February 2015

Why are FHO physicians advised to focus on Out of Basket Billings to maximize their income?

When capitation payments generate up to 80% of FHO physician’s income and reflects his/her enrolled patient roster.

Fee for Service (FFS) generates about 8% of total income for claims submitted on both enrolled and non-enrolled patients, Of that 8% FFS income, half or 4%, is generated from Out of Basket billing for enrolled patients. Notably, an encounter with a non-enrolled patient pays an average of $31.00; while an encounter with an enrolled earns the physician between $55 to $65 dollars. Patient enrolment is the prime generator of a FHO physician’s income. However, in our experience very few medical practices have adapted their practice management processes that will assure full physician remuneration. For example:

Does your software accurately reflect a patient’s enrolment status as does it match the ministry data?
Are you tracking the patients who are dropping off your roster and why?

PCA offers a Practice Management Program designed for family practices in the FHO payment model. We will establish workable policies and procedures that will ensure the practice is being fully remunerated. This is a hands on program, delivered in your office, working with you and your staff.

Changes to Primary Health Care Physician Payments

The following is drawn from the MOH INFOBulletin #11125 issued Feb 12/15

The Managed Entry process into the FHO/FHN models will be reduced from 40 patients per month to 20 physicians per month starting June 1st. More importantly new FHO positions and the Income Stabilization Program will be limited to areas of “high need”.

The ministry has advised they will use a combination of RIO Score, family physician/patient ration and other factors to define the areas of “high need’. To date there is no information as to which geographic areas or communities have been deemed high need. The New Patient Premiums are being eliminated as of June 1st. The codes that remain are: Q023A Unattached Patient Fee, Q043A New Patient Fee FOBT Positive/CRC Increased Risk and Q053A Complex Vulnerable Patient Fee The Q200A Regular Patient Rostering and Q202A LTC Per Patient Rostering will continue to be used to manager the patient enrolment process but the rostering fee will no longer apply..

Continuing Medical Education will be discontinued on June 1, 2015. All CME activity prior to that date will be paid.
Primary Care Discount (reduction) – as of June 1, 2015 a 3.1% discount (reduction) will be applied to payments in the patient enrolment models FHN, FHO, FHG and CCM

The Much Maligned Access Bonus

We love to hate the Access Bonus and why not? Patients are tempted by walk in clinics on every corner so why would they take the extra time to go to the FHO’s After Hours clinic? If continuity of care matters to your patients they’ll make the trip. If their mind set is ‘fix this bit cause it hurts’ they are most likely to attend the walk in.

The task for the FHO physician is to assign patients to the right income stream based on their habits. Capitation for enrolled patients who seek you for care and fee for service for those who can’t, due to distance, or won’t due to inclination. PCA provides our clients with an Outside Use Analysis Report that simplifies the process of assigning patients to the right income stream.