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Update March 10 2023: The funding model for our clinic has changed as of Feb 28 2023. We have gone from a capitation (FHO) model, which is what the majority of family doctors use, to fee-for-service, which is the older model of funding but still the model that is used for walk in clinics and most specialists.

The fee-for-service model for family medicine is almost certainly worse, both for patients and doctors. However, the ministry changed the requirements for the minimum size of a FHO (Family health organization) from 4 to 6, so as a group of 4, we could no longer use the FHO funding model.

There will likely be significant changes to how the clinic operates over the next few months and this is to reflect the changes on how OHIP pays for medical care in the fee-for-service model. If there is a change to the way we do things that seems absurd from the patient perspective, you can be fairly confident that the reason is the rules of the funding model. Certainly there will be some growing pains and missteps, but hopefully also some positive changes. The goal will be operate the clinic in a way that is sustainable in the long term, still delivers a high quality of care, and minimizes the inconvenience to our patients.

One change that we will need to make is charging for faxed requests for prescription renewals. This is not a service covered by OHIP. In the FHO model, charging for prescription renewals has pros and cons and if not implemented correctly, could end up costing the clinic more money than it makes in fees. So some clinics charged and some did not. It was a business decision and not a matter of doctors being nice vs greedy.

In the fee-for-service model, if faxed renewals are offered at all, there would have to be a fee. Right now, we will offer this service to patients that request it and the fee will be $25. The pharmacy will have to send us a message that you consent to the fee along with the actual request.

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A physician's office in Canada is a private business with their own employees, equipment etc.  We send invoices to your insurance "company" (OHIP) for the services that we provide our patients.  They are the only game in town so they set the rules.  OHIP tells us what services we are allowed to charge to them as well as the price. If we are lucky, they pay us.  

While most services are covered by your health insurance (OHIP), some services are not.  These are called “uninsured services” and it would be considered fraud to bill OHIP for these services.  Some examples of the more common uninsured services include telephone calls, prescription renewals over the phone or by fax, insurance forms, sick notes.  

As mentioned above, faxed prescription renewals are not covered by OHIP.  The charge for this service is $25.

If you do not want to pay for this optional uninsured service then please do not purchase it.  We would be happy to see you for an appointment. 

In order to better help you understand what goes into a prescription renewal, please consider the following typical scenario:  A pharmacy faxes us a renewal request.  Our office then scans it and attaches it to your chart.  Our secretary then creates a "task" in our medical record software that the doctor needs to refill a medication.  I get this message and search your chart to make sure that you have had the appropriate monitoring (lab work, blood pressure, discussions on whether medication is still needed), I then check to see if you have been started on any medications by me or one of your specialists that may interact with this medication.  I also check to see if another doctor has changed the dose or stopped the medication. Often, we end up phoning patients to arrange for appropriate blood tests that need to be done for this medication.  After all this we send a prescription back to your pharmacy by fax.  Not one of these tasks is covered by OHIP.  The fees that we charge not only pay for the physical office and the supplies but also the wages for all employees of the clinic.