Posted 2017/09/25 & filed under Updates.

New Overhead Study – “On your mark, get ready, go!”

 

The new Overhead Study is about to start. Doctors from all sections will be randomly selected to achieve about 1:6 doctors being surveyed. The survey results will be anonymous, but vitally important. We are hoping that accurate income/income sources and expenses data can be collected. This information will allow fairer allocation of future increases and benefits. The new Modified Annual Net Doctor Income (MANDI) formula we are proposing needs solid inputs to be useful. And with a great income survey we will no longer be subject to the garbage-in-garbage-syndrome out when comparing doctors’ earnings. Please help us to get good information. At the Specialists of BC, we have been working hard with the Doctors of BC economics department to ensure that 2017 yields the best survey yet. If you are one of the doctors selected, please answer the survey honestly and accurately. We need you!

SSC telephone advice code

One of the SSC fee codes being “overbilled” at least in relation to the funds the SSC has available is the specialists’ telephone advice code (10001). It looks like there may be a cap imposed on the number that can be billed per doctor per month. Have you considered telehealth? All sections have good telehealth billing codes. What if the next time you are asked for advice, you request that the GP allow you to see and talk to the patient, perhaps on FaceTime or Skype? The patient could confirm a few key details, your advice may be improved, and you can now bill a telehealth visit – simple, moderate, consultation, whatever is appropriate. If you are facing a cap for telephone advice, this approach could allow continued payment for your advice, instead of giving it (and your time) away for free.

First LMA, now SSC fees running out of money

The Specialist Services Committee was awarded funds from government to engage specialists in innovation, resulting in the Labor Market Adjustment (LMA) fund, positive impacts on recruitment and retention, and some new fee codes (SSC fees) that promote quality and motivate physicians. The LMA fund was a fixed amount, and nine sections successfully applied for a portion of it. They created new codes and went to work. Unfortunately, it worked too well, and almost all the sections found that the amount they are billing exceeds the award.

These sections have been making tough decisions on how to reduce billings. Now the non-section specific SSC fees, such as telephone advice and discharge conferences, are also being billed beyond the original government awarded amounts. We all are faced with having to reduce those billings too. No matter how successful the codes were at encouraging the right practices, and even if they result in overall savings, we are being told they have to be reduced. The SSC is holding meetings and trying to work with specialists, but it is extraordinarily difficult, and any cuts are going to be uneven and surely unfair. Although we may have to reduce the services we deliver, none of us should accept prorating of any fees. If the government and SSC feel they do not have sufficient funds to provide necessary services to BC citizens, then they can explain it. They can choose what services to keep or suspend. But we must not prorate ourselves and continue to do the same work for less.

Doctors of BC new governance referendum passes

A proposal to reduce the DBC board size and create a large representative assembly (RA) was passed by a very large proportion of the doctors who voted. The Specialists of BC worked very hard on your behalf to ensure there was a fair distribution of specialists on both the board and the RA. As a result, at least four of the nine board positions and 49 of the 104 RA members must be specialists. We have convened a Specialists of BC governance working group to help ease the transition to this new governance model. Overall, I see an opportunity for a larger influence by specialists and the SBC within the Doctors of BC, as previously we rarely had even 25% of the board being specialists. We will keep you informed on progress, and how we plan to continue to protect specialists’ incomes and practices.

Join the Specialists of BC and receive 50% off your dues

Be sure to join your Specialist society for 2017 at https://www.doctorsofbc.ca/account/dues if you haven’t already done so – we’re offering a 50% discount on dues this year! This reduction will be applied automatically when you select your membership category online. Thank you for supporting the Specialists of BC.

As well, the SBC/SSPS Annual General Meeting is being held the evening of Wednesday, April 19, 2017 in Vancouver, where as a member you can vote on proposed constitution and bylaw amendments. Just join and then let us know if you plan to attend and we’ll send you the details.

Posted 2017/09/25 & filed under Updates.

