OHIP Billing

[brady23]

What is the difference b/w A005 (Consultation) - $77.20 vs. A007 (Intermediate Assessment) - $33.70 for Family Doctors?

 

[ploughboy]

What's the difference?  $43.50

That and you have to spend 50 minutes with the patient, and provide all the elements of a consultation, to bill an A005.

http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master11062015.pdf

[brady23]

2 hours ago, ploughboy said:

What's the difference?  $43.50

That and you have to spend 50 minutes with the patient, and provide all the elements of a consultation, to bill an A005.

http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master11062015.pdf

I see. I was confused how FM could be considered a consult, since usually they are the ones who refer to a specialist who get paid $100 for a 30 minute repeat consult, while an FM doing a new consult for 50 minutes is only $77.

But after looking into it, it seems FM can be consulted for procedures such as biopsies or suturing 

[goleafsgochris]

6 hours ago, ploughboy said:

What's the difference?  $43.50

That and you have to spend 50 minutes with the patient, and provide all the elements of a consultation, to bill an A005.

http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master11062015.pdf

Are these the codes that Family docs bill for your sort of standard office visit (like if a patient comes in for, say, adjustment of HTN meds)? 

[brady23]

5 hours ago, goleafsgochris said:

Are these the codes that Family docs bill for your sort of standard office visit (like if a patient comes in for, say, adjustment of HTN meds)? 

The 15 minute appointments are usually billed as A007 (Intermediate Assessments) - $33.70

So on average, FMs probably make ~$140/hr 

[rmorelan]

On 8/25/2018 at 11:27 PM, brady23 said:

The 15 minute appointments are usually billed as A007 (Intermediate Assessments) - $33.70

So on average, FMs probably make ~$140/hr 

I would say 4-5 visits is pretty standard an hour. I hate using the term make an hour because of course that is just gross income, and doesn't include overhead (which is variable). They aren't walking out of the office with a 140 dollar hourly wage - which I know you know ha. Still it is a new concept to a lot of people on the forum still because it is a bit outside of the normal experience for a job. 

[LittleDaisy]

38 minutes ago, rmorelan said:

I would say 4-5 visits is pretty standard an hour. I hate using the term make an hour because of course that is just gross income, and doesn't include overhead (which is variable). They aren't walking out of the office with a 140 dollar hourly wage - which I know you know ha. Still it is a new concept to a lot of people on the forum still because it is a bit outside of the normal experience for a job. 

That's the billing model of GPs who bill fee for service, mostly at walk- in clinics, they definitely see more than 4-5 patients in an hour. 

In FHT & FHOs, it's another game. The billing method is very different in primary care depends on where you end up working. It's too complicated to explain all the billing models on the forum. 

To OP, I think that I would focus on more shadowing opportunities in preclerkship, and see what you like the most in terms of specialties. For remuneration, there is no point doing something you aren't passionate about just for the sake of making more money.  At the end of day, you do have to like what you are doing, otherwise, you will be miserable as we spend most of our time working. 

After talking to a few FHT physicians, they usually make around 300-400 K (> 500 K those who bill mostly out of basket codes- OBS, addictions, STD, counselling, etc). 

[brady23]

24 minutes ago, LittleDaisy said:

That's the billing model of GPs who bill fee for service, mostly at walk- in clinics, they definitely see more than 4-5 patients in an hour. 

In FHT & FHOs, it's another game. The billing method is very different in primary care depends on where you end up working. It's too complicated to explain all the billing models on the forum. 

To OP, I think that I would focus on more shadowing opportunities in preclerkship, and see what you like the most in terms of specialties. For remuneration, there is no point doing something you aren't passionate about just for the sake of making more money.  At the end of day, you do have to like what you are doing, otherwise, you will be miserable as we spend most of our time working. 

After talking to a few FHT physicians, they usually make around 300-400 K (> 500 K those who bill mostly out of basket codes- OBS, addictions, STD, counselling, etc). 

Yup - too bad the government has restricted new grads from joining FHTs/FHOs except in particular areas, I think it's a great model. 

