2015 user conference understanding your patient population april 25, 2015 (gen-a60) presented by:...
TRANSCRIPT
2015 User Conference
Understanding Your Patient PopulationApril 25, 2015 (GEN-A60)
Presented by:
Susan J. Kressly, MD, FAAPMedical Director
General Session
2015 Office Practicum User Conference
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!
2015 Office Practicum User Conference
Patients & the Business of Your Practice
▪Who are your patients?▪Where do they come from?▪How do they utilize your office?
2015 Office Practicum User Conference
Key Demographics to Practice Health
▪Practice Panel▪Provider Panel per (PCP for primary care
or responsible specialist)▪Age▪ Insurance coverage▪Zip code
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
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”
2015 Office Practicum User Conference
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)
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
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?
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
Other Interesting Demographic Info
Birthday: why would a practice care?
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
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?
2015 Office Practicum User Conference
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?
2015 Office Practicum User Conference
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
2015 Office Practicum User Conference
Questions?
2015 Office Practicum User Conference
We want your feedback!