Re: Autumn increase in appts?

[Guest guest]

When Kaiser Permanente analyzed the data on office visit demand for a

family med practice, they found that 0.75% of a family medicine panel

will call on any given day seeking office care. For 1000 patients

in your panel you would expect 7.5 visits (1000 x 0.0075).

Of course this is an average. The larger the patient panel, the

more likely you will hit the predicted target. If you're a large

group practice you could predict almost to the person. Very small

panels have much wider variation. As Tim mentions below

" Currently I'm seeing 4-8 appts/day and have about 300 patients in

my EMR. "

To maintain same day access we have to maintain flexibility enough to

accommodate this variation in demand.

Tim asks about seasonal variation. This does occur and is

relatively predictable:

August surge for school and sports physicals

RSV/influenza season

So, he's right to be cautious about reaching " full " in a slow

season as it could spell burnout in the busy seasons.

G

08:19 AM 8/17/2006, you wrote:

What's everyone's experience

with the autumn and an increase in number of

appts? I assume there will be one due to acute visits for

colds/bronchitis/OM, etc, but is there a way to estimate how many

more

appts/day that might be?

Currently I'm seeing 4-8 appts/day and have about 300 patients in my EMR.

I've recently learned local insurers have more patients assigned to

me

than I knew... but that's a whole other story and I'm trying to

clarify

that and what I need to do. So currently I'm seeing about 2% of my

known

panel on average per day. I anticipate seeing 6-10 appts/ day as

" full

status " (beyond that I plan to do some aesthetics with laser

skin

treatments... also, another story).

Come Sept-Nov, should I be expecting 1-3 more appts/ day simply because

of

increased infection rates? Would that mean I'm about full now for

family

medicine? Should I continue until I have at least 400-500 patients if

I'm

hoping for 6-10 appts/day (ie 1.5 - 2 % of my panel per day)?

I'm being careful not to " overheat " as has been discussed so

often before.

So any pointers from you more experienced IMP'ers will be greatly

appreciated.

Tim

[Guest guest]

Gordon,

In my micropractice,

I have been running closer to 1% of my patients desiring appointments, which is

cool because it makes the math easier (1500 patients=15 patients a day). Maybe

I just have a slightly sicker population or maybe I just like to keep closer

tabs on my patients, but it may also be secondary to easier access means the patients

are coming in more often. I am curious if other IMPs

are running slightly higher than the Kaiser average.

Re:

Autumn increase in appts?

When Kaiser Permanente analyzed the data on office visit demand for a

family med practice, they found that 0.75% of a family medicine panel will call

on any given day seeking office care. For 1000 patients in your panel you

would expect 7.5 visits (1000 x 0.0075).

Of course this is an average. The larger the patient panel, the more

likely you will hit the predicted target. If you're a large group

practice you could predict almost to the person. Very small panels have

much wider variation. As Tim mentions below " Currently I'm seeing

4-8 appts/day and have about 300 patients in my EMR. "

To maintain same day access we have to maintain flexibility enough to

accommodate this variation in demand.

Tim asks about seasonal variation. This does occur and is relatively

predictable:

August surge for school and sports physicals

RSV/influenza season

So, he's right to be cautious about reaching " full " in a slow season

as it could spell burnout in the busy seasons.

G

08:19 AM 8/17/2006, you wrote:

What's everyone's experience with the autumn and an

increase in number of

appts? I assume there will be one due to acute visits for

colds/bronchitis/OM, etc, but is there a way to estimate how many more

appts/day that might be?

Currently I'm seeing 4-8 appts/day and have about 300 patients in my EMR.

I've recently learned local insurers have more patients assigned to me

than I knew... but that's a whole other story and I'm trying to clarify

that and what I need to do. So currently I'm seeing about 2% of my known

panel on average per day. I anticipate seeing 6-10 appts/ day as " full

status " (beyond that I plan to do some aesthetics with laser skin

treatments... also, another story).

Come Sept-Nov, should I be expecting 1-3 more appts/ day simply because of

increased infection rates? Would that mean I'm about full now for family

medicine? Should I continue until I have at least 400-500 patients if I'm

hoping for 6-10 appts/day (ie 1.5 - 2 % of my panel per day)?

