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As self-employed people, only doctors are barred from setting their own fees. All other self-employed people like dentists, accountants, lawyers, and everybody else in this society decide what their work is worth either individually or collectively and you decide if you want to pay for it. It’s called freedom and the market economy. However a few decades age, some politicians realized they could pass legislation to reward themselves the ownership of the services of doctors and ban them from collective or individual bargaining (the rights afforded to all other citizens of this country). They did so not out of “compassion” but to gain the votes of the public and for political power. The OMA is their puppet and via the Rand formula and conflict of interest, and it doesn’t count. After all, what better ploy to get votes than with promises of “free” doctors. The politicians tried and keeping trying to do it to other professions too, but none have been so divided and leaderless as the medical profession was, hence they did not succeed for example, even with dentistry. If they tried to take away individual or collective bargaining with let’s say teachers or cops, they would be taken to court when they would miserably lose. But no pandering doctor association had the resolve to take them to court, except for one individual doctor in QC and a group now in BC.
It is not bad enough that the politicians own us doctors with insured services, but through the CPSO, they get to own us with uninsured services too. The don’t even spend a cent on running the CPSO so it’s a dream for them.
For what it is worth and my own opinion those who come over from Quebec (Hull, Aylmer, etc.) should be paying through the nose. I believe that doctors should charge the Quebec residents who come over here to Ottawa exorbitant fees to dissuade them from coming over.
They take our appointments times, specialists visits, fill up our er’s etc. and more often than not, as in the case with my husband and his eye surgeon here in Ottawa, the waiting room is FULL of patients over from Quebec.
They take away the time WE need here in Ottawa and they have their OWN medical system over there.
You don’t see any of us going over to Hull for medical treatments of any kind. It is about time that this stops and perhaps the only way to do this is gauge their wallets.
I feel that you should look more specifically at eye doctor charges for cataracts
I am hearing from most of my patients that certain charges are presented as mandatory – eg ultrasounds when they are not
and others are presented as a safety issue – upgraded lenses (the canadian optho society says there is no safety issue)
then there is the whole confusion about jumping the line by going to a private clinic that most patients do not understand
and quite frankly neither do I as to where the increased cost is and why it should be faster
This is a major area where public runs into private and I think that clarity is important
This should not be buried in a general principle but spelled out specifically with input from both public and ontario eye doctors and family doctors
many of these patients are seniors and I feel are vulnerable and often cannot afford the money that they are spending
Perhaps an audit of a number of practises to look at the percentage uptake of these services to understand the extent of the issue
I agree with this. Our eye doctor charges us for an additional test $40. over & above the fee he charges for the examination. They claim this test is necessary.I have no benefits & I cannot afford the regular fee let alone the extra $40.I need to get my eyes checked but I cannot do it. My husband is a diabetic and we will scrape up the money for his extra fee.
My father (Chinese immigrant) saw a urologist for symptoms of prostatism and was told to pay $5000 for a TURP. My father declined and did not return. In some Asian countries it is customary for patients to pay a “red envelope” (stuffed with cash) to their doctors before a major procedure. I don’t believe in such practice and would like to see measures put in place to prevent wide adoption of such practice in Canada.
A reasonable block fee should be permissible for the following reasons:
1. Take the pressure off the public funds and
2. Allow patient to contribute and be accountable for some non-essential services such as work notes, notes for medical devices and services (sometimes of questionable necessity)
One of my Chinese patients was charged by a Chinese urologist’s office a fee for booking her surgery which is not permissible. I explained that to the patient who, although upset, did not want to complain for want of upsetting the specialist even though I told her I could send her elsewhere. I phoned the urologist’s office and just received a rude reply and I was told by the college that the patient had to complain.
