P2A042: Determining Pediatric Panel Size Using Expected Number of Annual Visits by Age

Background: With the shift to value-based and capitated healthcare financing, general pediatricians are increasingly responsible for quality and costs of a specific cohort of patients known as their “patient panel.” Optimizing patient counts per panel would better complement physician availability to ensure that quality-based outcomes and financial incentives can be obtained. As such, an optimal “panel size” would match quantities of annual available appointments with annual needed appointments. The annual number of needed appointments varies by age for recommended preventive health care visits (“well child checks”), acute illnesses, and chronic disease management. There is no known empirical method for determining the optimal number of patients per panel (“panel size”). Because the number of annual needed appointments varies with age, a panel’s average patient age may influence optimal panel size.

Objective: To determine if patient age variations within a pediatric panel influences the number of annual needed appointments.

Methods: This study was conducted in 4 steps. First, we determined the average annual number of visits by age using a retrospective cross-sectional study of all visits to our primary care clinic from 5/1/2020 to 4/30/2022 for patients ≤ 17 years. Second, we created 4 hypothetical panels, each containing ~1,200 patients. We intentionally varied each panel’s mean patient age to create 4 panels called “youngest,” “younger,” “older,” and “oldest.” Third, we determined expected annual visits for each hypothetical panel. To accomplish this, we multiplied the average annual number of visits for each age (from step 1) by the age of each patient within each hypothetical panel (from step 2). We then summed the expected number of annual visits for all patients within each hypothetical panel. Fourth, we compared the expected number of annual visits in each panel to the actual number of available appointments for a 1.0 FTE pediatrician in our clinic (2,856 appointments/year).

Results: From our 2-year retrospective data, there were 73,695 visits from 23,172 patients. The average annual number of visits was 2.8 and ranged from 5.8 (age < 12 months) to 2.4 (ages 5, 9, and 12 years) (Figure 1). As designed, the mean age of each hypothetical panel increased from 5.1 years (SD 4.6; youngest panel) to 11.9 years (SD 4.6; oldest panel) (Figure 2). The expected annual number of visits was highest in the youngest panel (3,759), then decreased (range: 3,441-3,132) (Figure 2). With 2,856 appointments/1.0 FTE in our clinic, the FTE needed to staff the 1,200 patient hypothetical panels varies from 1.2-1.4 FTE.

Conclusion: Using patient age (the study model), a more accurate panel size can be determined. Aligning provider appointment access with patient age distribution in their panel facilitates quality-based outcomes, continuity of care, and payment optimization.