I'm being careful not to " overheat " as has been discussed so often

before.

So any pointers from you more experienced IMP'ers will be greatly

appreciated.

Tim

[Guest guest]

: It is hard to know exactly how many patients are active. I think you will find the number several ways. You take total # visits/year and divide by number of patients/year total. However, my EMR can report on how many were seen within last year or not within last 12 months. Subtract off total and you would have a higher result. It may prove useful to evaluate based on one month or three months intervalsas well and try to evaluate chronic vs. acute visits. I just calculated the number of diabetics, and hypertensives, and hyperlipidemic patients. I also calculated medicare at 25% of all registered patients, but responsible for 40% visits and only 34% revenue. I am wondering if we will start to see rates for diabetes that yield tighter diabetic control, or rates of visit for other illness or prevention strategies that yield better clinical results. If these

numbers were known then the price of improved care could be determined. Perhaps fewer visits would yield better care? Could you develop protocols for thes and decrease cost and improve care further..

Get your email and more, right on the new Yahoo.com

[Guest guest]

Another issue to consider for an IMP office just starting out is whether

patients will be following from a former office or " finding you " over time

in a totally new location.

My average per day for patients who seem to be mine is a bit high. But

almost all my patients have followed me from my old office (10 miles away)

and the ones who contacted me first were the ones who needed regular

follow up... many diabetics, hypertensives, chronic pain... who I'd been

working closely with. Thus, my panel likely is fuller of " regulars " .

Many of the other patients I'm meeting for first time are younger and

healthier and less likely to be frequently in the office. I'm still

getting 5-10 charts each week from my old office as patients are planning

for care or getting sick again and then getting in touch with me. Those

patients will likely lower my average rate of visits if they are the sort

who come in <1 to 2 times a year.

Tim

> :

>

> It is hard to know exactly how many patients are active. I think you

> will find the number several ways. You take total # visits/year and

> divide by number of patients/year total. However, my EMR can report

> on how many were seen within last year or not within last 12 months.

> Subtract off total and you would have a higher result. It may prove

> useful to evaluate based on one month or three months intervalsas well

> and try to evaluate chronic vs. acute visits. I just calculated the

> number of diabetics, and hypertensives, and hyperlipidemic patients.

> I also calculated medicare at 25% of all registered patients, but

> responsible for 40% visits and only 34% revenue.

>

> I am wondering if we will start to see rates for diabetes that yield

> tighter diabetic control, or rates of visit for other illness or

> prevention strategies that yield better clinical results. If these

> numbers were known then the price of improved care could be determined.

> Perhaps fewer visits would yield better care? Could you develop

> protocols for thes and decrease cost and improve care further..

>

>

>

>

> ---------------------------------

> Get your email and more, right on the new Yahoo.com

[Guest guest]