I believe ethnic patients who do not speak English are taken advantage of by some doctors in the same ethnic group because they know the patients are very unlikely to complain. Unlike the gentleman who refused to pay and left, my patient chose to continue to see that particular procedure because she did not want to start all over again. Many of these patients come from cultures where complaining about an authority figure is not done, making them at higher risk of being taken advantage of. Unless the college has changed its rules, I believe physicians should be able to report this type of abuse and not just wait for patients to complain. This group of patients do not speak English and are culturally against reporting/causing problems. I see no other way of such problems being brought to the college’s attention than by allowing members to report abuse.
Re Patient Information Sheet:
There is good information regarding what the physician cannot do regarding block fees.
Could a section be added that discusses what physicians can do if patients have outstanding balances for uninsured services – only thing they can really do is refuse to provide further uninsured services. (However, having this ability in writing in the policy regarding uninsured services would be a useful guide when patients argue that I have to provide them with a sick note for work although they haven’t paid for the last 10)
In Ontario, physicians are now in a new and unique time, one in which might result in the previous guidelines no being no longer applicable. The government is now unilaterally reducing doctors fees, anywhere between 5% and 20% but the overhead costs of running an office are going up all the time due to inflation and market forces. One solution to this problem might be to allow doctors to ask patients to pay a “block fee” to cover increasing administrative and overhead fees. I realize from this it is a slippery slope to “extra billing” but I am not sure in this environment whether this is inappropriate. Perhaps the CPSO could develop guidelines for this-if inflation is 2%/year then an MD could roughly charge no more than 2% of total gross billings in “block fees”. For example if an MD has gross billings of $300,000, then he/she could not charge more than a total of $6000 in block fees divided amongst all the patients in the practise. If there were, say, 6000 patients, then this would translate into $1 per year per patient of “block fees”. While this may seem unpalatable for many, unfortunately, the Ontario government is forcing us to potentially look at all options.
This sounds reasonable when the Ontario Government is clawing back our salaries.
Three Divisional Court hearings (three judges presiding over each case) have made clear that physicians have the right to contract freely with patients. Neither OHIP, nor the Government were found to have the right to interfere with this process. The CPSO “policy” is therefore ultra vireos. The College requires no policy to deal with this as the Courts were very clear about this issue. As long as there is no coercion, we should be free to bill reasonably for those services which are not covered by the health plan.
I was told that if I provide an uninsured service, but the patient then refuses to pay, I am not allowed to withhold the service until the patient pays. I hope that my information is outdated because you can’t walk into a store, pick up something, refuse to pay for it and still expect to be able to walk away with it. This interesting rule goes beyond protecting the public. Do the court cases above allow us to withdraw uninsured services if the patient refuses to pay?
please provide link or cite where the ruling for each case .
I am highly interested
thanks in advance
Thank you. The information made available to the public should include examples of more current uninsured services than those used as examples. Email communication / portal messaging / Rx renewal via electronic means / video visits / Chart transfers on CD or usb etc are required examples, “Service” is changing dramatically and the Schedule of Benefits is not rewarding the work being done. Hence the need to educate which services are not insured in much greater detail.
Along the same thought is the need to educate the public about enrolment obligations by the public and their need to respect the obligations of using the services provided by their enrolment providers group.
Thank you for the opportunity to comment. We struggle getting past the Canadian mindset that health care is ALL free.
I think this policy is good as it is. Not every policy needs changing. This protects patient rights while allowing physicians to fairly be reimbursed for services they spend hours per week doing.
Physician should have the right to choose the fees they want to charge for uninsured services and the patient in turn has the right to choose to pay or not for the services they want to receive. Uninured services are fees not covered by the public health system and therefore the CPSO or the government has no right to interfere in the free choice which the physcian and the patient are excercising .Obviously the fees have to be reasonable for it to be profitable to the physician without hurting the patient.
I agree with the statement but the term reasonable may need further clarification.
It seems to me that some guidance should be provided as to what constitutes a reasonable fee.
Fees are known for individual uninsured services so providing guidance for block fees should not be a problem.
I believe we should be able to charge a new patient a modest administration fee when we take him or her on. Until the gov’t cutbacks we could bill a Q code and receive $100 per patient (more if they were seniors) just for rostering a new patient.
