Health systems still size most physician panels against a long-standing benchmark of 1,800 to 2,000 patients, but that number is probably wrong, according to a July 9 Kaufman Hall analysis.
The benchmark, usually paired with simple age and gender adjustments, treats patients as interchangeable, according to two Kaufman Hall physician enterprise leaders. Managing Director Matthew Bates and Assistant Vice President Michael Nelson said that two panels of 2,000 can carry very different workloads — one patient may need a single annual visit, while another has several chronic conditions and requires constant care coordination.
When panels ignore that complexity, the strain shows on both ends. Oversized panels fuel access bottlenecks and clinician burnout as acuity rises; undersized panels limit new-patient appointments and stall service line growth.
The fix is to risk-adjust panel size using Risk Adjustment Factor (RAF) scores derived from Hierarchical Condition Category (HCC) coding, which score patients by clinical complexity rather than counting heads. A practice serving a sicker population would justify fewer patients per physician than a healthier one.
The approach also closes a payment gap because many payers already use RAF and HCC methods to set risk-based and capitated reimbursement.
“Health systems that use a different method than their primary payers to measure panel size create both internal and external misalignment,” the authors wrote. “The result is a system in which clinicians manage panels based on one definition of complexity, while payment is determined by another. This disconnect distorts incentives and makes it harder to manage total cost of care effectively.”
The shift is not just a new formula. It depends on consistent clinical documentation, clear patient attribution — Mr. Bates and Mr. Nelson recommend an 18-to-24-month lookback to drop inactive patients — and benchmarks used to inform decisions rather than “fixed targets.”
Kaufman Hall advises health systems to start by auditing their current method, coding capabilities, attribution rules and benchmark selection.
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