Family physicians are critical to the healthcare system, providing comprehensive care to individuals and families. However, they often face numerous challenges in their practice that can impact patient care, overall efficiency, and revenue potential. In this blog post, we will explore five common challenges family physicians encounter in the FHO model and ways to overcome them.
Challenge 1: Managing Patient Roster
Many family physicians struggle with managing their patient roster effectively, often unaware that their EMR records may not align with the Ministry’s data. FHO physicians get approximately $200 in capitation per rostered patient per year. Physicians may sometimes see a discrepancy of 100-150 patients between their EMR and the Ministry’s records. This could result in $10,000 – $20,000 in unrealized annual capitation each year. Effectively administering the patient roster is an ongoing activity that physicians must perform to maximize their income potential.
Solution: An effective way to overcome this challenge is by regularly reviewing and reconciling your patient roster. It is important to identify the discrepancy between patients rostered according to the Ministry against patients you believe to be on your roster according to your EMR. In essence, effective roster management is extremely important in the FHO model to meet the needs of patients and physicians’ individual needs.
Consider leveraging DoctorCare’s Patient Care service for end-to-end roster management, including identifying non-rostered patients, sending rostering forms, and billing rostering codes.
Challenge 2: High Outside Use and Missed Access Bonus
Outside use occurs when enrolled patients visit a physician outside your FHO for comprehensive care, impacting your access bonus potential. The access bonus is an additional incentive for physicians, which they receive if their patients refrain from seeking medical care outside their group. It is important to clarify that when patients go to walk-in clinics, physicians do not lose their regular income but rather miss out on a bonus potential.
Managing high outside use is challenging, as it often involves educating patients and strategically de-rostering them.
Solution: We know it is hard to control patient behaviour, and most patients are unaware of the impact seeking care outside of your FHO may have. Some things you can do to manage your outside better include:
- Educate patients about continuity of care and what it means to be in a FHO group.
- Emphasize the availability of after-hours care your group provides and allow time in your schedule to book urgent appointments.
- Review outside use reports for frequent offenders and de-roster those patients strategically.
DoctorCare’s Practice Care report, can provide you with an annual trend analysis showing you which patients are incurring high outside use and when they should be de-rostered. Additionally, through our Patient Care service, patients can be notified to avoid walk-in clinics, and schedule appointments with the FHO after hours.
Challenge 3: Ineffective High-Needs Patient Management
Another challenge physicians often face is not identifying high-needs patients in their rostered list. High-needs patients need to see the physician more often than the average patient, which can impact your revenue potential if those patients are not de-rostered and seen on a fee-for-service basis. Physicians may overlook de-rostering these patients when necessary, leading to financial inefficiencies.
Solution: To optimally manage your revenue potential, you need to regularly review your list of high-needs patients to identify those that require the most services from you and de-roster the appropriate patients.
Similarly, to managing outside use, our Practice Care report includes a module designed to help you address your high-needs patients in more detail. This module highlights annual trends for high-needs patients and monitors your fee-for-service potential for frequently seen, enrolled patients. Moreover, the DoctorCare team can take the necessary steps to de-roster and transition these patients to a fee-for-service model on your behalf.
Challenge 4: Rejected Claims and Unpaid Revenue
Reconciliation of rejected billings takes considerable time, and unpaid claims due to errors result in significant amounts of revenue being left behind. Moreover, recent changes to the submission timeframes allow physicians only three months to resubmit their rejected claims, as opposed to six months. The error report you receive from the Ministry of Health can be confusing and not comprehensive, resulting in unaddressed billing errors piling up with no time to fix them.
Solution: Some tips to minimize claim rejections include:
- Include a referring physician when billing for consultations.
- Include your service location or facility code when applicable.
- Avoid combining codes that can’t be billed together.
- Verify coverage and patient health card details at the beginning of each visit.
- To avoid stale dated claims, develop a habit of billing regularly, either daily or weekly, to meet billing timeframes.
Our quick reference guide lists the most common error codes found in your error reports and Remittance Advice (RA) summaries and offers solutions to resolve each of the listed error codes. Alternatively, our Practice Care report highlights your rejected claims by providing a simple and easy-to-understand error report.
To take it a step further and reduce the administrative burden of error correction and claim resubmission, our Billing Care service automatically corrects and resubmits rejected claims on behalf of physicians, saving them valuable time and ensuring they receive the revenue they deserve.
Challenge 5: Inefficient Patient Communication and Recalls
Inefficient patient communication and recalls are another challenge many physicians encounter due to their busy schedules. To provide the best preventive care possible and effectively oversee chronic conditions like congestive heart failure and diabetes, it is essential to establish a systematized approach to patient recalls. If not managed effectively, this affects the continuity and quality of care provided to patients and results in a decrease in the income potential.
Solution: Having a recall system in place can contribute to the overall quality of medical care, reducing the risk of missed opportunities for diagnosis, treatment, or preventive interventions. It can also go a long way towards increasing your potential earnings.
DoctorCare offers custom solutions for patient recalls and reminders, ensuring proactive communication and follow-up care. We can help manage your recalls by identifying patients not seen in over three months, conducting monthly diabetic recalls, and setting up automatic reminders on your online booking system. Additionally, we provide patient communication support to help make clinic announcements, outside use education and other ad hoc messaging.
Need help optimizing your FHO practice?
We encourage you to take advantage of a complimentary FHO Practice Assessment to address any of these challenges. This assessment will help you identify areas of improvement and recommend tailored solutions to optimize your practice and enhance patient care.