There is some time and staff resources involved with taking on new patients. I should be able to charge b/w $50 and $100 dollars.
The govt created Q codes to compensate and give incentive for taking new patients. So the govt obviously saw some value to this service.Now that the Q codes are delisted I consider taking on new patients an uninsured service that we should be able to pass on to the patient. I know many patients without family doctors would be willing to pay this fee to have a family doctor to provide them excellent care when they can’t find a family doctor and have to rely on walk ins and emergency dept.The OMA in their usual supportive way sees it otherwise and told me I cannot bill for being available to provide service. In other words the OMA expects physicians to continue to work harder for lower pay when our expenses are escalating. I got a letter recently from our medical waste company stating fees will double in 2016 and triple in 2017. I will need to pay theses bills with less income. Thank you OMA. The OMA guidelines also recommend billing non OHIP patients 1.98 x the OHIP rate. In other words we are being paid 1/2 our real value. Thank you OMA for negotiating great fees for us.
Block fees are an important if not essential part of allowing a practice to provide uninsured services.
Any potential abuse of the system is preventable under the College policy which mandates that it MUST be voluntary, without coercion, that no preference is given insured patients and that payment or non payment remain discretionary and NEVER be used to determine patient eligibility etc.
Any steps to limit Block fees will undermine an office’s ability to service its patient population and remain viable.
I strongly suggest that these fees are working, that any variances from the College policies be enforced so that strict integrity be maintained, but that the viability of these fees should NOT be limited from their current status.,
I would like to offer block fee for email communication.
However this would be in the grey zone with the current policy.
-it’s not ‘direct’ patient care or is it?
-those with email access with have access to me 24/7 and usually get faster service rather than waiting until the next office appointment
Block fees and other fees should be allowed esp. with the government delisting and cutting back (inappropriately in many cases) a lot of fees.
Perhaps, the CPSO should work with the OMA and draft suggested fees for non-OHIP services.
I do not charge Block fees and I do not charge for letters (Except $5 for child tax benefit forms if they can afford it).
My own twin sons have needed forms and letters for University and the Military. Physicians have never charged them — other professionals have no difficulty charging them.
I want to respect the effort that those physicians spent helping my sons achieve their goals in life — there must be an answer.
I do not know what it is.
The current policy statement is generally good. The policy provides direction to doctors. Like many policy issues regarding healthcare, there is very little on the responsibility of the patients/clients. The policy should be more balanced so that the plicy provides general principles to physicians while also explaining to patients that they are responsible for the “purchase” of these non-insured services. The OMA guides is fairly comprehensive and CPSO should stick to principles and not the mechanism.
I am not a fan of block fees. If I provide an uninsured service to a patient I bill the patient for that service. If it is fair value to the patient I am not hesitant to do so. Some patients who I know have limited incomes I charge less or not at all. I have seen patients joining my practice from other practices who have paid block fees. Most seemed to have been mislead. They felt they had to pay the fee to be a patient of the doctor. Or they felt if they did not pay the fee they would at the back of the line for service. If you look at all the things that have to be explained to charge a block fee most offices don’t have the time to do it so the patient seems to get the message that they have to pay the fee or they won’t get service or can’t be a patient. I don’t see why it is so hard to just charge for the individual service. I agree with the other doctor who discussed opthalmology offices. Alot of patients are being sold upgrades on lens and tests and they don’t understand that the standard lens is fine for most patients. I had a patient the other day who was told that they should pay $1500 per eye for cataract removal to get the upgraded lens etc. When she balked at the cost she was made to feel guilty that she ” wouldn’t do what was best for her eyes.”
I think that this policy is reasonable but I think that patient responsibility for payment should be put into the policy. I have had many experiences where people just refuse to pay (i.e.: NS or letter done in advance of payment) despite numerous discussions and bills. Could you please ensure that what should be done about such patients be put in the policy. We are obliged to put up the list of services and fees ect what is the obligation of the patient when a service is rendered and they refuse to pay?