Governance referendum

There have been multiple Doctors of BC governance referenda in the last 15 to 20 years. Some feel the current 40-odd member Board is too large, and that a smaller board could be more nimble and effective. At the same time, the current Board may not be truly representative of all doctors. Thus, a proposal to create a nine-member board and a 104-member Representative Assembly (RA) has gone out to a vote of all DBC members. The RA would meet three times a year, be nearly half specialists, and elect the nine board members. Every section would be represented. The board would have three specialists and three GPs, and a seventh board member would balance the President elect, as either a specialist or GP. In short, the board would be four specialists and four GPs and the President could be either a GP or a Specialist. Overall, specialists are going to be much more fairly represented on both the Board and the RA. The Specialists of BC played a key role in achieving this fairness. I recommend that specialists support this referendum proposal.

Labor Market Adjustment fund

In 2010 $10 million was made available to specialty sections to improve recruitment and retention of Specialists. All sections were invited to develop a proposal to the Specialist Services Committee for access to this money. Nine sections were granted various fixed amounts and those sections created new billing codes. Unfortunately, this initiative proved too successful, and most of the sections have found utilization of their new codes has exceeded the fixed amounts they were awarded. They are now in the uncomfortable situation of trying to reduce fee amounts or utilization of those codes. Perhaps a lesson here if any new “fixed” awards are offered…

MANDI review

A Specialists of BC working group has come up with a new formula for comparing incomes between specialists. While still known as MANDI, the acronym now stands for Modified Annual (formerly Adjusted) Net Doctors Income. Nine specialty group reps and an economist and statistician from the Doctors of BC have considered many options and are recommending a two-stage cutoff to identify reasonably active full-time physicians and surgeons. After-hours and on-call income associated with surcharges will not be included when the physician is otherwise working full-time daytime hours. Daytime MOCAP is in, and the group feels this inclusion will fairly account for sessional, service contract, and private income. We are now waiting for the new Overhead and Income study to proceed. Once the data from it is available, we will be able to present this recommended formula to the Council of Specialists for approval. I implore all sections and members to participate in this study if selected so we can have the most accurate data possible. We do not want a new improved MANDI formula if adopted to suffer from Garbage-In-Garbage-Out.

Automatic membership in Societies and sections

All the sections and the GP and Specialist Societies work very hard on your behalf, and yet not all of you belong to and support your section or The Specialists of BC. We would like to propose to the Doctors of BC Board that when you join or renew your membership in the Doctors of BC, you automatically have membership in your section and Society. If all specialists were part of their section and Society, it could drastically reduce your annual society membership dues, perhaps from $450 to as little as $100 or $150, and everybody would be contributing equally to the work being done on your behalf. Please tell me what you think of this proposal. And in the meantime, please join the Specialists of BC for 2017 to receive 50 percent off your dues payment! Go to https://www.doctorsofbc.ca/account/dues

Posted 2017/09/25 & filed under Updates.

ANDI, MANDI, CANDI – what does it all mean?

In order to fairly compare incomes of doctors in different specialties, several formulas have been developed around Average Net Daily Income (ANDI), Modified Average Net Daily Income (MANDI) and so on. In the last arbitration, when Dr Toope applied the MANDI formula, some fairly big inequities resulted. Our Disparity Data and Overhead Working Group (DDOWG) is working with the Doctors of BC Economics department. Using data from the overhead study, and perhaps considering annual incomes, we hope to come up with an improved model. As we progress, we will be coming back to each specialty group for input and suggestions. Stay tuned…

Second same specialty consultations

After much negotiation between the Specialists of BC and the Tariff committee/MSP, the issue of second same specialty consults has been settled. When referring a patient to a colleague from the same specialty within two weeks of the first consultation, you must indicate that your colleague has some skill beyond your own, such as a general neurologist referring to an epilepsy neurologist or a retinal ophthalmologist referring to a cornea expert, in order to be paid in full for your consult. In the Note field of the billing claim, include something like “I am referring Mr. X to my same specialist colleague Y, because Y has a special skill beyond my own.” Tariff will also be developing a new mirror billing code for each specialty, for when you are seeing a patient on referral from a same specialist, which will be at the same consultation rate.

