Your Providers
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