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. 1998 Mar 24;158(6):741–746.

High-billing general practitioners and family physicians in Ontario: how do they do it? An analysis of practice patterns of GP/FPs with annual billings over $400,000.

B Chan 1, G M Anderson 1, M E Thériault 1
PMCID: PMC1229097  PMID: 9538852

Abstract

BACKGROUND: To better understand the reasons why some fee-for-service physicians have high billing levels, the authors compared the practice and demographic characteristics of general practitioners and family physicians (GP/FPs) who submitted over $400,000 in annual Ontario Health Insurance Plan (OHIP) fee-for-service claims in 1994-95 with those of GP/FPs who billed between $35,000 and $400,000. METHODS: The authors describe the OHIP billing and physician characteristic data for fiscal year 1994-95. They used multivariate logistic regression to determine factors independently associated with high billing status. RESULTS: A total of 219 GP/FPs (2.5% of the GP/FPs in Ontario) billed over $400,000 in 1994-95. Of these, 14 had billing patterns similar to those of specialists, and 27 billed predominantly for diagnostic and therapeutic procedures (particularly physiotherapy). The remaining 178 (81.3%) billed for a mix of services similar to that of other GP/FPs but on average had 2.6 times the volume of patient assessments and a greater share of their total billings derived from diagnostic and therapeutic procedures (9.1% v. 5.6%). Multivariate analysis indicated that these high-volume GP/FPs were less likely than GP/FPs who billed between $35,000 and $400,000 to be 60 years of age or older (odds ratio [OR] 0.09, p < 0.05) and female (OR 0.21) and were more likely to be foreign graduates (OR 1.85) and practising in a region with low physician supply (OR 0.45 for each increase of 1 physician per 1000 population). Metropolitan Toronto was an outlier to the latter relation and was more likely to have high-volume GP/FPs (OR 16.89). INTERPRETATION: High-billing GP/FPs attained their high billing levels by maintaining large numbers of patient visits and by performing procedures. Further research is needed to determine the time spent per patient and the quality of care delivered by these physicians as well as the appropriateness of the procedures that they perform.

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Selected References

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  1. Barer M. L., Lomas J., Sanmartin C. Re-minding our Ps and Qs: medical cost controls in Canada. Health Aff (Millwood) 1996 Summer;15(2):216–234. doi: 10.1377/hlthaff.15.2.216. [DOI] [PubMed] [Google Scholar]
  2. Bensing J. M., van den Brink-Muinen A., de Bakker D. H. Gender differences in practice style: a Dutch study of general practitioners. Med Care. 1993 Mar;31(3):219–229. doi: 10.1097/00005650-199303000-00004. [DOI] [PubMed] [Google Scholar]
  3. Bryant H. E., Jennett P. A., Kishinevsky M. Gender, family status, and career patterns of graduates of the University of Calgary Faculty of Medicine. Acad Med. 1991 Aug;66(8):483–485. doi: 10.1097/00001888-199108000-00016. [DOI] [PubMed] [Google Scholar]
  4. Davidson W., Molloy D. W., Somers G., Bédard M. Relation between physician characteristics and prescribing for elderly people in New Brunswick. CMAJ. 1994 Mar 15;150(6):917–921. [PMC free article] [PubMed] [Google Scholar]
  5. Epstein A. M., Begg C. B., McNeil B. J. The use of ambulatory testing in prepaid and fee-for-service group practices. Relation to perceived profitability. N Engl J Med. 1986 Apr 24;314(17):1089–1094. doi: 10.1056/NEJM198604243141706. [DOI] [PubMed] [Google Scholar]
  6. Hillman B. J., Joseph C. A., Mabry M. R., Sunshine J. H., Kennedy S. D., Noether M. Frequency and costs of diagnostic imaging in office practice--a comparison of self-referring and radiologist-referring physicians. N Engl J Med. 1990 Dec 6;323(23):1604–1608. doi: 10.1056/NEJM199012063232306. [DOI] [PubMed] [Google Scholar]
  7. Hillman B. J., Olson G. T., Griffith P. E., Sunshine J. H., Joseph C. A., Kennedy S. D., Nelson W. R., Bernhardt L. B. Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare population. JAMA. 1992 Oct 21;268(15):2050–2054. [PubMed] [Google Scholar]
  8. Mitchell J. M., Scott E. Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics. JAMA. 1992 Oct 21;268(15):2055–2059. [PubMed] [Google Scholar]
  9. Norton P. G., Dunn E. V., Soberman L. Family practice in Ontario. How physician demographics affect practice patterns. Can Fam Physician. 1994 Feb;40:249–256. [PMC free article] [PubMed] [Google Scholar]
  10. Sanmartin C. A., Snidal L. Profile of Canadian physicians: results of the 1990 Physician Resource Questionnaire. CMAJ. 1993 Oct 1;149(7):977–984. [PMC free article] [PubMed] [Google Scholar]
  11. Swedlow A., Johnson G., Smithline N., Milstein A. Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians. N Engl J Med. 1992 Nov 19;327(21):1502–1506. doi: 10.1056/NEJM199211193272107. [DOI] [PubMed] [Google Scholar]
  12. Woodward C. A., Cohen M. L., Ferrier B. M. Career interruptions and hours practiced: comparison between young men and women physicians. Can J Public Health. 1990 Jan-Feb;81(1):16–20. [PubMed] [Google Scholar]
  13. Woodward C. A., Hurley J. Comparison of activity level and service intensity of male and female physicians in five fields of medicine in Ontario. CMAJ. 1995 Oct 15;153(8):1097–1106. [PMC free article] [PubMed] [Google Scholar]

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