Question it answers
When patients wait weeks for primary care, how much capacity already sits inside the network's own practices?
New clinics and recruiting are slow and expensive when cash is low and clinicians are scarce. J. Michael Eaton frames the prior question this way: "Are we adding capacity because it is needed, or because we have not learned to use what we have?" The assessment answers it with a number, so leaders can decide how much new capacity to build.
How to use it
- Pull nine to twelve months of encounter data for one practice.
- Have your physicians list the conditions that can be safely managed virtually.
- Screen the primary diagnosis on each office visit against that list.
- Convert the qualifying visits to physician hours using standard visit times.
- Decide what the freed hours will be used for, and model it.
Step 3 produces the metric at the center of the assessment. Virtually addressable visits are the share of a practice's office visits whose primary diagnosis can be safely managed virtually.
Step 5 is the backfill. Freed hours become access and revenue when they go to new patients, complex patients, or higher-value services. Model more than one backfill rate, since existing work absorbs some freed time.
In practice
A clinically integrated network ran the assessment at one employed practice, comparing nine months of office visits with a physician-sourced list of virtually addressable conditions. About one-third of office visits could have been handled virtually, an opportunity worth roughly sixty hours per physician per month. The study also modeled opening panels to new patients with that time. These figures are an identified opportunity, and they gave leadership a clinical and numerical definition of the problem it could defend.
Where it breaks
- A diagnosis code is a proxy.
- The primary diagnosis misses the exam a visit needed and the second problem raised. Physician review of the list and a chart sample sets the safety floor.
- Moved visits generate follow-up.
- In one large integrated system, about a quarter of primary care visits had a follow-up within seven days, slightly more often after telemedicine (Reed et al., JAMA Network Open, 2021). Count freed hours net of that return traffic.
- Unused hours create no access.
- Hours that drift into inbox work leave the waitlist where it was. Under fee-for-service, a virtual visit can pay less than the office visit it replaces, so income can dip until backfill or a payer contract makes up the difference.
- One practice is a sample.
- Patient mix and coding habits vary by site, so run the screen at a second practice before sizing the whole network.
What it borrows
- Sharing the care. Amireh Ghorob and Thomas Bodenheimer argued that primary care access improves when work moves from the physician to the rest of the team ("Sharing the Care to Improve Access to Primary Care," NEJM, 2012). The assessment applies the same logic to the setting of care.
- The time a panel needs. Justin Porter and colleagues estimated that a primary care physician would need about 27 hours a day to deliver guideline-recommended care to a typical adult panel, and about 9 with team-based care ("Revisiting the Time Needed to Provide Adult Primary Care," Journal of General Internal Medicine, 2023). That gap is where freed hours go.