Doctors of BC Overhead Study 2016/2017

During the arbitration submissions to Dr Toope early this year, it became
apparent that the last overhead study by House in 2005 needed a full update
and an improved methodology. Working with the Doctors of BC Overhead
Committee, the Specialists of BC formed a working group that has been carefully considering income cutoffs, sample sizes, and methodological details.

We believe that enough progress has been made for us to wholeheartedly endorse the Doctors of BC proposed new overhead study. MNP will be conducting the survey, and the results will be exceedingly useful for all as we plan benefits, examine future disparity monies, and get ready for the next round of negotiations. We will be working with all sections to enable a clean study that provides the best data so far.

Transitioning young patients to adult specialists

The Section of Pediatrics has a Specialist Services Committee-funded grant for transitioning usually complex young patients from community pediatricians to adult care (including adult specialists in about 25 percent of the cases).

The section has interviewed community pediatricians and family physicians. Many said they had difficulty locating suitable adult specialists, because of full practices, lack of familiarity with disorders that pediatric patients grow up and enter adulthood with, and concerns over patient expectations that the specialist would do primary care.

The Section of Pediatrics would like to work with other specialty groups to enhance access to appropriate care, perhaps through a roster of specialists willing to take on these complex patients, or through further conversation before we even start to think about solutions.

If this topic interests you, please contact Stephanie Stevenson, the Executive Director of the section via email sstevenson@cw.bc.ca or phone (604) 875-3101. Thank you for your feedback and interest.

Facility Engagement

The new Facility Physician Engagement program and funding is fully underway. Most hospitals are establishing functioning Medical Staff Associations and Facility Engagement Working Groups to discuss interesting ideas. At my hospital in Kelowna, we’re talking about a formal program for fecal transplants. I will let you know how that turns out, but in the meantime, I will try to stay clear of the fan.

Posted 2017/09/25 & filed under Uncategorized.

Patient Access and Measurement – a DIY approach

The Specialists of BC has often been focused on fee code issues and disparities. This year I would like to shift the lens to the patient. As specialists, we are acutely aware of our lack of capacity, which makes it harder for patients to access us. Our difficulty in capacity is worsened by challenges in accessing resources to help our patients. And if we do improve access, how will we know if we don’t identify where we started from?

Collaborating with Dr Kevin Wing, head of Orthopedics, we want to enable careful measurement of waitlists of all kinds for both surgeons and specialists. Kevin has already achieved this feat for many orthopedic surgeons, and now we want to extend the analysis to other surgeons and medical specialists too.

And what of improving access? We can’t just go to government with our hands out; more money isn’t there. We need to think of other ways to improve access. In Kelowna, the neurology department put all stroke patients on one ward and instituted bi- weekly multi-disciplinary rounds, which include nursing, physio, OT, speech, pharmacy, and most importantly patients and their families. This strategy has improved quality and reduced acute bed stay by 25%, saving 1000 bed-days last year alone.

Dr David Kendler wants to create an easy button for osteoporosis, where every time a fragility fracture patient is treated in hospital, an automatic assessment of osteoporosis risk and treatment will take place.

Who else has ideas? How can we at the Specialists of BC assist you in improving access without just asking for more money? Are there efficiencies that can be found in your practice, specialty, hospital or health authority? Even small ones might provide valuable gains.

Practice Tips: Taking calendar month holidays could mean CMPA savings

You’ve likely heard that CMPA fees are going up rapidly, and our former 1985-level rebates are being reduced to 55%. Many of you may be paying hundreds or even thousands of dollars more per month. Did you know that CMPA generally allows you to change classification or even suspend coverage for full calendar months? So if you are planning an extended holiday, consider notifying CMPA and asking them to waive your premiums while you are away. Keep in mind, you cannot do any medical work during this time. But if you are not practicing anyway, maybe you can save a chunk of cash!

