Ban on accessory fees: How to compensate for lost revenue in clinics

As of January 26, 2017, the government of Quebec is forbidding physicians paid by the RAMQ from billing their patients for accessory fees. The twenty or so affected services include opening files, collecting blood samples, taking x-rays and performing physical examinations. This measure is supported by several healthcare stakeholders, including the former president of Quebec’s Collège des médecins, Yves Lamontagne, who believes that accessory fees are nothing more than a roundabout way of making more money. The thinking is that the public should not have to pay physicians to receive basic services, because they already pay the government to have access to free healthcare. However, several stakeholders are concerned about the impact the loss of the revenue generated by accessory fees will have on access to healthcare.

A loss of revenue with consequences

In total, accessory fees account for an estimated $83 million in revenue for medical clinics. Although the Minister of Health claims that patient services will not be affected, the President of the Fédération des médecins omnipraticiens du Québec instead believes that this measure is a step backwards for services provided to the population. In fact, a Radio-Canada report noted that some clinics are already starting to close their doors as a result of this measure. Whether you are for or against the ban on accessory fees, one thing is for sure: the most financially vulnerable clinics feel like they’re facing a dilemma. Should they compensate for the lost revenue by cutting salaries and equipment, or should they stop offering certain services in order to maintain their financial structure? PetalMD is proposing a possible solution.

Increasing clinic revenue by eliminating invisible expenditures

When you get used to a system, you don’t see how the expenditures associated with that system could be avoided. These expenditures become “normal” or “invisible.” A few years ago, PetalMD noticed that many of the invisible expenditures in medical clinics were the result of missed appointments and repetitive tasks. The company thus developed a cutting-edge e-booking solution capable of tackling both of these issues while facilitating access to healthcare. Here are a few examples of the possible savings achieved by clinics that adopt such a solution.

Reducing the number of missed appointments

Reducing the number of missed appointments: $11,900 per month

As general practitioners are concerned about the increasing number of missed appointments and the resulting losses of time, a study carried out by Canada Health Infoway notes that adopting an e-booking solution can reduce the rate of missed appointments from 13% to 4%. For a general practitioner who schedules an average of 18 consultations per day and works 4 days a week, this 9% reduction amounts to 7 more consultations per week. Considering that the average revenue per consultation is $85, this represents an additional $595 per week. For a medium-sized clinic where 6 physicians each work 40 weeks per year, this reduction in the number of missed appointments could mean additional revenue of up to $142,800 per year, or $11,900 per month!

Putting an end to telephone reminders: $7,700 per year

Administrative staff in clinics spend an average of 90 seconds per patient when they make appointment reminder calls. Coming back to the example of our clinic of 6 physicians who work 4 days a week for 40 weeks a year, with 18 consultations per day, this would add up to 432 hours dedicated to appointment reminder calls every year. Insofar as administrative assistants are paid an average of $18/hour, a solution that fully automates these calls would add up to indirect savings of $7,776 per year.


Eliminating the double entry of patient data: $4,600 per year

There are e-booking portals that involve no costs for clinics because the invoices are sent to patients. However, even with such a portal, data is not synchronized with electronic medical records (EMRs),which means that administrative staff must manually re-enter the appointment times in their own systems and that there is a risk of double bookings. Based on our observations, manual re-entry of data takes approximately 90 seconds per patient. Going back to our clinic of 6 physicians, suppose that this clinic offers 40 blocks of walk-in consultations per week from Monday to Friday. This represents 260 hours of work per year. Again, taking the average salary of $18/hour, this brings us to $4,680 per year.

Reducing the number of appointments made by telephone: $8,600 per year

We reviewed data from our users and reached the same conclusions as a study carried out by Canada Health Infoway, namely that each appointment made by telephone requires an average of 127 seconds of intervention. For our clinic of 6 physicians doing 18 consultations per day over a 40-week period of 4-day weeks, this amounts to just over 600 hours per year. Knowing that e-booking reduces by 80% the time spent by administrative staff making appointments by telephone, we can project 480 hours of savings per year. At $18/hour, this amounts to $8,640.

Caution: every clinic is different!

Each clinic obviously has its own reality and variables, which means that the above calculations are merely intended as an overview of possible savings. For example, a study cited by Canada Health Infoway estimates that overall savings resulting from the adoption of an e-booking solution approach $220 per physician per week. But regardless of the calculation used, it is indisputable that adopting an integrated e-booking solution considerably reduces a clinic’s operating costs. Can these savings compensate for the lost revenue caused by the ban on accessory fees? It’s hard to say, because every clinic is unique and free to choose what services to provide.

What about access to healthcare?

Nobody likes to suffer a loss of revenue. But socially speaking, the true issue behind the ban on accessory fees is access to healthcare. Beyond the economic considerations that too often monopolize our attention, the solution proposed by PetalMD enables clinics to devote more time to patients by eliminating many repetitive tasks. It also gives patients easier access to healthcare services as they don’t have to wait on hold or pay to make appointments online, while reducing the time lost by physicians as a result of missed appointments. Because at the end of the day, all medical clinics should work toward this common goal: facilitating access to healthcare.