Friday, August 27, 2021 | Karen Wilson
MedAxiom’s ninth annual Cardiovascular Provider Compensation and Production Survey Report – which will be released in early September – will unveil trends across cardiology, surgery, advanced practice providers (APPs) and non-clinical compensation, revealing the true impact of the coronavirus pandemic on cardiovascular programs. In addition to highlighting comparisons between private and integrated models, the 2021 report will feature new panel size metrics for workforce planning.
For nearly a decade, MedAxiom has collected patient panel as part of the MedAxcess data submission process. MedAxcess, the cardiovascular industry’s leading proprietary database and business intelligence application powered by more than 15 years of data and over 800 metrics, includes between four and five million active cardiology patients being managed by thousands of cardiologists of various subspecialties from nearly 150 practices.
Defining Patient Panel
Patient panel is a unique count of all patients seen by a physician or APP for a face-to-face Evaluation & Management (E&M) encounter during an 18-month period. Patient panel is collected at the practice level, not at the individual physician level. Each unique patient is counted only once no matter how many visits or how many providers seen during the relevant time period. The patient panel measure in MedAxcess takes the total unique patient count divided by the total physician FTE count to calculate the patient panel per physician. Practices can then compare their physicians’ individual patient panels to the MedAxiom benchmarks.
Using Patient Panel to Benchmark
With the addition of patient panel, MedAxiom is able to benchmark patient care and utilization not only on a per physician FTE basis, but for the practice’s active patient population. Selecting patient panel as the denominator allows a practice to compare key access, imaging and procedure measures “per 1,000 active patients.” While volume per physician is important, MedAxiom suggests that benchmarking for the group of patients under active care provides a more accurate picture of utilization and opportunities for transforming care delivery if benchmarks are not where practices want them to be. Further, with the expected tightening of reimbursement for fee-for-service activities, understanding and managing resource utilization at the population level (patient panel) will help guide redesign efforts.
Often, MedAxiom is asked how many physicians or total providers a practice should have. There are national data reported for the number of cardiologists per population, but those data are very generalized and do not take into account the addition of APPs or differences in disease prevalence. With patient panel as part of MedAxcess, the measure has already filtered to patients needing active cardiology management. While no benchmark data of this nature are perfect and all will have wide differences in variables across the population of respondents, the utilization patterns should be more accurate than simple national averages when considered across hundreds of groups and millions of cardiology patients nationally.
This becomes particularly true when considering the number of providers – cardiologists and APPs – per 1,000 active patients.
The graphs below show the median total provider and physician (cardiologist) FTEs per 1,000 active patients separated for integrated and private groups. The difference between total providers and physicians – the delta – shows the impact of APPs.
Patient Panel Trends
Since 2012, the year MedAxiom started collecting patient panel, the median total provider FTE per 1,000 active patients has fluctuated for both integrated and private groups but in general shows a downward trend. That trend is greater when focusing only on physicians, especially physicians in integrated practices. The trend lines suggest that while the number of providers per 1,000 active patients might be declining, the delta – the APPs working with cardiologists to make up the total provider count – is increasing, especially for integrated practices.
It must be acknowledged that with any new metric – particularly one with a relatively complicated definition like panel size – data from the first couple of years may be volatile. If the 2012 and 2013 data are removed, the trend on total providers appears flatter, while the trend on physicians still slants downward. This suggests that the cardiology community is moving more care to APPs as part of its clinical strategy. It is interesting that this trend is happening more quickly in the integrated environment. While the reason why is not known from these data, we do know that the economics of the two ownership models are starkly different and thus the motivations for moving care to APPs also divergent.
As with all 2020 data, it is important to note the impact of the pandemic. Nearly all members submitting data for 2020 reported a smaller patient panel than in 2019. This smaller denominator – a result of fewer patients being seen due to the pandemic – could be the reason for the 2020 uptick across the board. It will be interesting to see how 2021 compares and if medians are more in line with the trends coming into 2019.
In response to organizations’ continuing question on provider workforce needs, we can now use the MedAxiom benchmarks per 1,000 active patients to provide a guide. The 2020 median FTEs per 1,000 active patients translate to the estimated number of providers below for integrated and private practices of 15,000 and 25,000 active, unique patients (near the MedAxiom median and average for total panel, respectively).
Taking that one step further, MedAxiom is also frequently asked what an “optimal” sub-specialty mix might look like for cardiology practices. In the past, we have queried our members and may have used a statistic such as “seven cardiologists to support one electrophysiologist.” Now, we can turn to our total MedAxiom patient panel, comprised of millions of active cardiology patients, and benchmark FTEs by subspecialty.
The calculations produced by this wide base suggest that a reasonable mix of providers caring for 10,000 active cardiology patients (for ease of multiplication) are as estimated below.
This new metric and the resulting outputs are examples of how MedAxiom continually listens to its membership and seeks new value from the data you provide. Together we will continue to fulfill our mission to “transform cardiovascular care and improve heart health.”
Illustration: Lee Sauer
Karen Wilson, MHA, is Director of Member Relations at MedAxiom with two decades in healthcare beginning her career in hospital administration with a focus on strategic planning and service line management. She joined Virginia Cardiovascular Specialists (VCS) in 2001, a large independent cardiology group in Richmond, Virginia, and one of the original CLA practices, serving as a key member on the administrative team. She then transitioned to integrated cardiology practices in 2011 joining HCA’s Physician Services Group (PSG) in San Antonio as Director for Cardiology Business Development. PSG asked Karen to take on an operational role as interim administrator in 2017 for Cardiology Clinic of San Antonio. At MedAxiom, Karen works to ensure the needs of MedAxiom’s members are fully supported by combining her desire to serve people with her unique love of numbers, data analytics, and ability to provide order and understanding in a sometimes chaotic industry.
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