Assessing and increasing patient panel size in the public sector

Panel management is a central component of the primary care medical home, but faces numerous challenges in the safety net setting. In the San Francisco Department of Public Health, many of our community-based primary care clinics have difficulty accommodating all patients seeking care.

We evaluated patient panel size in our 7 clinics providing cradle-to-grave primary care services to more than 25,000 active patients.

We adjusted panel size for age, gender, diagnoses, homelessness, and substance abuse; set related policies; and assessed the effects on our clinics. On the basis of our previous data and targets set by other safety net providers, we established a minimum of 1125 patients per full-time paid primary care provider (ie, full-time equivalent [FTE]) in April 2009. We calculated the target panel size each clinic would have if all their providers reached the minimum panel size goal and compared it with the panel size attained by the clinic.

Nine months after establishing panel size policy, providers reached 82% of the aggregate target panel size. Five of the 7 clinics increased their adjusted panel size per FTE in the range of 2% to 23%. Two data-oriented and innovative clinics with some of the highest adjusted panel sizes per FTE largely maintained their panel size. Two clinics that had the lowest adjusted panel size per FTE realized a 23% and 8% respective gain; both clinics reduced barriers to new patient appointments. Two clinics acquired new providers and experienced a concomitant drop in panel size per FTE while the new clinicians expanded their panels. One of these clinics had difficulty managing high no-show rates and creating effective appointment templates.

Routine data generation, review of data with administrators and providers, data-driven policies and panel size standards, and interventions to bolster team-based care are important tools for increasing capacity at our primary care clinics.