I'm running just at that 1% also, . I have a panel of about 1000-1100 ( I'm uncertain now as  I'm trying to weed out the lost souls right now). My average number of visits/ day was 11 in July, 10 in June. My peak month was February this year, averaging 13 visits/day. My figures become strangely skewed, as my "half days" on Monday and Friday tend to be high demand, so I may see 8-9 patients in 3 hours instead of 5-6. I'm changing my schedule on Monday as time increases to make more hours available. The efficiency of those fast moving high-demand days is appealing also, though, so I'm changing my entire schedule starting next month, working several days in the week for 5 or 6 hours straight, starting at 11 AM. It will be interesting to see how that works. . . it's fun to be in charge of my own schedule and I haven't taken enough advantage of that yet (though I certainly don't ask anyone's permission when I want to go out of town).Gordon,In my micropractice, I have been running closer to 1% of my patients desiring appointments, which is cool because it makes the math easier (1500 patients=15 patients a day). Maybe I just have a slightly sicker population or maybe I just like to keep closer tabs on my patients, but it may also be secondary to easier access means the patients are coming in more often. I am curious if other IMPs are running slightly higher than the Kaiser average. -----Original Message-----From: [mailto: ] On Behalf Of L. Gordon Sent: Saturday, August 19, 2006 2:01 PMTo: Subject: Re: Autumn increase in appts? When Kaiser Permanente analyzed the data on office visit demand for a family med practice, they found that 0.75% of a family medicine panel will call on any given day seeking office care.  For 1000 patients in your panel you would expect 7.5 visits (1000 x 0.0075).Of course this is an average.  The larger the patient panel, the more likely you will hit the predicted target.  If you're a large group practice you could predict almost to the person.  Very small panels have much wider variation.  As Tim mentions below "Currently I'm seeing 4-8 appts/day and have about 300 patients in my EMR."To maintain same day access we have to maintain flexibility enough to accommodate this variation in demand.Tim asks about seasonal variation.  This does occur and is relatively predictable:August surge for school and sports physicalsRSV/influenza seasonSo, he's right to be cautious about reaching "full" in a slow season as it could spell burnout in the busy seasons.G08:19 AM 8/17/2006, you wrote:What's everyone's experience with the autumn and an increase in number ofappts? I assume there will be one due to acute visits forcolds/bronchitis/OM, etc, but is there a way to estimate how many moreappts/day that might be?Currently I'm seeing 4-8 appts/day and have about 300 patients in my EMR. I've recently learned local insurers have more patients assigned to methan I knew... but that's a whole other story and I'm trying to clarifythat and what I need to do. So currently I'm seeing about 2% of my knownpanel on average per day. I anticipate seeing 6-10 appts/ day as "fullstatus" (beyond that I plan to do some aesthetics with laser skintreatments... also, another story).Come Sept-Nov, should I be expecting 1-3 more appts/ day simply because ofincreased infection rates? Would that mean I'm about full now for familymedicine? Should I continue until I have at least 400-500 patients if I'mhoping for 6-10 appts/day (ie 1.5 - 2 % of my panel per day)?I'm being careful not to "overheat" as has been discussed so often before.So any pointers from you more experienced IMP'ers will be greatlyappreciated.Tim

[Guest guest]

I did my residency in the Kaiser system (1990-93) and

also worked for them as a staff physician for one year

(1998-1999) - my experience is that Kaiser makes it

such a hassle for people to call in (you rarely get a

live person right off, and waits can be up to 15-20

minutes+ on hold, so people are deterred from calling

in. So I think that 0.75% number is low.

I have about 270 patients now and we are seeing 2-4

patients a day consistently (wide variations of

course) - average is 3 a day so my percentage is 1.1%

- and I don't accept any insurance or Medicare. My

goal is to see about 10 a day (including walkins), so

I think about 900 patients will be enough for me

(maybe less if I keep getting Medicare patients -

right now Medicare patients make up 25% of my practice

- even though I am opted-out and they pay out of

pocket for my services).

Rancho Mirage, CA

--- " L. Gordon "

wrote:

> When Kaiser Permanente analyzed the data on office

> visit demand for a

> family med practice, they found that 0.75% of a

> family medicine panel

> will call on any given day seeking office care. For

> 1000 patients in

> your panel you would expect 7.5 visits (1000 x

> 0.0075).

> Of course this is an average. The larger the

> patient panel, the more

> likely you will hit the predicted target. If you're

> a large group

> practice you could predict almost to the person.

> Very small panels

> have much wider variation. As Tim mentions below

> " Currently I'm

> seeing 4-8 appts/day and have about 300 patients in

> my EMR. "

>

> To maintain same day access we have to maintain

> flexibility enough to

> accommodate this variation in demand.

>

> Tim asks about seasonal variation. This does occur

> and is relatively

> predictable:

> August surge for school and sports physicals

> RSV/influenza season

>

> So, he's right to be cautious about reaching " full "

> in a slow season

> as it could spell burnout in the busy seasons.

> G

>

> 08:19 AM 8/17/2006, you wrote:

>

> >What's everyone's experience with the autumn and an

> increase in number of

> >appts? I assume there will be one due to acute

> visits for

> >colds/bronchitis/OM, etc, but is there a way to

> estimate how many more

> >appts/day that might be?

> >

> >Currently I'm seeing 4-8 appts/day and have about

> 300 patients in my EMR.

