Reducing Outside Use Penalties

If you’re a family physician in a rostered system like me, you are surely familiar with the frustration of our patients’ “outside use” of other health services. Every quarter, we receive a report from the ministry of our rostered patients who received the services of other general practitioner physicians (usually at walk-in clinics). Each time this happens, we lose whatever money was billed by the other physician, often in the range of $50-100. If we don’t keep these outside visits in check, it can add up to many thousands of dollars per year.

After seeing a series of outside uses for a single patient, who among us has been tempted to say the following?

“Do you have any idea how much money you’ve cost me this month?!”
“I am actually LOSING money by taking care of you!”
“I’m going to have to demote you to the old-fashioned,
one-issue-per-visit form of medicine if you keep doing this…”

Naturally, being the nice doctors we are, we internalize these thoughts and try to keep the passive-aggression to a minimum. Many docs just give up, and learn to let this money go.

Most of these “outside uses” are preventable with better communication with our patients. Patients often have no idea how much money they are costing their family doctor when they receive these seemingly “free” services. They’re usually simple, benign visits, like a quick visit to a walk-in clinic near the patient’s work.

Most outside use is preventable with better communication; automating this with Ocean is a win-win Click To Tweet

Simply letting patients know about outside use after it happens is often good enough to prevent future penalties. Unfortunately, it takes a lot of work to track patients down, and it’s an awkward, paternalistic conversation when you do. It’s hard to explain what constitutes “outside use” (e.g. ER and specialist visits are OK, but sports medicine and addictions visits often are not!) Also, have you tried to explain what “de-rostering” means to a patient? It’s complicated and especially under the context of a veiled threat like this.

Surely there’s a good way to communicate this information! We just need to be clear with our patients about the boundaries, and explain them in a constructive, non-judgmental manner. After spending hours crafting various tactful ways to deliver this news to my own patients, both in spoken and written form, I realized how badly I needed to create a standardized letter for this task.

Here’s my initial template:

What do you think? I try to strike the right tone: informative and corrective, but not too accusatory or money-focused.

The best part is how I send this out to patients: each quarter, after receiving the outside use report, I have my staff use Ocean to send it as a private online questionnaire for patients to complete. This way, I avoid the awkward face-to-face confrontation. I also save on postage, and I get some helpful feedback on the patient’s perspectives on their particular outside use.

After deploying it at my clinic, my outside use has plummeted after delegating this unpleasant task. In some cases, I believe it’s simply a matter of patients being better informed. In other cases, the questionnaire has given patients an easy, comfortable way to let me know if they have switched to a new GP.

Recently, a patient indicated through the form that she had moved to a doctor closer to her home. With that information, I was able to de-roster her, dated the day prior to her outside use. The de-rostering allows me to recover the money I would otherwise lose. Without sending this letter, I wouldn’t even know she had switched, and I’d continue to be dinged $33.70 every time she went in for one of these visits to her new family doctor!

Like all our forms, my “Outside Use Notification” is available to any Ocean user. I’d love to hear if you decide to take this approach. Do you have other ideas on how to reduce outside use using a similar automated technique? I’d love to hear about those too.