Dr. Arielle Cheifetz is lead for a FHO group of six doctors in general family practice. Her downtown Toronto clinic has been operating for over 10 years caring for approximately 6,000 patients representing a cross-section of the city: working young professionals, newborns, children, and marginalized citizens. We sat down with Dr. Cheifetz to talk about the challenges of being a FHO group leader and how DoctorCare has helped the group.
DoctorCare: Tell us about transitioning the practice to a FHO and some of the challenges you faced.
Dr. Cheifetz: Well we are a bit different in that we are both a FHO and a FHT. When we formed the clinic, it was the first time any of the doctors had practiced in that model. We did have a little in-house expertise for the billing aspect. After a while though, it became clear that was insufficient.
We were having a lot of difficulty with roster reconciliation – who was on, who was off. We couldn’t keep up with the changes coming from the Ministry – in-basket, out-of-basket, new bonuses. Also just trying to fully understand everything: How were capitation rates calculated? What counted as outside use? Who were those patients? How much were we losing? Were those patients frequent outside users or was it a one-time thing? Was it indicative of anything we should change?
We were missing opportunities and the level of work was becoming burdensome on both the doctors and our administrative staff.
Doctor Care: So you decided to get some help?
Dr. Cheifetz: We reached out to other FHOs and talked to other people about how they were managing. There were lots of options on the table that were appealing but they were too expensive. We went with a single consultant with a small team. They took over processing the RA every month. Our model is that everything goes to the group and then it’s distributed. This is a lot of work and adds complexity. We needed someone to parse out the confusing documents from the Ministry every month and figure out what to write on that paycheque.
They simplified that process and our in-house people would double-check for accuracy and it improved. They would also encourage us to make better financial decisions when it came to high outside use patients.
DoctorCare: So what changed?
Dr. Cheifetz: It started to become apparent that because our consultant was so heavily anchored in the financial model, they didn’t necessarily understand some of the competing motivations in our practice. Because we are not just a FHO but also a FHT we get funding directly from the Ministry and we have a certain duty to keep a roster a certain size. We started to become uncomfortable with the personality mismatch. At the same time, we began to see an overall decline in the quality of accuracy. The double-checking was becoming more onerous and when we did have billing questions, we were getting back inaccurate information.
At our monthly meeting, the group decided it was time to look at some alternatives and my job as the FHO lead was to do the research and bring it to the group to decide.
DoctorCare: What were the key things you were looking for in a new provider?
Dr. Cheifetz: We definitely needed someone to continue with the processing of the RA. We also needed to have someone to call – and pick up at the other end – when we were getting billing errors we didn’t understand. It was also important for our provider to understand the philosophy and nature of our group. The cost was also a factor. We are still a small practice and didn’t want to have to go above the current cost.
“They (DoctorCare) weren’t just giving us a list of our outside users but could tell us how much the individual patient was costing us because of particular uses, and also give us the date we could de-roster if we choose. The quality of the quarterly reports was also a huge win for us.”
DoctorCare: Why did you choose DoctorCare?
Dr. Cheifetz: DoctorCare brought a lot of things to the table that had been missing for us. Their ability to synthesize all of the raw data and recognize patterns was very important. They weren’t just giving us a list of our outside users but could tell us how much the individual patient was costing us because of particular uses, and also give us the date we could de-roster if we choose. The quality of the quarterly reports was also a huge win for us. Seeing how many people we added and who may have unintentionally dropped off, was attractive. The service levels, including meeting with each of us individually but then enabling us to act on our own timeline, was also very appealing. At the end of it all, it felt like it was going to be very little work on my part as the lead.
DoctorCare: Where have you noticed the biggest change since switching to DoctorCare?
Dr. Cheiftetz: The support is so fast and responsive and whenever we call, they almost always have the right answers. They are also proactive if they see something odd. For example, when we go through arbitration and a strange back pay appears, DoctorCare sees that and is proactive about how to deal with it.
We quickly saw more accuracy in our roster reconciliation and we have a much clearer understanding of where the opportunities lie. And all of the suggestions DoctorCare brings feel in line with the intention of the schedule of benefits. For me personally, when I go through my quarterly report, I can very quickly review and take action on roster reconciliation, billing errors, eligibility for diabetics and my high outside users.
There is no way a FHO group should be doing this (billing management) exclusively in-house and hope to get the same kind of results. We are doctors first, clinical experts more than financial experts, and I highly encourage other FHO groups to bring someone in to manage this. It seems foolish to be using doctor time that could be spent on patient care to do this level of work.
