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

In this episode of Ask MGMA, host Daniel Williams and co-host Cristy Good delve into the complexities of panel size management for medical group practices. They discuss the importance of capacity planning, workforce utilization, care team strategy, and burnout prevention. The episode includes practical insights into panel attribution, right-sizing based on risk and resources, workload distribution, and the role of technology in optimizing care. Cristy also shares tips on measuring and monitoring key metrics to ensure successful implementation of panel management strategies.

00:51 – Introduction and Welcome

01:22 – Understanding Panel Size Management

04:12 – Right Sizing with Risk and Resources

05:38 – Distributing Workload Across Care Teams

06:42 – Optimizing Schedules for Panel Management

07:38 – Aligning Compensation with Panel Size

10:12 – Key Metrics and Checkpoints

11:12 – Final Thoughts and Resources

Additional Resources:

• MGMA Playbooks
• MGMA Events
• MGMA Consulting
• MGMA DataDive
• MGMA Stat
• MGMA Podcasts

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Episode Transcript

Daniel Williams (00:55):
Hi, everyone. I'm Daniel Williams, senior
editor at MGMA and host of theMGMA Podcast Network. We are
back with another of our verypopular ask MGMA podcast with
cohost Christy Good, who's asenior adviser with MGMA and
worked many years at practices,in labs, all kinds of things out

(01:17):
there. So, Christy, welcome backto the show.

Cristy Good (01:20):
Thank you.

Daniel Williams (01:22):
All right. So today we're unpacking one of the
most operationally complex andfinancially impactful issues
facing medical group leaders,and that's panel size
management. Panel size isn'tjust about assigning patients to
a provider. It's about capacityplanning, workforce utilization,

(01:44):
care team strategy, burnoutprevention, and access
optimization. So, we're going totalk about this a lot because
through Ask MGMA, Christy hasreceived questions about panel
size management.
So talk about panel managementand what's going on right now.

Cristy Good (02:05):
Sure. I think most people think of panel management
or panel size, and we knowthere's a calculation for it.
The right size panel equals thedays worked per year times the
visits per day, and you dividethat by visit rate. But panel
size is also affected by risingpatient demand, staffing

(02:27):
shortage, and a greater push forvalue based care just to keep it
all encompassed. So what'schanging is the complexity of
patients and the expectationaround access and the pressure
on the providers.
It isn't that static calculationthat I mentioned really anymore.

(02:47):
It's very dynamic. It has toflex based on staffing and FTA
changes, burnout levels andpatient acuity. So many
practices really should befocusing on an infrastructure to
monitor and adjust those real,almost like real time, as best
as possible.

Daniel Williams (03:05):
Yeah. Thanks so much for sharing that and
defining it. We were talkingoffline about a checklist. So
one of the first checklist itemsis panel attribution. What are
the most efficient ways practiceleaders can operationalize
attribution across teams?

Cristy Good (03:24):
Standardization is key. So use a clear attribution
model, like patients seen withinthe past twelve to eighteen
months, and automate thoseprocesses using your EHR logic
or your population healthplatform, whichever one you're
using, and then validate thatlist regularly. So you want to
take out those that aredeceased, those that are

(03:46):
inactive, or any duplicatepatients. We know it happens.
It's not great to haveduplicates, but it happens.
And then run this reviewquarterly and involve
operations, IT, and clinicalleads. You really need to make
sure that everyone from frontdesk, schedulers, really
understand this process so thatthey know what's working and

(04:06):
they can bring up anything thatmight not be working well or
what they see if there's anyproblems.

Daniel Williams (04:12):
Okay. One of the other aspects of this, as
you were explaining to meoffline, is rightsizing with
those risk and resources.Popular ranges for primary care,
twelve hundred to 2,000patients. But let's be honest,
every admin wants to knowwhere's my provider on that
spectrum. Do you want to shareabout that?

Cristy Good (04:33):
The great thing is MGMA has data dive benchmarks
for panel size for manypractices, specialties, and
primary care. So if you areinterested in something like
that, we do have that, and youcan reach out to our survey team
and get that data, or ourcustomer service, and we can
help you figure out what thatlooks like. But in the meantime,

(04:55):
though, there are many thingsthat you have to remember.
That's where data stratificationcomes in. And so using HCC
scores, chronic conditioncounts, and age data to get a
patient complexity index ishelpful.
Then you factor in your staffingratio. Does provider have access
to RNs or PAs or NPs, abehavioral health consultant, a

(05:17):
care coordinator? So withoutteam support, you're gonna skew
towards the lower end with arobust group of staffing and
standing orders in place. Youcan confidently stretch that
upper range, But access metrics,time to their next available
appointments, should also besomething to consider and look
at.

Daniel Williams (05:36):
Okay. So how can practices then most
effectively distribute panelrelated workload across those
care teams?

Cristy Good (05:47):
Yeah. So you want to make sure that you look at
your scope of practice, yourMAs, your RNs, your PAs, your
NPs. Make sure that they'reworking 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 helpredistribute tasks.