Callback fees get special attention

The 1200m series of callback fee codes are not owned by any section, which means they only receive a bump if a fee increase is applied across the board. With the advent of targeted funding, these fees have lowered relatively by about 2% over the last decade or so. Recently the Society of General Practitioners and the Specialists of BC collaborated on a motion that was passed by the Doctors of BC board, asking that these fees be enhanced in the next negotiations. When any of us are called back in the evenings, weekends, or late at night, wouldn’t it be nice if the fee was at least treated equally to other fees?

Doctor Pharmacist?

The BC College of Pharmacy is floating the idea of increasing the scope and range of pharmacists’ activities to allow them to order class 1 prescriptions, begin/change treatment after examination, and request lab tests, all without a medical license. The details are here: Certified Pharmacist Prescriber Draft Framework

The Specialists of BC Council representatives have shared their thoughts with us, and feel that four weeks to get feedback from doctors is not reasonable. Training, responsibility, liability, collaboration, patient safety and costs are just a few of the many important issues that need time for discussion. Let me know what you think and also please take a moment to fill out this brief Doctors of BC survey. We will respond as best we can given the short notice.

Representation and governance

As you may know, the Doctors of BC is revisiting its governance structure. The most recent draft proposal would separate governance (the Board) from representation (the representative forum or RF). The proposed Board would be nine physician members, at least two of whom must be specialists. The proposed RF would have 50 physician members, with between 20 and 25 being specialists; one of these seats would go to the Specialists of BC. The RF is advisory to the Board.

Currently the Specialists of BC has a guaranteed voting seat on the Doctors of BC board which we would lose under the new proposal. Let me know how you feel about this governance idea.

Posted 2017/09/25 & filed under Uncategorized.

Doctors of BC proposal could separate governance from representation

The Doctors of BC is discussing the notion of a smaller, leaner board. The current board has about 40 members and meets about ten times a year for a full day. There are ten specialist delegates on the board now. The DBC Governance Committee is proposing a “Representative Assembly” of about 50 members meeting three times per year, with about 22 specialists who would advise and elect the board. The board would consist of nine members, all of whom could be GPs. The Specialists of BC believe at least half the board must be specialists, and that the GP and Specialist societies should be at the board as well. Please let me know if you support this position.

 

Practice Tip: Audit trail and exceptional callback

What time did you get called in or see the patient anyway? MSP would like all billings associated with a time to be auditable. That is, if you get called at 6:30 pm, and then come in to see the patient at 7:15 pm, they would like some sort of audit trail. We are recommending that when you dictate your consult or note, mention in it what time you were called and came in. E.g. I was called about this 45-year-old patient with abdominal pain at 6:30 pm, and came in to see them at 7:15 pm. This approach provides a great audit trail, and only adds a few words to your dictation.

We have learned that even if you have not been designated by your health authority for callback, you can still make a claim for exceptional callback if you meet all the other criteria. You may already be doing something you could be receiving payment for!

Getting the best from an overhead study

The Doctors of BC has struck a new overhead committee to try to determine doctors’ current incomes, sources, and office overhead expenses. This project is far more complicated than you might have guessed. As it is too costly to survey all of us, how many doctors should be included? What income sources are there and why do they matter? What are the legitimate expenses to you running your practice? The list goes on. There is a saying: “In God we trust, all others require corroboration.” It can de difficult to recall your exact income, sources, and expenses, so it would be much better to have all survey data corroborated. We will continue to work closely with the Overhead Committee to ensure that this study is of the highest quality possible.

