FHO Doctors: Managing Outside Use Post-COVID-19

On July 30, 2021, the Ministry of Health (MOH) announced that the virtual care K-codes will start impacting Outside Use when rendered on or after October 1, 2021. These codes will impact a physician’s Access Bonus when billed by primary care providers outside their enrolled patient’s FHO/FHN group.

Prior to the pandemic, physicians were able to capture up to 95% of their Access Bonus. However, for the past year, Access Bonus was insignificant as the K-codes were not being counted as Outside Use. Now that the codes are applicable to Outside Use again, we will share an update on how to manage your Outside Use to help you achieve your Access Bonus.

Note: for more information on how to bill the virtual K-codes, read our Comprehensive Guide to OHIP codes for Virtual Care and COVID-19 blog here.

More than just another warning for FHO doctors.

Before the COVID-19 pandemic, FHO doctors were receiving letters from the MOH about service obligations relating to negative Outside Use results as well as other poor performance metrics such as an insufficient number of patients seen per week. In some cases, the Ministry even threatened to strip a group of 95% of their FHO standing.

We have been in continuous contact with the MOH and they are standing firm on their position that continued high Outside Use is a breach of the FHO agreement. The Ministry will also be measuring FHO performance against current FHO averages and top performers in other areas including:

  • Number of patients seen per week per physician
  • Group collaboration (percent of visits to an enrolling group but not an enrolling physician)
  • After hours requirements met on 1 and 5 patient blocks

MOH staff are looking into a more aggressive approach including dissolving FHOs if results don’t improve.

Quick tips to reduce your Outside Use in the short term.

Here are some recommendations you can implement to quickly resolve poor Outside Use performance in the short term:

  • Educate patients about continuity of care and what it means to be in a FHO group.
  • Review Outside Use reports for frequent offenders.
  • Ensure your group offers after-hours care and patients are aware after-hours care is available to them. Allow time in your schedule to book urgent appointments.
  • De-roster patients strategically.
  • Stagger physician hours to maximize hours available to patients.
  • Coordinate with your coworkers to make sure there is always someone available on the phone.
  • Keep virtual care appointments as an option for patients to maximize options for them to receive care from you.

Looking for more information and strategies to manage Outside Use? Watch our on-demand webinar: FHO Optimization and Outside Use Management Strategies.

Challenges managing your roster? We can help!

DoctorCare takes time-consuming administrative tasks off your plate. We help FHO doctors consistently minimize Outside Use and streamline and create efficiencies in MOH billing.

Practice Care provides the insights you need to determine which of your patients are receiving care outside of your group (including virtual care), and gives guidance on the appropriate patients to de-roster and optimally manage your Access Bonus including:

  • Provide a list of your high Outside Use offenders over a six-month period.
  • Recommend patient communications tactics that are easy and fast to implement.
  • Recommend best practices to address patient access issues within your group and for each doctor.

We also analyze which patients incurred high Outside Use in the past six months and when they should be de-rostered. By de-rostering the appropriate patients, we reduce the impact of incurred Outside Use and help you achieve your Access Bonus.

We have worked with almost half of the approximately 200 FHO groups across Ontario. In fact, we saved one practice over $20,000 by helping them reduce Outside Use and streamline billing practices. We can help you resolve your individual or group’s risk and set you up with a plan for success.

Ready to get started? Contact us today!

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