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Practice Management


Does your uninsured services

program need a “check-up”?
by Jonathan Marcus, MD, CCFP

ost medical practices charge patients for some uninsured services
some of the time. While many physicians may have difficulty
describing their overall approach to what is referred to as an unin-
sured services program, almost all physicians have such a program in place,
even if it is very rudimentary.
Steps for implementing and maintaining 5. Develop and implement policies revenue and offset unpaid work,
an uninsured services program related to uninsured services (e.g., without resorting to the common
An uninsured services program when to apply charges, when to strategies of increasing daily patient
(USP) is an overall strategy that a waive fees, etc.). volume or practice roster size —
medical office implements to bill 6. Develop and implement commu- options which can further exacer-
and collect for uninsured services. nications strategies surrounding bate service levels.
It is important for physicians to the USP (both internally with Yet, many physicians are not
review their USPs on a regular basis, practice staff, and externally with inclined to examine their USPs, and
since even small changes can im- patients). it can be hard to motivate them to
prove patient service while simulta- 7. Determine how to go about fee change since they’ve grown used to
neously providing compensation collection (i.e. point of service, or whatever system they are using.
for physicians’ time. mailing bills). Furthermore, many physicians
Following are eight steps to 8. Deal with problems, and reassess are not familiar with the concept of
implementing and maintaining a and evolve the program. managing a USP, or the regulations
successful uninsured services pro- and laws governing USP fees, and
gram: Managing an uninsured services are not taught the necessary busi-
1. Identify any uninsured services program ness skills.
provided by the practice. Physicians tell me that over time, Uninsured services can typically
2. Decide which services to charge more and more of their practice has be divided into two categories:
for. become dedicated to work that is 1. Unavoidable (e.g, patient notes,
3. Determine prices.1 not compensated by the provincial other paperwork, missed appoint-
4. Decide whether to include a block health insurance plan. ments).
fee,2 and determine how to man- These uninsured services can pro- 2. Optional (e.g., telephone ser-
age it. vide an opportunity to raise practice vices, such as offering advice and
42 Ontario Medical Review • February 2010
prescription repeats to patients they view as a viable business. Con- grams. The time to conduct your
over the phone). sequently, they are not interested in “USP check-up” is now.
Providing both “unavoidable” providing services for which they do A future article will provide prac-
and “optional” services fully to not get paid. tical tips to help overcome barriers
patients, while getting paid effi- Like most physicians, they may to providing, and being paid for,
ciently for all services performed, not be comfortable asking for money uninsured services.
will satisfy the needs of both patients from patients. They easily identify OMR
and physicians. and avoid situations — including
However, many physicians have the provision of certain optional References
significant problems achieving this uninsured services — where their 1. The OMA “Physician’s Guide to
goal due to the reasons indicated time is not being properly compen- Third Party and Other Uninsured
above, as well as others described sated, or they may encounter diffi- Services” is a valuable practice re-
below. These physicians typically culty collecting payment. source, and provides guidance for
fall into two main categories of prac- These physicians limit uninsured physicians and office staff on unin-
tice style: services and thus may inconvenience sured and third party requested
patients. Patients may perceive this services, suggested fees, relevant
• The “Marcus Welby” type as a lack of interest in their concerns. policies, and interpretations of per-
Many people remember the well- Both the “Marcus-Welby” and tinent regulations. The 2010 Edition
loved doctor of the 1970s television “efficiency-phile” types of physi- of the Guide is available online at:
drama, Marcus Welby MD. Dr Welby cians have functional and dysfunc-
was always there for his patients tional aspects to how they deal with Billing/ThirdPartyGuide.pdf
whenever they needed him; a good their practices. Physicians may rec- 2. General information on the topic
role model in many ways. ognize characteristics in either or of block fees was presented in an
These types of physicians are very both types that fit their own practice article entitled “Implementing a suc-
focused on the needs of their patterns. cessful block billing plan, and billing
patients, sometimes to the detri- I recommend physicians adopt for uninsured services: seven steps
ment of their own needs. They want the functional behaviours of both for success, tips for educating staff &
to provide ultimate service and have types. Providing excellent patient patients, FAQs,” which appeared in
a hard time saying no to requests. care, while maintaining office effi- the March 2009 edition of the OMR
These physicians do not view ciency and developing a simple, A copy of the article is posted online
their practice as a business, and are effective payment system for all at:
not comfortable asking patients for uninsured work, creates a win-win omr/mar/09/Mar09_practice_
money. They often work overtime situation. management.pdf
charting and fitting in patients. Patients are quite accepting of an
Their offices frequently run late. uninsured services program if the Dr. Jonathan Marcus is a family physician, entre-
They may feel a bit trapped or taken program is conducted fairly and preneur, and adjunct lecturer in the University
advantage of, and often feel “burnt consistently, facilitated by proper of Toronto Department of Family and Commu-
out.” communication. nity Medicine. He writes and speaks on health-
These physicians undervalue un- care innovation from the ground up.
insured services or provide them for Conclusion
free. Although patients may appreci- The demand for uninsured services The Practice Management column is
ate this, it is not good for their care is increasing. If physicians are not provided by the OMA Member Services
in the long run, as the overall health being compensated for the time Department. Do you have a topic or
of the practice suffers. required to provide these services, question you would like to see appear in
their offices can gradually become the Ontario Medical Review? Please let
• The “efficiency-phile” type overwhelmed with the extra admin- the Practice Advisory Services team know
Physicians who fall into the “effi- istrative costs. Therefore, it is well at 416.340.2911, or 1.800.268.7215,
ciency-phile” style of practice fre- worth the time to plan, execute and ext. 2911, or e-mail: practiceadvisory@
quently have a well-run practice that monitor uninsured services pro-

Ontario Medical Review • February 2010 43