VHA Physician Productivity and Staffing Advisory Group

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VHA Physician Productivity and Staffing Advisory
Group

• Report of the Primary Care Subcommittee
• Submitted to Dr. J. Perlin and Ms. L. Miller
  6/30/03

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Charge to Advisory Group

• Evaluate the relative productivity of full time
  and part time VA physicians (both within VA
  benchmarking to external providers)
• Improve the management of providers and better
  understand how resources become services in
  outpatient care
• Demonstrate how veteran acuity and needs are
  related to physician and other support staffing
• Develop incentives to improve the delivery of
  care by clinical providers, and
• Develop a prototype infrastructure for conducting
  physician productivity and staffing studies in
  other specialties

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Methodology Primary Care

• Agreement to base productivity on panel size
• VA cares for defined population, with capitated
  allocation model
• Productivity measured by visits or RVUs promotes
  inefficiency
• VA made major advances in panel management with
  PCMM Directives on standardizing FTEE and panel
  counts developed
• Literature review on physician productivity
• Review of external benchmarks
• Analysis of current experience with panel sizes
  in VHA
• Survey of primary care clinics on practice
  characteristics
• Analysis of patient characteristics use of
  primary care services
• Preliminary analysis on relationship of panel
  size to quality, access, satisfaction, and cost
• Review and input throughout by Advisory Group
  with Primary Care representative from each VISN
  CO Chief Consultant

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VA Panel Sizes Today
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External Benchmarks
Visits / Hour are adjusted for VA population
support staff / MD ratio
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Factors Influencing Panel Size

• Mid-Levels (NP or PA) panel 72 of MD
• New Providers takes time (15-18 months) to build
  full panel
• Specialized Panels 6.8 of Primary Care is
  delivered in specialized primary care panels
  (HIV, dialysis, SCI etc.). Panels are smaller (
  600)
• Support Staff and Exam Rooms significantly
  related to productivity within VA as well as
  private sector
• Patient Characteristics (Disease
  Severity/Reliance) predicts 26 of variation in
  patient visit rates and affects panel size
• Education1 Resident bookable hour increases
  panel by 5
• Part Time Providers no difference in
  productivity

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Recommendations

• Approve Directive providing guidance on primary
  care panel sizes maximum panel size should be
  established locally for each Primary Care
  Provider in PCMM
• Target Panel Size for Established PCP
• MD 1,200 with range 1,000 1,400
• Non-MD 900 with range of 750 1,050
• Panels should be adjusted for factors that affect
  panel size guidance is provided
• Gains in productivity can be achieved by
  optimizing ratio of support staff and exam rooms