At the end of the day, I am pretty passionate about FM and will likely go into it, but it's still interesting noting the differences in remuneration b/w it and other disciplines 

[rmorelan]

1 hour ago, brady23 said:

Yup - too bad the government has restricted new grads from joining FHTs/FHOs except in particular areas, I think it's a great model. 

At the end of the day, I am pretty passionate about FM and will likely go into it, but it's still interesting noting the differences in remuneration b/w it and other disciplines 

I thought they dropped that policy? I hope so as it sounded illogical. 

[member_225]

4 hours ago, LittleDaisy said:

That's the billing model of GPs who bill fee for service, mostly at walk- in clinics, they definitely see more than 4-5 patients in an hour. 

In FHT & FHOs, it's another game. The billing method is very different in primary care depends on where you end up working. It's too complicated to explain all the billing models on the forum. 

To OP, I think that I would focus on more shadowing opportunities in preclerkship, and see what you like the most in terms of specialties. For remuneration, there is no point doing something you aren't passionate about just for the sake of making more money.  At the end of day, you do have to like what you are doing, otherwise, you will be miserable as we spend most of our time working. 

After talking to a few FHT physicians, they usually make around 300-400 K (> 500 K those who bill mostly out of basket codes- OBS, addictions, STD, counselling, etc). 

300-400k before overhead or after?

[#YOLO]

9 minutes ago, member_225 said:

300-400k before overhead or after?

fho doc i worked with was doing 450k pre overhead at 25% 

[LittleDaisy]

1 hour ago, #YOLO said:

fho doc i worked with was doing 450k pre overhead at 25% 

Yeah pre-overhead. To rmorelan, yes, they are still restricting the number of FHT positions in urban areas. In GTAs, I think that it is around 20 positions every year. 

I think that a lot of FHT & FHO family physicians are making more than academic specialists to be honest, as academic staff physicians do share money ---> GIM staff make around 300 K in downtown TO for example. I work with a few GP staff who are making around 500 k pre-overhead, with 20% overhead as they are working in a big FHT (where everyone shares the cost of the office, etc) but they are doing mostly prenatal care, addictions, infectious diseases, counselling---> bill out of basket with a lot of patients rostered to them. 

At the end of day, you should always do what you love. Everyone in medicine makes good money. 

[rmorelan]

9 hours ago, LittleDaisy said:

Yeah pre-overhead. To rmorelan, yes, they are still restricting the number of FHT positions in urban areas. In GTAs, I think that it is around 20 positions every year. 

I think that a lot of FHT & FHO family physicians are making more than academic specialists to be honest, as academic staff physicians do share money ---> GIM staff make around 300 K in downtown TO for example. I work with a few GP staff who are making around 500 k pre-overhead, with 20% overhead as they are working in a big FHT (where everyone shares the cost of the office, etc) but they are doing mostly prenatal care, addictions, infectious diseases, counselling---> bill out of basket with a lot of patients rostered to them. 

At the end of day, you should always do what you love. Everyone in medicine makes good money. 

thanks - I thought I saw they dropped that - with the shear number of family graduates every year 20 is  really nothing. 

They certainly can if they put in the time to do so. That is what makes a lot of the math with this complex - you have a lot of people with a lot of different objectives. Even those trying to at least to a degree max their incomes may be doing it for different reasons. I know doctors who are working or did work a ton for the first ten years just to reach a point to coast from there. Others that earn and spend every dime. Others that want more free time right from the start. Plus all of this is a moving target anyway - the government changes the rules every 2-3 years but your planning cycle is much longer than that. 

[PeterPatting]

On 8/28/2018 at 12:16 AM, LittleDaisy said:

Yeah pre-overhead. To rmorelan, yes, they are still restricting the number of FHT positions in urban areas. In GTAs, I think that it is around 20 positions every year. 

I think that a lot of FHT & FHO family physicians are making more than academic specialists to be honest, as academic staff physicians do share money ---> GIM staff make around 300 K in downtown TO for example. I work with a few GP staff who are making around 500 k pre-overhead, with 20% overhead as they are working in a big FHT (where everyone shares the cost of the office, etc) but they are doing mostly prenatal care, addictions, infectious diseases, counselling---> bill out of basket with a lot of patients rostered to them. 

