Docnote aims to fix the unpaid work problem in primary care

There’s a new software platform for primary care providers who are tired of performing uninsured services for free and not having a system for managing them. It’s called Docnote and was conceived by Dr. John O’Mahoney, a family doctor practising in Sarnia, Ont.Using Docnote.com, patients in need of a sick note, a prescription renewal, or a form filled out for short or long-term disability, select their provider and send a note stating what they require. The clinic informs the patient that there’s a fee, the patient remits payment and only then is the form transmitted, or the prescription renewal processed, eliminating the need for doctors to worry about arrears and collections.“Docnote is a comprehensive workflow management tool,” said Dr. O’Mahoney. “It deals with every uninsured service request that comes in, including the processing of it, the communication between the patient and the provider and the education aspect of it. There’s nothing like it on the market, which is why we built it.”Read: Bridging the fax gap: The push for a seamless referral systemThe problem with uninsured services is that many patients don’t understand that their primary care providers aren’t compensated for them. Not only do they not like paying for them, but “so many doctors I speak with don’t like asking for the money,” said Dr. O’Mahoney.Docnote does away with the uncomfortable conversations clinic staff have with patients about paying for uninsured services. Instead, a video on the Docnote platform educates patients about the convenience of using the online platform to get their sick note or prescription renewal without having to take time off work, make an appointment, go to the office and pay for parking.The provider still has to assess the patient depending on the situation, but that can be done through a phone call.Patients pay a fee set by the clinic—$20 for a sick note, for example—plus a convenience fee of 10% for Docnote (so patient pays $22). The only cost for providers using Docnote is a 5% transaction fee (so doctor receives $19)The system is customizable, allowing each clinic or provider to set their fees, discount them if they wish for clients who may be unable to pay, and offer the option of an annual fee. Every time patients request an uninsured service and are about to pay, they are given the option of paying an annual fee instead.“The average family doctor probably should be collecting $20,000 per year for uninsured services as a minimum,” said Dr. O’Mahoney. “If they’re charging for everything they should be charging, it could be $30,000 to $50,000 depending on the size of the practice. That’s important because the income I generate is reinvested in my practice. It helps me pay for my nurses, their bonuses and their time off to compete with the hospital so I can afford them.”Dr. O’Mahoney is no fan of the traditional annual plan solicitations that patients get in the mail from their doctors because “it’s typically your elderly patients who say, ‘My doc is a great guy. I feel I should pay because he’s asked me to.’ Maybe 15% of patients pay for the annual fee but don’t get any benefit from it because they’re typically not working and don’t need sick notes. That’s what I don’t like about it.”Docnote strikes a balance between finding a fair way to compensate doctors on the one hand and being sensitive to patients who can’t afford to pay for uninsured services. “We try to be fair,” said Dr. O’Mahoney. “We’re not ruthless. That’s why Docnote allows for discounts.”Aside from not being compensated for the uninsured services, doctors have to put up with the lack of a system to manage the work.“This is the reality of the unpaid work and the burden that is put on the shoulders of doctors,” said Simon Dermer, co-founder and CEO of Docnote. “It’s the burden of collecting the money, doing the work and having those uncomfortable conversations in an environment of declining reimbursement and inflation.“The sustainability of primary care is being called into question,” he added. “We see it in the headlines about doctors leaving the profession. How do you make primary care more sustainable? You start by charging for the work that you’ve been giving away.”Docnote has been live for approximately three years on a limited basis but was only officially launched for the wider market in January of this year.The application was thoroughly researched. “We spent 18 months interviewing medical office administrators and executive officers of health teams to figure out everyone’s pain points,” said Dr. O’Mahoney. “We spent a lot of time figuring out what the best workflow would be and what it has to have for doctors, office staff and patients.”Docnote currently has fewer than 100 clinics using the system, but “every day we’re onboarding new groups and growing exponentially,” said Dr. O’Mahoney. The focus to date has been on Ontario, but Docnote fills a need across the country and will be marketed Canada-wide.

Docnote aims to fix the unpaid work problem in primary care

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