(06:07):
Risk stratification is anotherpiece you just don't want to
treat the panel as a flat list,So identifying rising risk
patients and delegate outreachis really important and helpful.
So make sure you have teamhuddles and you have ways to
communicate with each other andcircle around so everyone's on

(06:27):
the same page and find out whereyou can help each other. There's
definitely ways that you canalign daily work and catch
capacity issues and preventoverload by just doing simple
things like that.

Daniel Williams (06:41):
Okay. Part of that, if we just drill down
then, scheduling is just soimportant to making sure this is
run efficiently. So what'sworking well in terms of
optimizing schedules so you cansupport panel management?

Cristy Good (06:58):
I think most practices have seen success in
using hybrid models. So having amix of advanced access and
predictive slot modeling, thatmeans carving out time for those
acute needs while stillsafeguarding slots for chronic
care follow ups and preventativevisits. That's where having some
emergency or urgent visits inyour time slots are important.

(07:19):
Another interesting thing that Ithink people don't think about
are registry dashboards to helpflag gaps ahead of time, and
telehealth integration adds someextra room in your schedule,
especially for those lowercomplexity touch points like med
refills or lab reviews.

Daniel Williams (07:37):
Okay. Now, you've noted in the checklist
that was put together thataligning compensation with panel
size, not just those RVUs, isessential. So how do practices
transition without disruptingprovider trust?

Cristy Good (07:53):
The big thing with working with any provider is
always transparency. So yourproviders need to understand how
panel size ties to quality,satisfaction, and career
continuity, not just volume. SoI know many people are on work
RVUs with productivities. Manyare adding those quality
measures as well to theircompensation models, and panel

(08:13):
size is one of those points thatthey often look at. So you can
introduce panel size with thoseRVU models very easily, such as
rewarding maintenance of chroniccare metrics, patient engagement
rates, or appropriate outreach,and then make sure you're
watching to see if there'sburnout risk among your

(08:34):
provider.
If your provider hits a 800plus, the rise spikes unless you
have a strong team based systemin place. And that's for you'll
wanna look at that 1,800 oryou'll wanna change it based on
your specialty because it mightbe lower or it could be higher.
But just keeping an eye on whatthat kind of sweet spot is for
your panel size, and then howare you doing, and is there

(08:56):
burnout?

Daniel Williams (08:57):
Okay. So you and I have talked about this,
and we've talked about this onall of our MGMA podcast.
Technology is playing a hugerole in so much of health care
right now. We've got things likeregistries. We've got predictive
analytics.
So let's just get real for amoment. What is going on right

(09:18):
now? And then good gracious, getout the crystal ball. What's
coming down the pike?

Cristy Good (09:23):
Right now, the most effective practices are using
registries to track overduescreenings. And I think many
people forget that. Your a onec's, your BP controls, things
you can act on quickly, they'relike the easy fruit. They're
building dashboards tied topanels so that you can know your
care gaps at a glance, andpredictive analytics is the next

(09:44):
layer. So using historical datato flag who's likely to escalate
is really important.
Combine that with outreachtriggers or automated reminders,
and you can catch issues beforethey require urgent care or ED
visits. So keeping peoplehealthy, keeping people home,
catching them so they're notrunning to the ER, I think is

(10:06):
very important, especially forour primary care and our
specialty practices.

Daniel Williams (10:11):
Okay. Last question then. Let's say we make
that transition, we get the newpanel management process put in
place, but we want to measureit. We want to monitor it to
make sure things are going well.So you mentioned earlier that
panel size isn't static.
What are some of the key metricsand checkpoints practice leaders

(10:31):
should be tracking?

Cristy Good (10:33):
Sure. So you want to look at your panel size per
provider, of course, but overlayit with access data like third
next available, which wementioned, visit lag time and no
show rates. And we do have acouple of those benchmarks part
of Data Dive. And pair thosewith patient satisfaction scores
and provider wellness data isalso helpful. And anytime you

(10:55):
have a provider go part time,retire, or you're onboarding a
new clinician, use those astriggers to reassess and
redistribute panels.
This should be part of yourquarterly business review
process, not something youscramble to fix during a crisis.

Daniel Williams (11:11):
Okay. Last thought then. I know that was
the last question, but anythingelse I didn't ask you about
panels that you wanna share? Youthink we covered everything
here?

Cristy Good (11:20):
Well, we always have more to cover, but I do
hope to have that checklist aswell as a dashboard out here
soon so people can keep an eyeout for it once we get it linked
on our website. That could behelpful for those that have more
questions. And then, of course,like I said, we have a lot of
benchmarks to help with thispanel size and right sizing and

(11:42):
other access to care questionsthat they might need data for.
So just keep us in mind andreach out anytime.

Daniel Williams (11:52):
Okay. Christie, thank you so much for joining us
again for ask MGMA.

Cristy Good (11:58):
Thank you.

Daniel Williams (11:59):
Alright, everybody. That is gonna do it
for this episode. For ourlisteners, you can download the
panel size management checklistin the show notes. We're gonna
drop other links in the episodeshow notes as well. And please,
as always, head over to mgma.comfor more resources, benchmarks,
and templates to help youoperationalize what we've been

(12:22):
talking about today.
And thanks for listening to AskMGMA. Until next time, I'm
Daniel Williams. Thank you somuch for listening.