Should primary care physicians consider closing their patient panels?
Do you have too many patients? Primary care physicians with crowded waiting rooms already feel overburdened. Many physicians are thinking of closing their practices to new patients. Experts say that no matter how busy you are, closing your panel may be a mistake.
As the Affordable Care ACT (ACA) kicks in, millions of newly insured patients may soon come knocking at your door. Many physicians are already working long hours yet don’t have enough time to spend with each patient. They need a breather and want to make sure they aren’t spread so thin that they can’t provide appropriate and effective care.
If you think the solution is closing your panel to new patients, you may want to think again. It’s almost always a mistake to close your panel to new patients, say the physician experts and practice management consultants who spoke to Medical Economics on the issue.
“Busy is in the eye of the beholder,” says Rosemarie Nelson, a Medical Group Management Association (MGMA) consultant based in Syracuse, NY. “The average panel for a primary care doctor is about 2,500 patients. Some busy practices are simply inefficient. A practice with 2,200 patients may want to close while another with 3,200 patients has figured out ways to accommodate new patients without sacrificing quality.”
Closing your panel should be a last resort. “Once you turn the faucet off, turning it back on when your situation changes may be a challenge if word gets around the community that you weren’t accepting new patients,” says William T. Manard, MD, director of clinical services in the Department of Family and Community Medicine at St. Louis University School of Medicine in St. Louis, Missouri.
“Even in mature practices, it’s essential to replace patients who leave your care,” says Gray Tuttle Jr., a consultant with the Rehmann Group in Lansing, Michigan. “Closing your panel causes misperceptions by patients and other doctors. They may conclude that the doctor is retiring, leaving or is ill. That can accelerate the contraction of your practice beyond what you wanted.”
Expanding your capacity for more patients
It’s clear there’s a problem when the waiting room is packed, it’s difficult for established patients to get an appointment, and sick patients can’t be seen soon enough, says Judy Bee, a principal of PPG Consulting in La Jolla, California. “Often unknown to the doctor, staff members are suggesting that patients go to an urgent care center because they’re just so jammed.”
Tuttle agrees. “If it takes more than a month for a new patient to get an appointment, the practice is probably pushing the limit on what it can accommodate,” he says.
“Established patients should be able to get in within two weeks. Practices need systems for same-day care or patients will go to urgent care centers instead.”
Here are five ways you can adjust your practice management process to accept more patients without substantially increasing your workload.
1. Scheduling fixes
How many patients did you see today that didn’t need to be seen right away? “It’s often as much as 40%,” Bee says. “Practices often see patients who are stable but chronically ill every three months. Instead of making an appointment that far in advance, you can send reminder cards. When patients call for an appointment, you’ll have a better idea of your capacity and can adjust the schedule so that there’s room for patients who have more acute needs.”
Physicians should save a few slots for sick patients who need to be seen that day, she says. Bee recommends a scheduling model where physicians determine the average number of work-ins for each day of the week. Then look at the average number of no-shows or last minute cancellations. Monitor the urgent patients or appointments made within one week. Note how many return appointments are made for patients seen as an emergency or urgent. This can help the practice best adjust its schedule.
2. Sharing more responsibility with midlevels
If the practice is still overwhelmed, it’s time to make better use of medical assistants and midlevel providers such as nurse practitioners and physician assistants.
“Medicine is a team effort and physicians need to rely more on their staffs to engage patients with data collection, coaching and even prescribing,” says Manard. “Resistance to change comes from both sides. Doctors have to convince themselves and colleagues that they can let go of some aspects of care and let midlevels handle them.
“Many patients expect to be cared for only by the doctor,” he says. “We need to educate patients that nurses and assistants can handle many parts of care that don’t require our level of training.
“We have also created protocols for preventive tests and common conditions, either by phone or face to face,” he adds. “Nurses can call in prescriptions, etc.”
Adding providers is a key strategy for any practice going forward. “It’s necessary to deal with the anticipated onslaught of demand created by the Affordable Care Act,” Tuttle says. “Properly using a midlevel can be a profit center.”