At the end of day, you should always do what you love. Everyone in medicine makes good money.

Interesting! I want to make sure I'm doing the math here correctly.

Pre-overhead Pre-Tax = 500k

Post-Overhead Pre-Tax = 400k (at 20% overhead)

Post-Overhead Post-Tax = 223k in ON? (I used this online personal tax calculator https://www.ey.com/ca/en/services/tax/tax-calculators-2018-personal-tax)

Is this correct? I know literally nothing about how taxes work for physician services, so if anyone could clarify that would be fantastic! Thanks!

[rmorelan]

7 hours ago, PeterPatting said:

Interesting! I want to make sure I'm doing the math here correctly.

Pre-overhead Pre-Tax = 500k

Post-Overhead Pre-Tax = 400k (at 20% overhead)

Post-Overhead Post-Tax = 223k in ON? (I used this online personal tax calculator https://www.ey.com/ca/en/services/tax/tax-calculators-2018-personal-tax)

Is this correct? I know literally nothing about how taxes work for physician services, so if anyone could clarify that would be fantastic! Thanks!

Some of those numbers I would say are pretty generous for a family doctor. Particularly the pretax number (it is much higher than average, and Little daisy I think is using the term "a few doctors" correctly here ha. Still it is dangerous to peg expected outcome on outliers). Your overhead number is pretty low too but it would relatively fall as your gross revenue rises (because some costs are fixed - like your office, your computer system, and so on) - but now that I tap danced around things ha, if you take your entire net income from your company out as income you would end up with those numbers. Now to be clear that isn't usually something people would do - at least not on a on going basis. Mostly because you have things like retirement to save for to start with ha. 

 

 

[brady23]

14 hours ago, PeterPatting said:

Interesting! I want to make sure I'm doing the math here correctly.

Pre-overhead Pre-Tax = 500k

Post-Overhead Pre-Tax = 400k (at 20% overhead)

Post-Overhead Post-Tax = 223k in ON? (I used this online personal tax calculator https://www.ey.com/ca/en/services/tax/tax-calculators-2018-personal-tax)

Is this correct? I know literally nothing about how taxes work for physician services, so if anyone could clarify that would be fantastic! Thanks!

 this is probably a more accurate (but conservative) estimate:

A007 (Intermediate Assessment $33.70) codes are the main code of FM docs for 15min appointments. If you work 9-5, and spend 7 hours seeing patients, you'll probably see around 28 patients per day.

28 x 33.70 = 943.60 per day

943.60 x 5 = 4718 per week

4718 x 52 = 245000 (pre-tax)

With 30% overhead, 172000 is your pre-tax income

After taxes, that's $112,000.

Again this is a conservative estimate. You get to bill 30% more for the hours you see patients after 5pm (minimum 3 hours) and hours worked on weekends. 

There's also bonuses I think for chronic condition patients (not sure how much that will add to income)

 

 

[freewheeler]

1 hour ago, brady23 said:

 this is probably a more accurate (but conservative) estimate:

A007 (Intermediate Assessment $33.70) codes are the main code of FM docs for 15min appointments. If you work 9-5, and spend 7 hours seeing patients, you'll probably see around 28 patients per day.

28 x 33.70 = 943.60 per day

943.60 x 5 = 4718 per week

4718 x 52 = 245000 (pre-tax)

With 30% overhead, 172000 is your pre-tax income

After taxes, that's $112,000.

Again this is a conservative estimate. You get to bill 30% more for the hours you see patients after 5pm (minimum 3 hours) and hours worked on weekends. 

There's also bonuses I think for chronic condition patients (not sure how much that will add to income)

 

 

I think calculating different examples can be helpful, but as a clerk I would say the following with regards to your estimate:

a) IMO 28 patients is a lot to see in one day, I'm not sure how people see 40+ in a day unless they're working longer hours in that day or their patients are incredibly straightforward ex. refills, urtis, etc.

b) Not all appointments are 15 mins, some can be shorter but many can take longer depending on psych or medical comorbidities in your patient panel

c) Working FM clinic 5 days a week is plenty, IMO 4 days might be better off, clinic isn't difficult but can be mind numbing and draining with all of the attention to managing patient expectations... Not to mention all of the labs/consults to review, referrals, forms and other paperwork outside of just patient visits and charting

d) No way would I ever work 52 weeks in a year. Seriously *@#& that.

e) Seeing patients after 5 pm? Hopefully not routinely.

