BC's Longitudinal Family Physician payment model did something unusual: it started paying family physicians for work they were already doing — the phone calls, the chart reviews, the coordination, the time. The catch is structural. Fee-for-service paid you when you billed a visit. LFP pays you when you log the work. Unlogged work is now unpaid work, and most clinics have no way to see how much of it there is.
We look at billing in almost every clinic we walk into, whether or not that's why we were called. The same leaks show up again and again.
The indirect time that never gets logged
Direct patient encounters get captured — they're anchored to an appointment, and the appointment is in the schedule. The leak is everything that isn't: the callback between patients, the result review at lunch, the form finished after the last visit, the care-coordination email thread. Each one is compensable time under LFP. Each one is also exactly the kind of two-minute fragment nobody stops to log, because stopping to log it takes as long as the work did.
The fix is rarely “try harder.” It's workflow: capture points built into the places the work already happens — the phone log, the inbox, the task list — so the time records itself as a by-product of doing the job.
The month nobody reconciles
Fee-for-service clinics grew up reconciling remittances, because rejected claims were visible money. Under LFP, many clinics stopped looking. Submissions go out, payments come in, and no one compares what was worked against what was paid. A clinic that never reconciles can't answer the only billing question that matters: what did we earn that we didn't bill? The absence of an error message is not the same as the absence of an error.
The panel that drifted
Part of LFP compensation follows the registered panel. Panels drift: patients move away, new patients never get formally attached, registrations lag behind reality. A panel that is smaller on paper than in the exam rooms is quiet, permanent underpayment — and it only gets caught when someone deliberately compares the roster to the reality.
The revenue that isn't LFP at all
ICBC and WorkSafeBC reports, insurer forms, uninsured services, third-party requests — the non-MSP streams have their own leak pattern: the work gets done, the invoice never goes out, or goes out at a rate that hasn't been reviewed in years. This is usually the easiest money in the building to recover, because nothing about it requires changing how anyone practises.
How to find your version of this
Every clinic leaks differently, which is why we start every billing engagement the same way: a leakage scan. Take one recent month. Compare the work that happened — schedule, phone log, inbox, forms out the door — against what was actually submitted and paid, stream by stream. The gap is your number. In our experience the number is rarely zero and usually surprising.
Then fix the workflow, not the people: capture points where the work happens, one monthly reconciliation habit, and a quarterly look at panel registration and third-party rates. Measured at the start, measured again at 60 days. That's the whole playbook.
— Himanshu, for TOSC · July 2026