How Accurate is the MSP Blue Book Billing?

[rmorelan]

Not really. An ophthalmologist working the same amount of hours, even if only on an elective basis, will significantly outperform the GP. The rural GP, by working hellishly, might match the income of a three-days-a-week ophthalmologist.

 

The fee schedule tends to favor not just procedures, but cutting-edge procedures.

 

well that is a pretty extreme specialty you picked to compare it to. If they can get into the 300K range then that is lining up with a lot of the standard specialties.

[thebouque]

well that is a pretty extreme specialty you picked to compare it to. If they can get into the 300K range then that is lining up with a lot of the standard specialties.

 

With all due respect, I don't think it's brooks who picked ophtho to compare it to family.

[rmorelan]

With all due respect, I don't think it's brooks who picked ophtho to compare it to family.

 

ha, did I lose a theme in the thread Quite possible. Wasn't being critical of the choice really, just that it seems there is a lot of focus on a handful of specialties in general (for obvious reasons) and yet the major of specialties of course are not in those fields.

[thebouque]

ha, did I lose a theme in the thread Quite possible. Wasn't being critical of the chose really, just that it seems there is a lot of focus on a handful of specialties in general (for obvious reasons) and yet the major of specialties of course are not in those fields.

 

I totally agree We're focusing on the trees and we tend to lose sight of the forest.

[leviathan]

Not really. An ophthalmologist working the same amount of hours, even if only on an elective basis, will significantly outperform the GP. The rural GP, by working hellishly, might match the income of a three-days-a-week ophthalmologist.

 

The fee schedule tends to favor not just procedures, but cutting-edge procedures.

Knew you were going to say that.

 

As others said, we're comparing GPs to specialists and generalist surgeons, not GPs to specifically to ophthos. Those guys make more than everyone else, specialists included. Ophthos are also starting to see some pay cuts in most provinces.

[Physio101]

Im curious how a GP being able to bill $75 for seeing a patient for 5 mins not reflecting their importance?

[thebouque]

Im curious how a GP being able to bill $75 for seeing a patient for 5 mins not reflecting their importance?

 

La curiosité est un vilain défaut

[leviathan]

The monetary value of things tends to reflect their worth, their demand, or the costs associated with doing them plus profit.

 

The way things are currently, the fee schedule significantly overvalues(relative to other billing codes) procedures based on new technologies that can be performed at quick intervals. There is a tacit implication that such things are more valuable than, say, family medicine or psych E&M codes and therefore, ophthalmologists are more valuable than family doctors or psychiatrists.

 

Given all the lip service aimed at drawing people to the "specialties in need": family med, psych, geriatrics etc., the billing rates do not reflect the supposed importance of these practitioners. Until they do, recruitment will be a problem (even moreso given the huge swath of opportunities south of the border)

I still think if you compare it on an hourly basis, the pay differences are not very bad between MOST specialists and GPs. There are always exceptions to that rule, but then again they are in residency for less than half the duration.

[Physio101]

As it stands, high-technology procedures are the most lucrative whereas plain ol' talking and listening is not lucrative at all. This kind of thing runs a bit counter to medical ethics, but it is what it is.

 

Once again, how is telling someone they need to go to physio with no hands on assessment, going over test results for 1 min and getting $75 for that not lucrative! I've never heard of a poor GP.

[Physio101]

Very little of what a family doctor does involves referrals to physiotherapy. More likely, it involves managing noncompliant diabetics, poor demented victims of polypharmacy, the worried well, those that want to leech WSIB, those that want demerol, and people who want a referral to a specialist.

 

Going over test results requires more than 1 minute when they are abnormal.

 

None of this is 75 bucks for one minute. If it were, then sign me up!

 

I have not seen "poor" GPs, but I've seen GPs in worse financial shape than teachers. That's not a good thing.

 

Definitely not saying thats a majority of what they do, just making the point that no matter how much time they put in, there getting there $75.

[HycrestJIT]

Once again, how is telling someone they need to go to physio with no hands on assessment, going over test results for 1 min and getting $75 for that not lucrative! I've never heard of a poor GP.

 

Where is a family doc getting $75 per patient?

 

In Alberta, your typical office visit that doesn't include a comprehensive history and physical is an 03.03A, paying $35.91 for up to 15 minutes (and time modifiers may be added after if you spend longer than that).

[Physio101]

Where is a family doc getting $75 per patient?

 

In Alberta, your typical office visit that doesn't include a comprehensive history and physical is an 03.03A, paying $35.91 for up to 15 minutes (and time modifiers may be added after if you spend longer than that).

 

I believe thats the fee schedule in ontario

[Dongzhuo]

Definitely not saying thats a majority of what they do, just making the point that no matter how much time they put in, there getting there $75.

