There are many reasons why the healthcare needs of our population are complex, one of the largest being that our population is ageing.

And as we know, with ageing comes many more acute and chronic healthcare problems. 

There are online forums where doctors in Ontario can speak freely about the challenges they experience in their work. One of the topics that is receiving significant attention at the moment is the time required to manage complex patients. It is clearly a point of concern. 

The current payment model for family doctors in Ontario is based on number of transactions. An office visit occurs and a bill is submitted for that visit (anywhere from $24 to $38). But not all visits are equal. Some visits require more time, attention and specialization. Time however is not factored into the current payment model, so there is a disincentive for doctors to spend time with their patients.

Recently, I spoke to a family doctor in Northern Ontario who sees ten patients per hour. I worry about how they can sustain that pace. I worry about the possibility of errors. I worry about complex patients not getting the care and attention they need. Although I understand how doctors are being incentivized to work this way.

Engineers, architects, plumbers and lawyers bill for time. If the job is more complex, it takes more time. 

Keith was 82 years of age. He had several health problems including: type 1 diabetes, bowel obstruction, myasthenia gravis and depression.

Keith had several specialists who were all in silos. Disconnected. Not interacting. Hustling Keith into and out of their offices without providing an integrated and comprehensive solution. 

His family doctor was expected by Keith and the other providers to provide that service but family doctors are not compensated for that work. 

Complexity is a reality. It takes time and requires attention. If we believe that, we need to allow for care that supports it and that needs to be reflected in compensation.

It appears to be time to rethink and redesign how complex patients can be appropriately managed by doctors.

RCM Health has focused on addressing complexity for over 25 years. We seem to have developed a process, team and ecosystem that works well to address these complex cases.

Some of keys to success are: active listening, summarising the patient's narrative to a concise summary, inviting very smart domain experts to contribute, and managing all the details of the case from scheduling MRIs to confirming appointments. It is a process that takes time. 

To learn more about RCM services:

647-350-5500

info@rcmhealth.ca

Raymond Rupert  

CEO  

RCM Health Consultancy Inc.

www.rcmhealth.ca