Specialists of BC welcomes two specialty groups back to Council

I am exceptionally pleased to welcome Dermatology and Anesthesiology back to the Council of Specialists. Dr Evert Tuyp from Dermatology has been unbelievably active in helping us with overhead and disparity issues. Way to go Evert — and thank you. From Anesthesiology, Dr Peter Gajecki recently joined the Council. Anesthesiologists are important in so many aspects of medicine, and their practices are somewhat different from many others; it’s wonderful to get their input on the many issues we face. As specialists, we have issues that are common to us all, and others unique to specific groups. I want to cover both these angles with all our sections. Welcome Evert and Peter!

Posted 2017/09/25 & filed under Updates.

Another overhead study

When we get a raise, compare income disparities, or perhaps even choose a specialty, what each of us pays in overhead is vitally important. Overhead studies undertaken in 1995 and 2005 showed just how difficult it is to obtain the highly varied information needed. The Specialists of BC wants to participate in the current study from the get go, before questionnaires are finalized and before anybody shares personal financial info. We aim to see that this study is fair and useful, and takes into account our members’ ideas. We met with MNP, the consulting accountants and discussed Alberta’s “Model Office” approach as well as the previous average section expense listings. A group of our members is going to be monitoring the interim results, helping to ensure we all follow and understand where this iteration is going.

Practice Tip: Consultation Audits

The fee guide preamble specifies what is required for a proper consult: a history, appropriate examination, diagnostic formulation and treatment plan. The writeup for a simple arm fracture in a healthy young person likely will be shorter than the one for an older patient with complex presentation and multiple co-morbidities. Nevertheless, every consult must have those basic parts, and a one or two-line report is unlikely to pass an audit. Remember, to MSP if you didn’t write it, you didn’t do it!

Disparity adjudication results

Dr Stephen Toope released his binding recommendations on December 22. During the lead up to his decision, sections had an opportunity to put their best foot forward, showing how the data supported their requests. The Specialists of BC worked closely with the Doctors of BC economists to provide the information needed. Dr Toope relied heavily on the MANDI Model for intersectional (within BC) disparity results, and on Dr Evert Tuyp’s interprovincial fee code model for comparisons across the country. Application of these models left out some sections, and intense discussions on the results are underway. Each section who will receive an award is now tasked with recommending how those funds should be allocated within their own sections. Once this is done, the economics department and MSP need to confirm that the fee changes fit within the award. Be patient, as the last award took over a year to work its way from arbitrator’s decision into final new fees or fee schedule changes.

Specialists of BC welcomes another specialty group

The newly recognized section of Palliative Medicine is set to join the Specialists of BC. We look forward to working with the more than 150 palliative care doctors in the province. Palliative Medicine has an FRCP in Palliative medicine as well as a CCFP certification, and the Specialists of BC welcomes them both. Congratulations to the section of Palliative Medicine!

Posted 2017/09/25 & filed under Updates.

Specialists of BC meet with Ministry of Health to talk strategy

For the first time, Executive members of the Specialists of BC met with the deputy minister of health to discuss how we could improve quality and efficiency in BC’s healthcare system. With Stephen Brown and his colleagues, we agreed to initiate Specialist Ventures, which will take specialists’ ideas about healthcare and develop them at a high level. Patient cohering and regular interdisciplinary ward rounds improved care and reduced length of acute stays by 25 per cent for Kelowna General’s stroke patients last year. Applied more broadly, these initiatives could become a Specialist Venture. Traditionally, the Society of Specialists (now Specialists of BC) was mostly concerned with fees, disparities, and inter-sectional monetary issues. Specialists Ventures is one way that we are shifting our focus to achieve better working conditions for specialists and support improved patient health outcomes. We are the Specialists of BC. We are a place where Specialists have a clear voice and that voice is represented.

