Patient empanelment: the importance of understanding who is at home in the medical home.

The policy brief by Peterson et al in this issue of the Journal of the American Board of Family Medicine presents a concise and provocative analysis of panel size estimation by family physicians. Empanelment is a foundational building block of high-performing primary care. Family physicians need to know the patients they are serving. One essential piece of information is the number of patients in their primary care practice—commonly referred to as “panel size”. By asking 1 simple question of family physicians, “Approximately what is the size of your patient panel?” the authors found that only about one-third of respondents who provide direct patient care could estimate their panel size. It is startling that so few of these family physicians could give even a rough estimate of the number of patients active in their practice. Among the minority who provided panel size estimates, larger panel sizes were associated with spending more time in direct patient care. However, there was wide variation in panel sizes estimated by family physicians reporting a similar amount of time spent in patient care. For example, of the family physicians reporting 61% to 80% of their time spent in direct patient care, about as many estimated panel sizes of 0–1000 patients as estimated panel sizes of 2501 to 4500. This variation is not readily explained by part-time versus full-time activity and may be influenced by differences across physicians in the patient case mix; the extent of involvement of nurse practitioners, physician assistants, and other team members sharing the work of managing the patient panel; and other factors. However, given the difficulty so many of the respondents had in estimating panel size, we suspect that much of the variation reflects inattention to systematically measuring, standardizing, and addressing panel size as a core element of practice management. As Peterson et al pointed out, nearly 70% of these family physicians have an electronic health record, so the technology for panel size estimation is certainly present. Availability of technology does not guarantee that it is optimized.