How much does is cost to care for a baby, pregnant woman, diabetic, heart disease patient, or provide primary care among the myriad of other services offered by your family doctor? According to the Ontario Government, too much. According to you and me?
I am not about to rehash the many exemplary articles and blog posts that have so eloquently outlined the issues (see attached PDF). My focus is to ask you a single question: Are you getting value for what is spent on primary care health teams?
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The Ontario Government first told us that their policy was to encourage more physicians to take on more patients to reduce the number of Ontarians without a family doctor. We did so. We added four new physicians in the past year for a total of 14. We added a mental health nurse (funded by the Ministry of Health) and another RPN (funded by us) for a total of 5 nurses and also added a nurse’s assistant (funded by us). We have a total of 13 additional support staff.
They encouraged us to set up teams of physicians, nurses and ancillary staff in order to accommodate the service demands. We did so in 2010. Hours were expanded from 8 AM to 8 PM Monday to Friday, 10 AM to 1 PM Saturday and Sunday and holidays. We added, more urgent care drop in times, same day, same week, same month, and emergency appointment slots every weekday.
They wanted us to increase family doctor availability to reduce walk-in clinic use. Understandably, the government does not want to pay twice for patient services and would prefer they see their own doctor and not use walk-in clinics. We did so. We crunched patient utilization data so that we could determine what days of the week required more physician availability to reduce the “sorry your doctor cannot see you today” scenario. Our practice has been successful to the tune of reducing walk-in clinic use by our patients by 60 to 70 %.
OntarioMD provided funding to construct electronic health record (EMR) technology into our practices to streamline care and facilitate disease prevention. Many physicians took them up on this at great cost from both an monetary and administrative perspective. In our Centre, we are presently adding a patient EMR portal so they can book appointments on-line, have access to their medical records and test results, and make prescription renewal requests circumventing our busy phone lines.
Using my own practice data (I am quite obsessive of tracking every expense and financial machination of our practice) the total average monthly cost to provide patient care per patient regardless of their personal health status is $16.67 or $200 per year. OK, let’s give some latitude and be more liberal (forgive me) and say $20 per patient per month*.
What does this cover? EVERYTHING! The docs income, overhead costs to cover staff salaries and benefits, taxes, rent, utilities, accountant and legal fees, insurance, phones, computer technology and upgrades, medical supplies, medical equipment purchases, cleaning services, Centre maintenance, and over 30 other expense categories.
What the government has done in response to our good-faith efforts is to unilaterally impose cuts on physicians by making them responsible for patient demand for services and to reduce the service fees for many of my specialist colleagues. The more patient-driven and patient follow-up visits to see their doctor, the more it costs. The more these costs run over a government-imposed arbitrary cap on payments, the more they claw back from physicians for services that have already been provided. Joseph Heller would be proud.
Remember they encouraged us increase access so that more people could have access to primary care and a family doctor. Now that we are achieving this goal, the Ontario government says that they cannot afford it and that physicians have to be the ones to make up for the extra health care costs.
The inner workings of government
Keep track of who’s doing what to get federal policy made. In The Functionary.
The Functionary
Our newsletter about the public service.
Nominated for a Digital Publishing Award.
They have already removed all EMR funding from our practice ($4000/mo to maintain 50 workstations, and technical support for the EMR servers). They have removed the funding for administration of our health team (or better known as a Family Health Organization (FHO)) at a cost of another $4000/mo. The latter amount is used for patient analytics to improve access to our centre and the managerial expenses to do so.
The three pay cuts in one year to date have resulted in an approximate eight per cent reduction in income for the practice. More is in store including a feared ten to 20 per cent cut in April 2016.
So, is $16.67 per patient per month for primary care health teams value for money and health outcomes? We are doing what we can but the direction being taken by this government will erode our ability to provide the high-quality care provided to date. It is an unstable and untenable state of affairs where in the end, my patients will witness the erosion of health care services despite our best efforts to fill in the gaps. It is not way to run a railroad nor a health care system.
Notes: The number is derived from a family physician with a registered patient roster of 1600. This physician earns about $320,000 annual gross pay from which 30 – 40 peer cent goes to overhead expenses.
$320K/1600 = $200 per patient.
$200 per patient/12 months = $16.67 per patient per month.
There is more to this story, the nuances of which results in a myriad of combinations and permutations specific to each physician’s practice composition, patient profile and geographic location (rent is more in downtown Toronto than it is in suburban Ottawa for example) but this average is a reasonable starting point for discussion purposes.
