This document provides instructions on how to use the BCM Clinic Panel Based Financial Distribution method which can support clinics if they decide to distribute funds using this process.
Note examples are included to provide guidance on how to carry out BCM Clinic panel-based financial distribution. Information included in the templates are fictional numbers.
- In the panel-based model given, the overhead is paid by the Associates as per the Business agreement (as done in the Fee for Service environment) i.e., Total cost per month for clinic: 70% fixed/30% variable used to determine OH
- If a panel is growing, the complexity can be monitored as the panel makeup changes. This could be quarterly if there is significant growth then it can be spaced out
- If the clinic has locums, they are paid out of the ‘Internal Negation pool”. For example: if the physician is away and the contribution was 10%, the rest of that physician’s BCM payment for that period would drop down to the "Residual Pool" in the BCM Clinic Panel Based Financial Distribution Sample Spreadsheet and can be used to cover both the Locum as well as compensation for colleagues covering the doctor’s patients while they are away
- Residents, Physician Assistants, Nurses (essentially the team) see all patients as they don’t have their own panel and are considered neutral so are not used in the continuity/contribution calculations for internal clinic adjustment
Instructions
There are three sample spreadsheets provided below to support this work:
- BCM Clinic Panel Based Financial Distribution Sample Spreadsheet
- BCM Complexity Determined Quarterly Sample template
- BCM Continuity Sample Template
- The BCM Clinic Panel Based Financial Distribution Sample Spreadsheet is completed on a bi-weekly basis by the assigned person responsible in the clinic for financial matters. This may be a physician with access to the clinic’s banking, the clinic manager, etc. This may consider all income into the clinic account as per the clinic’s business agreement. It is important to note that the 15% paid on the in-basket shadow billings, BCP, and RRNP will be automatically deposited into this account for all providers. This is managed differently depending on the clinic business arrangement.
- The BCM Complexity Determined Quarterly Sample Template outlines the complexity amount given for the patient cohort by doctor. The amount would then be transferred to the main BCM Clinic Panel Based Financial Distribution Sample Spreadsheet by the clinic manager or other staff member responsible to do this work.
- The BCM Continuity Sample Template provides an example of how the continuity for the doctors can be calculated. The template also includes the contribution of each sample doctor and how this is calculated. This information is then transferred to the BCM Clinic Panel Based Financial Distribution Sample Spreadsheet by the clinic manager or other staff member responsible to do this work.
| Note: Input information in yellow boxes to calculate payment. Input information in green boxes quarterly for adjustment if needed. Input payment amounts in orange boxes. |
| Step | Description |
| 1. | Input name of doctor under ‘Doctor’ - column ‘B’ |
| 2. | Input BCM panel size for each doctor under ‘BCM Panel Size’ - column ‘C’ |
| 3. | Input complexity % under ‘Complexity’ field - column ‘D’ (this information will be input in the BCM Complexity Determined Quarterly Sample Template) and can be transferred to this spreadsheet. See BCM Complexity Determined Quarterly Sample Template for further details |
| 4. | Information is automatically calculated in ‘Adjusted (Post Comp)’ field – column ‘E’ |
| 5. | Information in the ‘Initial Payment BCM’ field is automatically calculated – column ‘F’ |
| 6. | Input 'Continuity %' under the ‘Continuity’ field - column ‘G’ (this information can be transferred from the BCM Continuity Sample Template) |
| 7. | Information is automatically calculated in the ‘Gross Post-Negation' field – column ‘H’ |
| 8. | Information for the 'Contribution %' field – column ‘I’ can be transferred from the BCM Continuity Sample Template |
| 9. | Information for the ‘Contribution Income’ is automatically calculated – column ‘J’ |
| 10. | Information for the ‘Total Payment’ field is automatically calculated – column ‘K’ |
| 11. | Information for ‘Residual Pool’ is automatically calculated – column ‘E’ |
| 12. | Information for ‘Residual Post Locum’ is automatically calculated – column ‘F’ |
| 13. | Locum hours must be input manually if applicable by clinic manager or staff member responsible - column ‘E’ |
| 14. | Information for the ‘Locum payment’ field is automatically calculated – column ‘E’ |
| 15. | Information for the ‘Total Paid’ field is automatically calculated – column ‘K’ |
| Note: this information is pulled from the ‘AP002RS1 Capitation Payment Summary Report’ which is received biweekly by the clinic and describes the current clinic panel breakdowns and payments. |
| Step | Description |
| 1. | The spreadsheet sample includes: ‘Age Categories, ‘BCM Amount for Category’. ‘Doctor Name/Panel’ and ‘Total BCM Amount’. |
| 2. | The ‘Total Complexity Percentage’ per sample doctor is provided automatically at the bottom of the spreadsheet and should be included in the ‘Complexity’ field - column ‘D’ in the BCM Clinic Panel Based Financial Distribution Example Spreadsheet under the corresponding doctor. |
| 3. | The total panel size per doctor is given at the bottom of the spreadsheet and should be included in the 'BCM Panel Size’ field - column ‘C’ in the BCM Clinic Panel Based Financial Distribution Example Spreadsheet for the corresponding doctor |
| This sample spreadsheet contains sample doctor names, number of patients seen by own doctor and by colleagues. It also contains doctor continuity and doctor contribution. |
| Step | Description |
| 1. | Enter the number of patients seen by their own doctor or other doctors within the clinic under ‘Doctor Name Patient’. See examples given in the BCM Continuity Sample Template Field Names and Definitions Once the ‘Doctor Name Patient’ field has been populated, this will automatically create a continuity rate by doctor and contribution rate by doctor. |
| 2. | The continuity information can then be transferred to the ‘Continuity’ field – column ‘G’ in the BCM Clinic Panel Based Financial Distribution Example Spreadsheet by the clinic manager or other staff member responsible to do this work |
| 3. | The contribution rate can then be transferred to the ‘Contribution %’ field – column ‘I’ in the BCM Clinic Panel Based Financial Distribution Example template |
Below is an outline of the fields included in the BCM Clinic Panel Based Financial Distribution Sample Spreadsheet and a summary of how information from the two additional templates is included.