> >I've recently learned local insurers have more

> patients assigned to me

> >than I knew... but that's a whole other story and

> I'm trying to clarify

> >that and what I need to do. So currently I'm seeing

> about 2% of my known

> >panel on average per day. I anticipate seeing 6-10

> appts/ day as " full

> >status " (beyond that I plan to do some aesthetics

> with laser skin

> >treatments... also, another story).

> >

> >Come Sept-Nov, should I be expecting 1-3 more

> appts/ day simply because of

> >increased infection rates? Would that mean I'm

> about full now for family

> >medicine? Should I continue until I have at least

> 400-500 patients if I'm

> >hoping for 6-10 appts/day (ie 1.5 - 2 % of my panel

> per day)?

> >

> >I'm being careful not to " overheat " as has been

> discussed so often before.

> >So any pointers from you more experienced IMP'ers

> will be greatly

> >appreciated.

> >Tim

> >

> >

>

__________________________________________________

[Guest guest]

I did my residency in the Kaiser system (1990-93) and

also worked for them as a staff physician for one year

(1998-1999) - my experience is that Kaiser makes it

such a hassle for people to call in (you rarely get a

live person right off, and waits can be up to 15-20

minutes+ on hold, so people are deterred from calling

in. So I think that 0.75% number is low.

I have about 270 patients now and we are seeing 2-4

patients a day consistently (wide variations of

course) - average is 3 a day so my percentage is 1.1%

- and I don't accept any insurance or Medicare. My

goal is to see about 10 a day (including walkins), so

I think about 900 patients will be enough for me

(maybe less if I keep getting Medicare patients -

right now Medicare patients make up 25% of my practice

- even though I am opted-out and they pay out of

pocket for my services).

Rancho Mirage, CA

--- " L. Gordon "

wrote:

> When Kaiser Permanente analyzed the data on office

> visit demand for a

> family med practice, they found that 0.75% of a

> family medicine panel

> will call on any given day seeking office care. For

> 1000 patients in

> your panel you would expect 7.5 visits (1000 x

> 0.0075).

> Of course this is an average. The larger the

> patient panel, the more

> likely you will hit the predicted target. If you're

> a large group

> practice you could predict almost to the person.

> Very small panels

> have much wider variation. As Tim mentions below

> " Currently I'm

> seeing 4-8 appts/day and have about 300 patients in

> my EMR. "

>

> To maintain same day access we have to maintain

> flexibility enough to

> accommodate this variation in demand.

>

> Tim asks about seasonal variation. This does occur

> and is relatively

> predictable:

> August surge for school and sports physicals

> RSV/influenza season

>

> So, he's right to be cautious about reaching " full "

> in a slow season

> as it could spell burnout in the busy seasons.

> G

>

> 08:19 AM 8/17/2006, you wrote:

>

> >What's everyone's experience with the autumn and an

> increase in number of

> >appts? I assume there will be one due to acute

> visits for

> >colds/bronchitis/OM, etc, but is there a way to

> estimate how many more

> >appts/day that might be?

> >

> >Currently I'm seeing 4-8 appts/day and have about

> 300 patients in my EMR.

> >I've recently learned local insurers have more

> patients assigned to me

> >than I knew... but that's a whole other story and

> I'm trying to clarify

> >that and what I need to do. So currently I'm seeing

> about 2% of my known

> >panel on average per day. I anticipate seeing 6-10

> appts/ day as " full

> >status " (beyond that I plan to do some aesthetics

> with laser skin

> >treatments... also, another story).

> >

> >Come Sept-Nov, should I be expecting 1-3 more

> appts/ day simply because of

> >increased infection rates? Would that mean I'm

> about full now for family

> >medicine? Should I continue until I have at least

> 400-500 patients if I'm

> >hoping for 6-10 appts/day (ie 1.5 - 2 % of my panel

> per day)?

> >

> >I'm being careful not to " overheat " as has been

> discussed so often before.

> >So any pointers from you more experienced IMP'ers

> will be greatly

> >appreciated.

> >Tim

> >

> >

>

__________________________________________________