The Ministry of Health says they conducted an in-depth analysis on the anticipated costs of new funding arrangements for doctors. When asked by the Auditor General of Ontario, they couldn’t quite find it.
They may have similarly just overlooked the fact that a significant number of doctors in family health groups (13%) and family health organizations (18%) had actually not signed their contracts or declaration forms, leading the auditor to question whether these doctors fully understood their obligations under these new arrangements. Whoops!
The auditor’s report gives a clear indication why the docs suddenly had an overriding interest in group practice – much higher compensation levels.
In 2007/08 a family physician getting paid on a fee-for-service basis was receiving an average gross income of $285,000 – of which they had to pay out expenses. During the same year physicians working in various group practice models made from $360,000 to $405,000 in gross income.
As a result by the end of 2009/10 more than 7,500 of the province’s almost 12,000 family physicians were participating in alternate funding arrangements for group practice. These family physicians received 76 per cent of the total amount paid to all family physicians.
While the new arrangements did allow 500,000 more Ontarians to have access to a family doctor, it made no difference in the wait time to see one.
Patients signed on to these group practices were supposed to use them exclusively since the arrangements included blanket compensation for each patient signed up to the practice – or what is referred to as a capitation model. However, 22 per cent of these patients never darkened the door of their doctor in 2009/10, about half choosing to visit another doctor instead. Physicians in these practices received $123 million just for having patients enrolled who never showed up. Those that did receive these patients were instead compensated by OHIP.
Despite the capitation model, the docs in group practice were still able to bill for services left out of the contract, including flu shots and pap smear technical services. In fact, 27 per cent of all services delivered by these doctors were not covered by the alternate arrangements, leading to an additional $72 million in compensation.
With the Ontario Medical Association contract coming up for negotiation in 2012, the Ministry will likely want to make some adjustments.
In response to the Auditor’s report, they state: “a thorough formal evaluation of these models will provide an opportunity to adjust the models based on experience and study.”
Let’s just hope they don’t lose that too.