This article from Medscape gives some food for thought with the idea of creating a "panel". Might be helpful with P4P considerations. BD (may require a subscription)
Practices and individual providers should not take on more work than they can manage. If a panel is too large, the excess demand results in a never-ending and ever-expanding delay in services in addition to constant deflections to other providers, resulting in discontinuity. On the other hand, if a panel is too small, demand may not be adequate to support the practice. The demand for appointments must equal the supply of appointments if timely service is desired. A simple equation can be used to express this:
Panel size × visits per patient per year (demand) = provider visits per day × provider days per year (supply).
- It makes patients happy. Patient surveys clearly demonstrate that patients want the opportunity to choose a primary care provider; they want access to that provider when they choose; and they want a quality health care experience. Establishing a panel links each patient with a provider with whom they have a health care relationship.
- It defines the workload. Establishing a panel helps divide and define workload within a practice and helps ensure that each provider is carrying his or her fair share.
- It predicts patient demand. Panels are the source of demand not only for visits but also for non-visit work (paperwork, e-mail, etc.), tests, procedures and hospitalizations. Understanding the panel helps a practice anticipate that demand both.
- It reveals provider performance issues. Understanding the panel allows groups to see the effects of provider variability. For example, if two providers have the same panel size but one provider has more demand than the other, then the practice can explore why this difference exists (e.g., one physician uses shorter return-visit intervals) and whether it is justified.
- It helps improve outcomes. Identifying individual panels enables providers to make a commitment to continuity (that is, to taking care of their own patients for all their visits), which results in improved clinical outcomes,[17,18,28-30] reduced costs and enhanced revenue per visit.[13,16,19,31]