Your complaint is well founded. I would, however, like to add some patient perspective to this unpleasant issue of uninsured service fees. I’m in my 50th year of chronic illness, so I’ve seen my share of GPs and specialists. This message board is heavily loaded with physician perspective, so I’ll say in advance many of you will likely roll your eyes over the logistics of putting my perceptions into practice. I beg you nevertheless to glean a kernel of insight into your patients’ feelings and minds from my comments.
I feel there’s a respectful way in which the parting of a patient’s cash for a doctor’s uninsured service should be handled. If there is a simple “posted announcement” in my doctor’s office saying “I’ll be billing you for xyz from now on”, I personally feel a tad disrespected, even if the fee is “reasonable.” And I’m a patient you’d like to have – compliant, pleasant, respectful and able to pay uninsured fees. But if that poster were phrased as proposed charges to which you will be requesting my consent, that would make me feel I’m going to enter into a two-way agreement – one that considers my personal needs as well as my doctor’s. So far, I’ve never actually been “asked” about these fees – just “informed” or “told” they will happen. Sometimes these fees are reasonable, sometimes crazy, and sometimes unstated.
I feel this “I’m-informing-you” language increases the risk of a patient’s refusal to pay. After all, the patient isn’t given the opportunity to “agree” to these charges. What if their perception is that $5 is an okay fee, but $50 ain’t? I think there’s a fundamentally moral and ethical obligation to make sure matters of cash exchange are more personal than the poster on the wall I often see, or the form letter I’m expected to sign stating I “agree”. This is actually a matter of “consent” and quality of the doctor-patient relationship rather than “new billing fees” like those at Rogers or my bank. After all, I don’t really have an easy choice about needing to see my doctor, or of finding an alternative doctor to the one I see. And, after all, my doctors are making a living off the misfortune of my illness – so this is indeed a matter of ethics to me.
In practice, I’d love to see a doctor articulate the fees in writing, ask the patient to “consent”, and provide the opportunity to “not consent” to each separate fee. Consenting patients likely won’t be delinquent (we hope!). Any patient who doesn’t consent may need a more personal pre-discussion (I know, I see your eyes rolling ..). This may avert delinquency and open up a fruitful negotiation with patients about what they consider “fair.” No patient wants to be put in the position of confronting their doctor with upset over a fee; this festers resentment before I’ve even met you! We need to be explicitly invited to agree or not, and this needs to be done before the fee occurs. And I haven’t even discussed the ethics of inviting me to withdraw consent (if, for example, the fee is “unreasonable” for me).
All that said, there are awful, greedy human beings who are physicians, and there are awful, greedy human beings who are patients. If I’m allowed to switch to a physician who is a delightful human being, I think physicians should be able to drop awful patients after fair warning and established certainty that they’re abusing what is supposed to be a mutually respectful relationship.
Reasonable to have a CPSO policy on ensuring reasonable fee’s for physician services.
I agree with the comments about fee addressing patient care through new means of patient contact such as e-mail. Also may need some guidance for physician working in capitation compensation models. Wonder if there are any comments on managing patients that fail to pay their bills? Presumably, the physician will need to keep them as a patient, but does not have to provide any care outside what is covered by OHIP. What happens if they fail to pay the cancellation charge? Don’t bother to renew their OHIP? Are these reasons to terminate the doctor patient relationship? In our community where we are the only physician services in the region this is not feasible.
I recently reviewed the uninsured/block fees policy document (http://policyconsult.cpso.on.ca/?page_id=7251). The block fees part does not pertain to dermatologists. However, the uninsured part does (as it would for plastic surgeons, ENT, etc) and says that we should charge reasonable fees, and that they be based on OMA guidelines, and that there be a list of prices that is provided; this does not work with cosmetic treatments/lesion removal.