Specialists of BC: Insider Billing Tips

Orthopedic Surgery says: 1. Regularly talk to your billing person about how s/he submits the different types of billings such as night, weekend and transfer of emergency patients to ensure you are in sync. 2. There are modifications of the elective booking language to try to reflect the degree of urgency better and therefore the priority code used for the patient’s booking. Discussing these modifications with your booking person or MOA should result in fewer total joints being booked as category 5 (26 weeks) and more as category 4 (12 weeks). These completion times are optimal, not actual. If you have a great tip or idea, please let us know so we can share it! We will be establishing a section on our website for members of the Specialists of BC so that we can share these important tips.

MSP challenges value of second consultations

The Medical Services Plan recently began insisting that when surgeons see a patient because a surgery is delayed, they can only be paid 80% of a consult. The Specialists of BC has been working to clarify the role and place of same-specialty second consultations. Through the Tariff Committee, the Specialists of BC is appealing the MSP’s decision, which will affect surgical sections and may set a precedent for other groups as well.

“As somebody who teaches residents and fellows, and is frequently retained by the CMPA to help establish standards of care, I believe that operating on a patient without personally performing an up-to-date consultation is below the standard of care in Canada. In the setting of trauma, up to date means just before you operate, ” said Dr Kevin Wing, head of the section of Orthopedic Surgery.

PMA disparity arbitration process begins

The specialist disparity process dictated by the current Physician Master Agreement is underway in earnest. Arbitrator Dr Stephen Toope has agreed to make all submissions available on line for review by the parties before he delivers his judgment by December 15, 2015. The Specialists of BC continues to be available for assistance to groups involved and to facilitate the dissemination of information.

115-1665 West Broadway, Vancouver, BC V6J 5A4 T: 604.739.1334 | 1.800.665.2262 ext 2941 | ssps.bc.ca

Posted 2017/09/25 & filed under Updates.

 A new name for a new focus

John resetI am your new President, Dr John Falconer, a clinical neurologist from Kelowna specializing in stroke. I have served as head of the section of neurology for a number of years, and now am excited to take on the leadership of The Specialists of BC, formerly  the Society of Specialist Physicians and Surgeons (SSPS) of BC.

Our name is changing because our focus is changing. I will continue to advocate on economics, but I also want to work even more closely with all the specialty groups on their own needs and issues.

Although different specialists have different kinds of practices, we have one thing in common: We are all Specialists.

We need a place where our voice is clear and we feel represented. We need a place where specialists can share ideas, and help each other. We need a place where we can support patients, helping to provide access, services and the specialists they need. That place is The Specialists of BC.

I await your comments and questions, and look forward to working with and for you.

Will we get paid for second consultations?

Last fall, MSP unilaterally declared that only one kind of specialist could bill a consult within a 14-day period. If a cardiologist saw a patient and then referred to a cardiac electrophysiologist, only one cardiology consult could be billed. The Specialists of BC went to bat on behalf of all sections, and achieved recognition that sub-specialties exist, and that there are appropriate times for a second opinion from a colleague. This resolution alone will save many specialists thousands of dollars per year, and provide for the care our patients deserve.

Looking for commonalities in disparity funding allocation

The recent Physician’s Master Agreement (PMA) allows for $55 million to be distributed to specialists in an effort to reduce disparity between specialist sections within BC, and between BC specialists and their colleagues in other provinces. Working with the Doctors of BC economics department, The Specialists of BC has obtained extensive data sets to compare incomes of the different specialty sections within and outside BC. We will be creating an opportunity for sections to develop common submissions to the appointed arbitrator, Dr Stephen Toope. Stay tuned…

The Specialists Insider Billing Tip #1

The first in a series presented by The Specialists of BC on billing effectively for specialty care.

ear and eye

If you are consulted on a patient in the ICU, and you continue to follow them for more than two days in a week, did you know that you can bill for each day you are required to provide directive care?

  • Bill regular daily visits, as if you were MRP (even though you are not), and in the note record mention:
    • “Patient is in the ICU.”
  • You can now receive payment for up to seven days per week, not just two days per week for regular consultative follow up directive care.

If anyone else has a great tip idea, please let us know so we can share them!