Sunday, March 14, 2010

Show me the money

The latest Saskatchewan Medical Association “President’s Letter” had some encouraging tidbits in it. The SMA and Government are negotiating physicians’ fee-for-service agreement. Usually the focus is on the percent increase in global funding to physicians, but this time the newsletter mentions some initiatives the Ministry of Health is proposing around Quality and Access. “Clinical Practice Redesign” and “Dedicated Quality Improvement Work” are noted as areas for targeted funding. They’re both laudable, if as-yet undefined, goals.

But, I’m most interested in the suggestion that funding may be given for “Physician contacts with patients via telephone and email”. I think this has great potential for improving patient access and satisfaction.

I’ve heard from many patients that they have trouble reaching their family physician (or specialist) over the phone. They may have a quick question that could be handled over the phone, but instead are required by “office policy” to make an appointment to see the doctor in person. Last month, my wife was quite annoyed at being subjected to this approach when she wanted to find out the results (normal, as it turned out) of my son’s xrays. She drove across town, and waited to be seen, all to receive 30 seconds worth of information. That’s not good value.

We shouldn’t be surprised that doctors require patients to come in for a “face-to face”. (See a previous post about this: “Awkward”) There’s no value (i.e. fee code) assigned to alternate ways of communicating with patients. I spend between 30 and 60 minutes daily returning phone calls and emails, as well as writing patients letters about results or follow-up. That’s an unpaid hour of work. I’m sure that lawyers and accountants would shake their heads at that.

Even though I plan to continue to communicate with my patients like this, whether I get paid for it or not, I can envision ways that I might change my practice if this alternate communication gets its own fee code. At present, I see phone calls as “extras” that I fit in between “real” (i.e. billable) visits. If I were to be paid for phone calls, I might schedule blocks of time to make them. I could get calls done during regular hours rather than after the end of the scheduled workday. Also, my staff could tell my patients when they should expect a call. That would be more convenient for patients, and would likely reduce the amount of phone tag frustration. I don’t like it when the cable guy says he’ll be around “sometime between 9 and 5 on Wednesday”, and I’m sure patients don’t like to hear a similar message about when the doctor will return their call.

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