I remove/excise/laser numerous varied lesions for patients for entirely cosmetic reasons, and the cost to the patient is based on a plethora of factors, namely the size, location and depth of the lesion, nature of the lesion, whether sutures or other special equipment/supplies are required etc. As well, clinics that have higher rent (e.g. downtown), may charge more for these lesions, and sometimes extra specialization & training are required to provide the optimal result, or expensive laser equipment is required to administer the treatment and provide the optimal results of lesion removal and minimal to no scar, the cost of which the patient will have to pay for. It is not possible to list the prices or provide a list to patients as the costs are so variable based on many different factors, including discounts (at the discretion of the physician) that are typically given if multiple lesions are removed.
Patients are clearly instructed prior to their treatment of the cost (under no pressure or duress), and they have the right to shop around or to not have the treatment at all as the lesions are just cosmetic. I hope this document can be updated to reflect the nuances of cosmetic treatments so that the document is not held against hard working and honest physicians if a patient complains that they didn’t like the fee they were charged.
Physicians are self employed individuals and should have the right just like any other professional to set their own fees for uninsured services. The government already controls the insured services, so I believe that neither the government nor CPSO/OMA should have anything to do with uninsured services, each individual doctor should set fees for uninsured services, as the cost for maintaining each office differs from one physician to another.
It is ridiculous that the College meddles with how much a physician’s time or work is worth.
At the minimum, the OMA can give guidelines on how to bill for uninsured services but should not dictate specific amounts.
Block fees are a good idea but the terms of service may differ from office to office, needs to be put in writing so that the patient is aware. Also before any uninsured service is provided the fee should be settled, so the person who needs the service is able to decide if he/she wants to pay for the service and get it or not.
Uninsured services do take time to accomplish so each physician should be adequately compensated for the service rendered.
It is also important to note that most physicians are compassionate people and are able to show compassion to those who can not afford the set fees.
i believe with the current situation with billings and the government, it is an uncertain time and review of a financial policy that may be viewed as punitive for patients is not in our best interests as a profession. if possible, i would table revisions for another year or two.
I agree with the previous postings, that the rate charged for uninsured services should be left to the discretion of the treating physician. They should be posted for patient’s to review or inquired about by the patient before receive any medical services from the physician. I have little sympathy for patients who choose not to review or ask about posted rates, and then complain about them when it comes time to pay.
On the other side of the coin, I have had a number of patients come back to me after seeing an Obstetrician for prenatal care asking whether they have to pay the block fee that was being charged. Invariably I advise them against paying, though they are understandably reticent, out of concern that not dong so may displease the specialist. The current policy does emphasize the optional nature of block fees. This should be retained in any future changes.
Given the recent government cutbacks, it is imperative that physicians have input into any changes into the fee structure.
Unlike lawyers and other ‘fee-for-service’ occupations, physicians are unable to set their own fees. We would like to be compensated for the work that we do, in an equitable way, whether this compensation is via OHIP or from uninsured services.
I strongly feel that the previous cutbacks should be reversed with retro-pay first of all. I also think that physicians should be able to charge for late fees and cancelled appointments, as these significantly impact our livelihood, as well as healthcare costs in Canada. Furthermore, we are often required to complete health-related forms, emails, and calls which we are unable to claim or bill for – Any time spent by physicians relating to the care of patients should be accounted for and compensated.
In regards to block fees and uninsured services, it is possible that given the recent government cutbacks that we may be headed to a tiered system or non-OHIP system; what will happen then? We have our patients’ best interests at heart and hope that those who need healthcare the most will continue to receive services.
I feel that not only is it our right to stand up for our profession and play an active role in changes that are made, but our obligation and responsibility to continue to fight for the needs of our patients in order to ensure their health and safety.
As a member of the public, I appreciate that Physicians should be able to charge for services not covered by OHIP.
I feel the policy I have read is generally good, but should be updated to include new and upcoming technologies especially in communication.
I would disagree with the idea of adding Block fees to cover overhead or services delisted by OHIP (such as the Q code for taking on a new patient) which are really essential services.
These issues should be addressed by the OMA or in court if necessary by having the Ontario government adequately compensate Physicians for the essential care they do.