 

Right and wrong. Usually a simple case pays 35 dollars though. But you're right in that most things dont take too long. Walk ins are the best since you don't really know the patient and don't have the social obligation to be chatty. Let me give you common examples of what a typical days work is like:

1. Can I get a refill for my meds?

2. I'm worried about this mole can you check it out?

3. I've been having this chest cold....

4. I feel burning when I pee...

5. I'm having headaches after my MVC 2 weeks ago

6. I've got ear wax in my ear

7. Can you write this note for me?

8. I twisted my ankle the other day....

9. My vision is blurry when I look at far distances

10. I have this twinge in my outer thigh.. Wonder what that means?

 

As you can see, probably takes 2 minutes to send them on their way...

 

2500 is possible in a days work

[rmorelan]

I believe thats the fee schedule in ontario

 

that schedule of fees is confusing

 

I think what we should be looking at is (Ontario):

 

Monday to Friday - Daytime (08:00h to 17:00h)

H102 Comprehensive assessment and care 37.20

H103 Multiple systems assessment 35.65

H101 Minor assessment 15.00

H104 Re assessment 15.00

 

there certainly are not that wide of differences between provinces.

[rmorelan]

Right and wrong. Usually a simple case pays 35 dollars though. But you're right in that most things dont take too long. Walk ins are the best since you don't really know the patient and don't have the social obligation to be chatty. Let me give you common examples of what a typical days work is like:

1. Can I get a refill for my meds?

2. I'm worried about this mole can you check it out?

3. I've been having this chest cold....

4. I feel burning when I pee...

5. I'm having headaches after my MVC 2 weeks ago

6. I've got ear wax in my ear

7. Can you write this note for me?

8. I twisted my ankle the other day....

9. My vision is blurry when I look at far distances

10. I have this twinge in my outer thigh.. Wonder what that means?

 

As you can see, probably takes 2 minutes to send them on their way...

 

2500 is possible in a days work

 

that is an impressive rate - 72 patients to do that at 35 in a day!

 

It also means that with the average patient roster of 2500 you could burn through all your patients in theory in 7 weeks if you work 5 days a week at that rate (see them all once during that time).

 

It also would generate 600K a year assuming 4 weeks vacation - about twice what would be considered a good FM practice.

[Dongzhuo]

that is an impressive rate - 72 patients to do that at 35 in a day!

 

It also means that with the average patient roster of 2500 you could burn through all your patients in theory in 7 weeks if you work 5 days a week at that rate (see them all once during that time).

 

It also would generate 600K a year assuming 4 weeks vacation - about twice what would be considered a good FM practice.

 

This is of course not in your average "bleeding heart" family practice. This has to be a busy fast paced medicentre/ walkin where the patient flow has to be fast. But you're right in that it can't be extrapolated to 70 patients. Though it's doable but extraordinary Tiring. Usually 50 is the human limit. Also the income is not all from msp. There are note costs, insurance costs, and procedures that increase your base visit price. From my experience (r2) if you are going into family with a financial mindset....gross 550K in Alberta is reasonable and 700k if you're really really pushing it.

[fmresident]

Definitely not saying thats a majority of what they do, just making the point that no matter how much time they put in, there getting there $75.

 

You should consider spending more time learning grammar rules and less time on misinterpreting the schedule of benefits.

 

Very few visits earn 75 for family med. I think a complete assessment (as in not minor or intermediate assessment) in emerge overnight is worth about 75.

[fmresident]

that is an impressive rate - 72 patients to do that at 35 in a day!

 

It also means that with the average patient roster of 2500 you could burn through all your patients in theory in 7 weeks if you work 5 days a week at that rate (see them all once during that time).

 

It also would generate 600K a year assuming 4 weeks vacation - about twice what would be considered a good FM practice.

 

You don't see rostered patients this fast. In Ontario, if you have a roster, you only get shadow billing 10-15%. So, 10% of 34.70 per patient! Not much incentive to go quickly! The incentive is to have a big list - which causes other problems, like timely access.

 

The incentive to go quickly is in walk-in, as mentioned above, because you get 100% of the billings. But 2500 is a massive day in a walk-in.

[fmresident]

This is of course not in your average "bleeding heart" family practice. This has to be a busy fast paced medicentre/ walkin where the patient flow has to be fast. But you're right in that it can't be extrapolated to 70 patients. Though it's doable but extraordinary Tiring. Usually 50 is the human limit. Also the income is not all from msp. There are note costs, insurance costs, and procedures that increase your base visit price. From my experience (r2) if you are going into family with a financial mindset....gross 550K in Alberta is reasonable and 700k if you're really really pushing it.

 

Unless the office is extremely efficient in the way they turnover patients, procedures are generally not worth it. You get more per patient, but not more for your time because you see fewer people. That's why it's way less common in family practice now.

 

A surgeon can run three rooms at the hospital with hospital-paid nurses and equipment and fire through the outpatient procedures, but most family docs don't have that.