St. Cloud VA Health care
System announcement

News & Announcements

To our Veterans, we apologize for the any distraction to care this may have caused.

A central focus of the 2013 OIG hotline complaint was increasing panel sizes caused by the unexpected departure of several providers in a short timeframe.

Impacts to Veterans included a higher rate of appointments cancelled by clinic and unrequested provider reassignments.  

During and since that period of time, the St. Cloud VA has worked hard to minimize the impact to Veterans. Overall, access to primary care, safety and quality remained high.

The allegations in the complaint were thoroughly reviewed and action plans, where appropriate, were put into place

Actions plans and improvement efforts include: 

• St. Cloud VA initiated a recruitment workgroup to enhance outreach and other recruitment strategies with the goal of increasing the number of permanent medical staff across the organization.
• In consultation with provider staff, the orientation and training plan for new providers was revised, to include the assignment of a mentor.
• Graduated clinic schedules were implemented for new providers. 
• Established providers made a commitment to maintain higher panel sizes to support new providers.  

Veterans can be assured of receiving safe, quality care at the St. Cloud VA, as evidenced by numerous, ongoing measurements of quality, including internal and external reviews by numerous independent accreditation agencies.

Facts: Panel Management 

• Regardless of assigned panel size, primary care providers are assigned a maximum of twelve 30-minute appointment slots per day.  This is done to allow providers sufficient time to prepare for, provide, and follow-up on the clinical care needs of patients.  
• Over the past three years, primary care provider panel sizes have been routinely consistent and generally within acceptable ranges. On two brief occasions, panel sizes increased in the fall of 2013 and again in the fall of 2015 (See Figure 1). Both circumstances occurred because of unforeseen provider departures.  
• Panel size is the number of unique patients for whom a care team, consisting of a medical provider (Physician, Physician’s Assistant, or Nurse Practitioner), Registered Nurse, Licensed Practical Nurse, and Medical Support Assistant, supported by other dedicated staff including Clinical Pharmacists, is responsible. This team directly supports the provider in managing the health care needs of the assigned patient panel. 
• In the Veterans Health Administration, the baseline expected panel is 1,200 patients for a full-time physician provider. After adjustment for various factors, expected panels for VHA primary care providers largely fall in the range of 1,000 to 1,400, per VHA Handbook 1101.02.   
• At the end of September, 2013, average primary care physician panel size was 1,810 patients; average advanced practice provider panel was 1,281. At the end of September 2014, the average primary care physician panel was 1,340 patients; average advanced practice provider panel was 1,044 patients. At the end of September, 2015, average primary care physician panel was 1,429 patients; average advanced practice provider panel was 1,082 patients.   
• At the end of September, 2015, full-time physician provider panel sizes ranged from a high of 1,505 to a low of 1,286. Full-time provider panel sizes for advanced practice professionals ranged from a high of 1,380 to a low of 496.   
• A day later, on October 1, full-time physician provider panel sizes ranged from a high of 1,684 to a low of 1,430.  Full-time provider panel sizes for advanced practice professionals ranged from a high of 1,394 to a low of 489.   
• Panel sizes increased in late FY15 due to four full-time primary care physician losses. Two physicians transferred to another VA facility, one accepted a position in the private sector, and one resigned. Two advance practice provider losses occurred: one retired and another accepted a position in the private sector.  
• The patient panels of providers who depart are redistributed to other providers, and this procedure contributed to the increased panel sizes experienced during the fall of 2013 and 2015.  
• The primary means of reducing panel sizes is the recruitment and retention of providers, and St. Cloud VA has improved the number of providers managing primary care panels. 
• In consultation with primary care physicians, St. Cloud has been proactive in hiring additional advanced practice professionals, so that the physicians can serve in a consultative role and as a resource for the mid-level providers. 
• An additional full-time primary care physician and eight advanced practice providers have been hired. Additionally, three physicians and five additional advanced practice providers are in the credentialing process.  
• As these new hires are on-boarded, panel sizes are projected to begin stabilizing at approximately 1,127 per physician provider and 655 per advance practice provider by end of 1st Quarter, FY 16, continuing through the 9 month ramp-up period as new providers acclimate to a full panel. Additional hiring and unforeseen provider departures will cause projections to change.