There are two ways to improve quality measures. The most important way is to improve quality (duh). But your good quality can be diluted if you don’t manage the denominator.
Most physician practices don’t manage their panels. Panel management is the key to top P4P results. If your panel includes patients that are no longer seeing your physicians, then ultimately they will be non-compliant with you health management targets (e.g., diabetic eye exams, annual physicals, chlamydia screenings, etc.).
My experience is that a physician practice takes no action when a patient leaves their panel (moves, switches insurances, dies). In fact, they often don’t know. But these people will pull down your P4P results. Physician practices need to introduce new processes to actively track down patients that they have not seen and flag when they have left their panel. Their IT systems also need to be able to flag them as out of the panel. So they can be excluded from the P4P denominator.
Ideally the system will allow the practice to document why and when the patient left as well. This information could come in handy if we get to the point that these results start getting audited.