Depending on how you structure your practice, daily workflow and your patient panel, FM can either be tolerable or your own personal living hell.

[#YOLO]

31 minutes ago, freewheeler said:

I think calculating different examples can be helpful, but as a clerk I would say the following with regards to your estimate:

a) IMO 28 patients is a lot to see in one day, I'm not sure how people see 40+ in a day unless they're working longer hours in that day or their patients are incredibly straightforward ex. refills, urtis, etc.

b) Not all appointments are 15 mins, some can be shorter but many can take longer depending on psych or medical comorbidities in your patient panel

c) Working FM clinic 5 days a week is plenty, IMO 4 days might be better off, clinic isn't difficult but can be mind numbing and draining with all of the attention to managing patient expectations... Not to mention all of the labs/consults to review, referrals, forms and other paperwork outside of just patient visits and charting

d) No way would I ever work 52 weeks in a year. Seriously *@#& that.

e) Seeing patients after 5 pm? Hopefully not routinely.

Depending on how you structure your practice, daily workflow and your patient panel, FM can either be tolerable or your own personal living hell.

28 is not a lot...i did that as a resident. 

[LittleDaisy]

4 hours ago, brady23 said:

 this is probably a more accurate (but conservative) estimate:

A007 (Intermediate Assessment $33.70) codes are the main code of FM docs for 15min appointments. If you work 9-5, and spend 7 hours seeing patients, you'll probably see around 28 patients per day.

28 x 33.70 = 943.60 per day

943.60 x 5 = 4718 per week

4718 x 52 = 245000 (pre-tax)

With 30% overhead, 172000 is your pre-tax income

After taxes, that's $112,000.

Again this is a conservative estimate. You get to bill 30% more for the hours you see patients after 5pm (minimum 3 hours) and hours worked on weekends. 

There's also bonuses I think for chronic condition patients (not sure how much that will add to income)

 

 

That's straight fee for service. Trust me, the walk-in physicians are seeing patients more than every 15 minutes.

Most of the doctors are within FHO, FHT, they get roster fees per patient, from 200 $ for a healthy pt to 900$ for an elderly. The most satisfying billing is when you bill the outbasket patients: HIV, pregnancy, mental illness, SUD, counselling, STI etc=--> which gives you 62.7 $ plus your base salary----> that's where the 500  k come from.

But the FHT positions are hard to come by nowadays.

As a PGY-2, I see a patient q 15 minutes, it's doable when you happen to know the majority of your patients. I hope that this helps! I have some staff who see patients q 10 minutes.

If you join a FHO, or FHT, you will be required to do evening calls, so from 5 pm and onwards. 

[loremipsum]

Does anyone know if OHIP billings are subject to overall clawbacks that were talked about a while ago by Hoskins? 

[BigM]

7 hours ago, loremipsum said:

Does anyone know if OHIP billings are subject to overall clawbacks that were talked about a while ago by Hoskins? 

Yes, there has been an across the board cut of 7%.

[member_225]

19 hours ago, BigM said:

Yes, there has been an across the board cut of 7%.

how is that fair 

[VivaColombia]

I'd even expect more cuts to come soon...the provincial deficit is large and the budget won't balance itself. Rough times ahead...

[IMislove]

25 minutes ago, member_225 said:

how is that fair 

Unilateral government action if I am not mistaken? Hence why we are still in this lovely pickle of trying to get a contract hah. Again correct me if mistaken. Can't say we're not gluttons for punishment.

[NeuroD]

55 minutes ago, member_225 said:

how is that fair 

Easy. Patients need doctors to do more than the government wants to pay for...so they just get the doctors to do it for free :D. Fair, right? Oh...you disagree? Can't imagine why :p