Please be advised that as a governing body you have no right to get involved with uninsured fees.
Our useless self serving organization the OMA URGED US TO TAKE A FEE CUT 2 years ago and now the less than average organization tried to negotiate a no fee increase!!!
As far as I’m concerned this organization has no idea as to the lack of control I have over my overhead Much less my future retirement plans!!
Their fee schedule is at best insulting taking into consideration a dental hygienist commands more for dental cleaning than OMA advises for third party physical. As a result I NEVER AND WILL NEVER USE THEIR GUIDELINES. I inform the patients of my fees in bold print and they have access to OMA FEE SCHEDULE.
After 23 years of practice the paltry fees this organization has come out with is insulting. If patients think it’s too much they can see another doctor.
Not only that no one can tell me to do otherwise.
I have nothing to do with the OMA as they do not have my best interest at hand.
Doctors should have the right to be competitive. If patients are willing to pay for my services that may be twice that of my colleague then let him.
The college should stay very clear of this.
In the past I’ve seen the college make knee jerk decisions on issues where they absolutely have no EVIDENCE ON WHAT IMPACT IT MAY HAVE.
I’m a physician that practices evidence based medicine.
The college states a REASONABLE FEE??
My rights to negotiate in a democratic society are unilateral hence reasonable no longer exists. I will charge what is reasonable to cover raising overhead, loss off raises over the years. Things the OMA GROOSLY OVERLOOK
An OMA set fee should be permissible for the following reasons:
1. Take the pressure off the Govt. funds
2. Allow patient to contribute and be accountable for some non-essential services such as
fitness to work notes
fitness to continue Gym activities
3. OMA set fees for seeing out of province patients unless health services start being covered by a Federal Health Insurance plan rather than being covered by a Provincial Health insurance plan as these patients are being seen instead of the provinces pt where the physician practices and are taking up spots of that provinces patient.
The CPSO is overstepping its boundaries when the issues of uninsured services by Ontario physician is on the table.
How far is regulation really regulating when the body regulated is being regulated into extinction !!!
The CPSO should remember that the physician / physician office is also primarily a member of the public hence the mandate to protect the public also extends to them
No business can survive the draconian rules currently in existence, hence the average physician work till old age because they cannot AFFORD to retire!
Power corrupts and absolute power corrupts absolutely .
The physician reserves the right to charge anyone what he feels for his service and anyone that cannot afford it can try another physician who may be cheaper , after all patients move their file for the flimsiest reason
It is a free market economy
What is the college role in insured service? This is a medical doctor in free market , you also want to regulate that ?
sometime ago a patient came to see his physician and ask if it was true that the lawyer paid $75 for the copies his records , the physician a little perturbed answered yes and ask why the question .
out of compassion the patient replied “doc, I got involved in an accident, you looked after me, and the record you wrote was used by my lawyer to get the insurance company to settle me over nine hundred thousand dollars and the lawyer charged me over two hundred and fifty thousand dollars even though the case never went to court and all they paid you was seventy five dollars!? .his doc. replied yes , he was so sad and concluded, ‘you know doc. , things have got to change and your profession has to step up ” to which the doc. replied I don’t make the rules, I hope someday, those that do will see through your compassion for us.
this is just of the numerous tales and experience we go through in this profession.
I hope this count for something
cost of running a medical office has doubled since 2000. yet the A007 code, the bread and butter of family and walkin clinics, has gone from 29 to 33.70.
with reason, so has gone the any logic from such a policy on uninsured services, the only place where the physician may have some clout to keep up with inflation. what is a physician to do to keep up with inflation? quit? choose another profession?
College of Medical Laboratory Technologists of OntarioResponse in PDF format.
College of Physicians and Surgeons of SaskatchewanWe have reviewed your policy. It is clearly written and is easily understood. We do not have such a policy in our province. We have no further comments.
Canadian Doctors for MedicareResponse in PDF format.
Professional Association of Residents of OntarioResponse in PDF format.