| BCM Clinic Panel Based Financial Distribution Sample Spreadsheet Field Names and Definitions |
| Field Name | Definition |
| Clinic Income Total | BCM payment for the bi-weekly pay period BCM payment plus out of basket payments from locums, plus 15% in basket payments paid to the clinic BA, BCM, RRNP, BCM BCP. Locums are paid an hourly rate so any income to clinic is deposited to the clinic BCM account. |
| Total Patient Panel | Total number of clinic patients |
| Adjusted Patient Panel | The clinic determines the complexity of the patients in the panels (see BCM Complexity Determined Quarterly Sample Template for details). |
| Average Per Patient Payment | Clinic income/adjusted patient panel |
| Doctor | List of doctors in the clinic |
| BCM Panel Size | Panel size per doctor |
| Complexity | % calculated and transferred from the BCM Complexity Determined Quarterly Sample Template |
| Adjusted (Post Comp) |
The clinic determines the complexity of the patient panel using information from the AP002RS1 Capitation Payment Summary Report. The BCM Complexity Determined Quarterly Sample Template is included for demonstration purposes with examples of doctors. E.g., Doctor 1 has a large panel but lots of young children and healthy people, so the complexity is 95%; the adjusted panel size is 1247.35. Doctor 2 has a small panel but is heavy with mental health. Due to this, the complexity calculated is 105%. |
| Initial Payment BCM | The adjusted panel/average per patient payment e.g., Doctor 1 Adjusted panel size: 1247.35 x Average Per Patient Payment 7.235273289 = 9024.918137 |
| Field Name | Definition |
| Continuity |
This is a mechanism to promote continuity of care and compensate physicians for looking after patients when colleagues are not able to. This is carried out a week before the payment is due and can be considered “internal negation”. Information from the BCM Continuity Template would be plugged into this field. See separate spreadsheet for details. Examples of how the internal negation are included below. Refer to the BCM Continuity Sample Template for details. |
| Gross Post Negation | This is the Initial Payment BCM x ‘Continuity’, received by each physician based on their work in clinic - ‘Internal Negation’. |
| Contribution % |
This is the % of visits in which the patients belonged to the physician's colleagues. Note: 35.8% of the patients seen by Doc 1 In this pay period were patients of Doc 2 &3. |
| Contribution Income | This is the total amount of money received the physicians’ “contribution” to their colleagues practice but is taken from the ‘Residual Post Locum’ amount |
| Total Payment | This is the amount received by the physician that period which includes their BCM gross post negation plus contribution amount. |
| Residual Pool |
This is the money that “drops” after continuity is calculated and is used to pay any Locums their agreed upon Locum rate (Calculation: sum of ‘Initial Payment BCM’ – sum of ‘Gross Post Negation’). After all locums are paid, the remainder is divided amongst the doctors based on their contribution %. Note: in the example given in the BCM Clinic Panel Based Financial Distribution Example template, the physicians receive under ‘Gross Post Negation’: $40,645.80608, the remaining $9354. 19 goes to the ‘Residual Pool’. This becomes a source of funding for the clinic. This can be used to pay Locums or other team. |
| Residual Post Locum |
This amount is shared back between the Associate Physicians based on their contribution. Calculation: Sum of ‘Residual Pool’ - ‘Locum Payment’ amount. For example, in the BCM Clinic Panel Based Financial Distribution Example template Doctor 5 looked after 21.48% of their colleagues’ patients. This means they will receive under ‘Contribution Income’ $1203 |
| Locum Hours | Number of hours worked by Locums |
| Locum Rate | Locum rate per hour |
| Locum Payment | Calculation: Locum hours x Locum rate = Total Locum Payment |
| BCM Complexity Determined Quarterly Sample Template Field Names and Definitions |
| Field Name | Definition |
| Age Categories | Cohort based on gender and age |
| BCM Amount for Category | Funding amount given per category |
| Doctor Name Panel | Doctor Name and number of patients in the specific category |
| Total BCM Amount |
The total BCM amount given. The calculation is: BCM Amount for Category x Doctor Name Panel e.g., Age Categories: F Und 1: $8.71 x Doctor A Panel: 7 = Total BCM Amount $60.97 (see sample spreadsheet for this example) |
| BCM Continuity Sample Template Field Names and Definitions |
| Field Name | Definition |
| Patient Seen by Doctors | Name of Doctor seeing patient |
| Doctor Name and Patient | Name of Doctor and number of patients e.g., Doctor A Patient |
| Unattached (patient) | Patient is not affiliated to a doctor |
| Doctor and Continuity |
Example 1:
Continuity for Doctor 1:
Example 2:
Continuity for Doctor 2:
Example 3:
Continuity for Doctor 3
|
| Doctor and Contribution |
This is the % of patients seen by a given physician in the pay period, that were for patients paneled to their colleagues. By seeing these patients internally, it prevents external negation but limits access to one’s own patients for appointments & thus needs to be accounted for. Hence “internal negation” consists of continuity and contribution. |