2015 User Conference

Understanding Your Patient PopulationApril 25, 2015 (GEN-A60)

Presented by:

Susan J. Kressly, MD, FAAPMedical Director

General Session

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Learning Objectives

▪Understand why knowing key metrics of your patient population is important

▪ Identify 2 things you want to know about your patient population to improve practice financial health….and then go do it!

▪ Identify 2 things you want to know about your patient population to improve quality of care……and then go do it!

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Patients & the Business of Your Practice

▪Who are your patients?▪Where do they come from?▪How do they utilize your office?

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Key Demographics to Practice Health

▪Practice Panel▪Provider Panel per (PCP for primary care

or responsible specialist)▪Age▪ Insurance coverage▪Zip code

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Defining Active Patients

▪CMS definition: has had at least one service provided by practice within the past 3 years

▪How does your practice define “active?”▪Patient register is “active”▪Seen within the past 2 years▪Record requests to transfer is easy (do you have a written policy on how to handle this?)

▪What about the “patients who are not engaged?”

▪How do you manage the “not sure” group?▪Periodic identification and outreach▪Written policy to move to “inactive” status

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Identifying Active Patients

Why does it matter?▪ May have false sense of your total

number of patients you are serving▪ May be “leaking” patients to competition

without being aware▪ Insurance companies may be “attributing” these

patients to your panel even though you don’t consider them active▪Implications for HEDIS and P4P metrics▪Implications for population payments moving forward

▪Ask payers to remove from your panel if efforts to engage them unsuccessful and you consider them “inactive”

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What Should the Panel Size Be?

▪The number of patients you can effectively care for

▪Varies based on multiple factors including style of provider, # of patients seen per day and # of hours worked per year

▪AAFP has a worksheet based on the following formula:

Panel size × visits per patient per year (demand) = provider visits per day × provider days per year (supply)

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Desired Patient Panel Size

▪$$ matters also ▪Overhead▪Provider financial expectations▪Insurance contracts (including capitation and other payment models based on panel)

▪Other reasons panel size might matter▪Determining if/when to hire another provider▪Determining whether to close/open a provider/insurance/practice panel

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Pediatric Practice Panel Size Trends

▪Decreasing over the past few years▪Use to be 1,500-2,500 per FTE▪Many profitable practices now have

1,000-1,250 ▪Why?

▪Less “quick sick” (visits lost to RBCs, success of vaccines)

▪More well visits with better payment▪More employed physicians?▪More part time physicians?▪More team based care?

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Why Define the Provider Panel?

▪ It makes patients happy

▪ It defines the workload

▪ It predicts patient demand

▪ It reveals provider performance issues

▪ It helps improve outcomes

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PCP Distribution

Why such disparity?▪SJK cut back 1

day per week & closed panel

▪SSM new to practice

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Ages of Patient Panel

▪ Is KEY to pediatric practices

▪Regarding average number of visits, one infant is worth about 4 adolescents

▪ Ideal:

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What Happened?

Practice had provider go out on maternity leave and closed to new patients

ACA??

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Insurance Distribution

▪ Depends on your geography

▪ Helps you strategize▪Negotiating contracts

▪Dropping problematic/low payers

▪ The more diversity of good paying contracts, the stronger financial position

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Address / Zip Code

How might we use this?▪May help shape

marketing strategy

▪Thinking of opening another office?

▪Do NOT include PHI when exporting

Patient Demographics

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Other Interesting Demographic Info

Birthday: why would a practice care?

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Birth Month Distribution Kressly Peds

And the MOST popular birthday is………

JUNE 3rd

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Moving toward Population Health

▪ Important to understand your patient needs

▪Key to thriving in healthcare market moving forward

▪Better positioned to negotiate fair payment

▪Better positioned to plan effective practice business strategy

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Meaningful Use Demographics

▪Race/Ethnicity▪Can help you identify high risk patients

▪May help you decide to include culturally sensitive staffing

▪Language▪Can help you anticipate translation services needs

▪May help you decide on multi-lingual staffing

▪Will allow you to anticipate patient education/handout needs

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Clinical Demographics

▪Problem List Frequency▪Will allow you to create appropriate Care Plans

▪May inspire you to add additional services/personnel such as

▪Asthma educator▪Diabetes educator▪Purchase Spirometry

▪Can assist with population risk stratification▪Do your patients have more complex healthcare needs than your peers in your community?

▪Should you be paid more to coordinate their care?

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Utilization

▪Do you know who your under-utilizers are?▪Clinical care plan recalls should identify these patients

▪Both for well visits and chronic disease management care plans

▪How can you better engage them?

▪Do you know who your over-utilizers are?▪Visit history may not paint the whole picture▪Staff often can identify “needy” patients▪May need insurance cost data to identify “super-utilizers”

▪How can you better meet their needs?

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Is there one in your practice?

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Resources

▪ Free web chart tool▪ Directions on how to geomap addresses from a

spreadsheet▪ Medscape article on estimating a reasonable

patient panel size moving toward team-based care

▪ AAFP article: Panel Size: How Many Patients Can One Doctor Manage?

▪ AAFP article: It’s Time to Start Practicing Population-Based Health Care

▪ Medscape article: Primary Care Pediatrics and Public Health

▪ Super-utilizers: Common Themes from Innovative Complex Care Management Programs

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Questions?

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We want your feedback!