Practice Management

OMA MEMBER SERVICES

Does your uninsured services

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

M
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
over the phone).
Providing both “unavoidable”
and “optional” services fully to
patients, while getting paid effi-
ciently for all services performed,
will satisfy the needs of both patients
and physicians.
However, many physicians have
significant problems achieving this
goal due to the reasons indicated
above, as well as others described
below. These physicians typically
fall into two main categories of prac-
tice style:
• The “Marcus Welby” type
Many people remember the well-
loved doctor of the 1970s television
drama, Marcus Welby MD. Dr Welby
was always there for his patients
whenever they needed him; a good
role model in many ways.
These types of physicians are very
focused on the needs of their
patients, sometimes to the detri-
ment of their own needs. They want
to provide ultimate service and have
a hard time saying no to requests.
These physicians do not view
their practice as a business, and are
not comfortable asking patients for
money. They often work overtime
charting and fitting in patients.
Their offices frequently run late.
They may feel a bit trapped or taken
advantage of, and often feel “burnt
out.”
These physicians undervalue un-
insured services or provide them for
free. Although patients may appreci-
ate this, it is not good for their care
in the long run, as the overall health
of the practice suffers.
• The “efficiency-phile” type
Physicians who fall into the “effi-
ciency-phile” style of practice fre-
quently have a well-run practice that
they view as a viable business. Con-
sequently, they are not interested in
providing services for which they do
not get paid.
Like most physicians, they may
not be comfortable asking for money
from patients. They easily identify
and avoid situations — including
the provision of certain optional
uninsured services — where their
time is not being properly compen-
sated, or they may encounter diffi-
culty collecting payment.
These physicians limit uninsured
services and thus may inconvenience
patients. Patients may perceive this
as a lack of interest in their concerns.
Both the “Marcus-Welby” and
“efficiency-phile” types of physi-
cians have functional and dysfunc-
tional aspects to how they deal with
their practices. Physicians may rec-
ognize characteristics in either or
both types that fit their own practice
patterns.
I recommend physicians adopt
the functional behaviours of both
types. Providing excellent patient
care, while maintaining office effi-
ciency and developing a simple,
effective payment system for all
uninsured work, creates a win-win
situation.
Patients are quite accepting of an
uninsured services program if the
program is conducted fairly and
consistently, facilitated by proper
communication.
Conclusion
The demand for uninsured services
is increasing. If physicians are not
being compensated for the time
required to provide these services,
their offices can gradually become
overwhelmed with the extra admin-
istrative costs. Therefore, it is well
worth the time to plan, execute and
monitor uninsured services pro-
grams. The time to conduct your
“USP check-up” is now.
A future article will provide prac-
tical tips to help overcome barriers
to providing, and being paid for,
uninsured services.
OMR
References
1. The OMA “Physician’s Guide to
Third Party and Other Uninsured
Services” is a valuable practice re-
source, and provides guidance for
physicians and office staff on unin-
sured and third party requested
services, suggested fees, relevant
policies, and interpretations of per-
tinent regulations. The 2010 Edition
of the Guide is available online at:
https://www.oma.org/Economics/
Billing/ThirdPartyGuide.pdf
2. General information on the topic
of block fees was presented in an
article entitled “Implementing a suc-
cessful block billing plan, and billing
for uninsured services: seven steps
for success, tips for educating staff &
patients, FAQs,” which appeared in
the March 2009 edition of the OMR
A copy of the article is posted online
at: https://www.oma.org/pcomm/
omr/mar/09/Mar09_practice_
management.pdf
Dr. Jonathan Marcus is a family physician, entre-
preneur, and adjunct lecturer in the University
of Toronto Department of Family and Commu-
nity Medicine. He writes and speaks on health-
care innovation from the ground up.
The Practice Management column is
provided by the OMA Member Services
Department. Do you have a topic or
question you would like to see appear in
the Ontario Medical Review? Please let
the Practice Advisory Services team know
at 416.340.2911, or 1.800.268.7215,
ext. 2911, or e-mail: practiceadvisory@
oma.org.
Ontario Medical Review • February 2010 43