Quality Improvement Tips

Managing supply and demand in your medical practice - Part 1

by Lisa S. on 5/31/2011 3:37:04 PM MST

By Elaine Skoch, RN, MN, EMBA, NEA-BC, HealthTeamWorks Director of Systems Transformation

Every medical practice wants enough patients to keep caregivers busy and revenue steady, but backlogs in the waiting room benefit no one. Patients kept waiting may seek another practice or go to the emergency room — at higher cost to the healthcare system. A full waiting room may keep providers and staff in a rush, which may result in less-than-optimal care.
Well-run practices balance supply and demand. They establish processes to match their patient-panel size with their capacity to deliver care effectively and efficiently. To use an old saw, they “do today’s work today,” instead of constantly playing catch-up with tasks left over from the day — or days — before.

Doing today’s work today hinges on improving access to care. You want enough patients visiting and calling (and e-mailing) your practice to keep staff busy and revenue flowing, but you don’t want to be overwhelmed by “bad backlog.” To improve  access and gain an understanding of your practice’s supply of and demand for services:

• Calculate  the practice’s ideal panel size;
• Equalize supply and demand;
• Consolidate appointment types; and
• Develop options for patients to obtain your services.

Open-access scheduling relies on the theory that demand is predictable and may vary seasonally. (You may need to monitor seasonal changes in demand to fill down-time with preventive or follow-up services.) You want to match your appointment supply to demand.

Calculating panel size

To determine how many patients your practice can see comfortably and thoroughly, figure the number of unique visits you’ve had over a certain time period — say 18 months. Then figure the average number of provider visits a day in your clinic and the clinical days worked per year. Use this formula to figure your ideal panel size:

Provider visits per day x clinical days worked
                    Visits per patient
For example, let’s say your practice had 6,300 patient visits over the last 18 months made by 2,000 individuals. Your providers see an average of 24 patients a day and put in 240 clinical work days annually (this number takes into account vacation time and holidays): 6,300 ÷ 2,000 = 3.15 visits per patient per period. Your panel size formula looks like this:

24 visits per day x 240 days worked
           3.15 visits per patient

You can meet the demand of 1,829 patients comfortably. (The age and gender breakdown of your panel can influence this number. Breaking down panel demographics could make the calculation more precise. For example, we know that panels with more women of child-bearing age or with large pediatric or elderly populations average more visits per person.)

Calculating supply

Next, determine your practice’s capacity, or supply. Get the number of available appointment slots by multiplying 20 (the average number of slots available per day without overbooking or double-booking) by 240 clinical work days to get 4,800 visits. That’s the number of appointments your practice has available in a year. As things stand, you’re 961 slots short of capacity, because 1,829 x 3.15 = 5,761 visits.

Less clear-cut are considerations about your practice’s efficiency and access. How effective is your work flow? How well do providers and staff communicate? How do you manage no-show patients? How often do providers get interrupted in the exam room? Do you emphasize prevention and patient self-care? A host of variables affects your clinic’s ability to see patients efficiently and provide high-quality care.

Next week: Part 2