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-DOLLAR/

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 p hysicians (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 therapeuti c procedures (particularly physiotherapy). The remaining 178 (81.3%) b illed for a mix of services similar to that of other GP/FPs but on ave rage had 2.6 times the volume of patient assessments and a greater sha re of their total billings derived from diagnostic and therapeutic pro cedures (9.1% v. 5.6%): Multivariate analysis indicated that these hig h-volume GP/FPs were less likely than GP/FPs who billed between $35 00 0 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 gradu ates (QR 1.85) and practising in a region with low physician supply (O R 0.45 for each increase of 1 physician per 1000 population). Metropol itan Toronto was an outlier to the latter relation and was more likely to have high-volume GP/FPs (OR 16.89). Interpretation: High-billing G P/FPs attained their high billing levels by maintaining large numbers of patient visits and by performing procedures. Further research is I needed to determine the time spent per patient and the quality of care delivered by these physicians as well as the appropriateness of the p rocedures that they perform.