Posted 2018/11/16 & filed under Updates.

What is extra billing?

The government of BC has decided to enforce legislation that bans extra billing. What does that edict mean? The federal and provincial government mandates that as medical practitioners, we cannot charge patients more for a medically necessary service than would be paid by MSP. Billing MSP at the current rate and then charging patients an extra amount is double billing and has always been illegal. However, private clinics and imaging centers have been operating for years in BC. In this case, a patient is charged whatever fee the private center charges, but no billing to MSP takes place. This approach has allowed some patients to expedite their assessment or treatment. The government buys medical services from some private clinics for WorkSafe BC, for example, albeit outside the MSP budget.

Clearly any emergency medical need in BC is dealt with immediately. Here we are talking about people with non-emergent problems who don’t want to wait for public resources.
Some argue that allowing patients who wish to pay privately for services may free up public resources for those who do not. Others argue that this loophole allows government to under-fund resources, or that it means some patients who can afford it may get faster care than others. If the ban on extra billing stops any private care, what happens to wait lists? I think the government had better be ready to handle the outcry as public waitlists climb when private clinics cannot assess or treat anyone. What do you think? Please let me know.

When do you want your $10,000 this year?

The Specialist Services Committee (SSC) offers funding of up to $10,000 per physician in leadership training scholarships to cover tuition and travel costs. Certificants or fellows of the Royal College of Physicians and Surgeons of Canada practicing in BC can be funded for programs offered by recognized academic institutions, professional bodies and/or quality improvement organizations, with preference given to programs reflecting Canadian context.

Specialists symposium 2019: Get together with your peers

The Specialists of BC and the Specialist Services Committee are in discussions with the Ministry of Health to co-sponsor a “Specialists in BC Symposium” early in the new year. This gathering could be an opportunity to:

• clarify what and how specialists practice in BC
• share telehealth experiences by BC specialists
• define a role for physician extenders
• identify which specialists could work with our GP colleagues in the Patient Medical Home model
• investigate whether there are areas where we could work more efficiently, without asking for more money
• look at recruitment and retention issues and fixes for BC specialists
• what is working in other jurisdictions

There may be many more ideas worthy of inclusion in our symposium. Feel free to share things you would like to discuss!

Priorities for Specialists Services Committee?

The SSC created the telephone consult codes (10001 etc) which have been really great for encouraging communication between us and our GP colleagues. Do you think the telephone codes and other SSC fees need more work? Are you okay with the restrictions that were placed to contain costs, or do we need to prioritize removing or changing them? What are other ways we could utilize funding to improve care? I’d like to hear from you!

Join the Specialists of BC today and receive $100 off your dues

Be part of the Specialists of BC for 2018! Go to https://www.doctorsofbc.ca/
account/dues to get your $100 discount on dues. The reduction will be applied automatically when you select your membership category. Thank you for supporting the Specialists of BC.

Posted 2018/11/16 & filed under Updates.

Who will be leading the Doctors of BC next year?

There is an election being held NOW for this year’s President-Elect of the Doctors of BC. You should have received a link to a ballot to vote on Friday, April 13 from Everyone Counts Canada. You can vote until May 14, 2018. There are two candidates running. The first is Dr Kathleen Ross, a family practitioner in Coquitlam. Dr Ross is a solid choice but I can’t help noting that it has been four years since our provincial medical organization has had a specialist president, and that the Doctors of BC has only had seven specialist presidents in the past 20 years, with another GP incoming in June.

The other candidate Dr Lloyd Oppel is an Emergency Medicine physician who is our Council of Specialists chair, and is on the new Doctors of BC Board, as well as having served there previously and in many other capacities for the profession in the past twenty-plus years. Lloyd’s unique perspective, in addition to the many contacts he has within the specialist community that he is an integral member of, and within the GP community, and the wealth of knowledge and experience he brings to the table will be particularly welcome in this, a negotiating year.

Whoever you decide to support, please be sure to vote, and urge your colleagues to exercise their right to choose a president-elect.

Practice Tip

One complaint we hear from patients is about the “black hole” that referrals to specialists go into. Their GP may advise a specialist’s consult to help in their care, and then send a referral letter to a specialist. But then what? Unfortunately, many of us have a significant waiting list. As we try to work through it, how many of us let the referring doctor and patient know when they might expect an appointment? If you are not doing this, perhaps it is time for you to consider a system change in your practice. Don’t let specialists be the booking black hole.

Specialists of BC and the Specialist Services Committee (SSC)

The Specialist Services Committee (SSC) is about to start developing their next three-year strategic plan. The SSC is a tripartite committee consisting of the Ministry of Health, the Health Authorities, and the Doctors of BC. The Specialists of BC believes the new plan is an opportunity for all specialists to engage with the SSC through the Specialists of BC. The Specialists of BC is looking to form an energetic new partnership with the SSC. We are going to be at the committee table, to help take a leadership role in providing specialty care for our patients and ensuring the right kind and right number of specialists are where they need to be. We want to work with the Ministry and Health Authorities to co-develop new ideas. We need to be sure that specialists are provided with the resources and incentives they require to provide the very best care for BC citizens. Perhaps at the SSC what has been missing is the specialists of, and in, BC? Let’s pull together with the SSC and make it better.

Patient Medical Home

This project is one of the Ministry of Health’s objectives, working with our General Practice colleagues and their patients to create family practices supported to operate at their full potential, integrated into the health care system. As this initiative is being explored, we feel the Ministry should also be asking what it means to specialists. What is our role? How can we help GPs and patients interact more easily in the system? We need to be working with general practice at the start, not coming in at the end. Getting involved with the GP Home is but one of many ways we can support our members. You will be hearing more about this topic from us…

Posted 2018/11/16 & filed under Updates.

What will the new Representative Assembly talk about?

The Doctors of BC new governance structure has come into effect. On September 15, 2017, the Doctors of BC board of directors met, reduced from more than 40 members to 9. The 103-member Representative Assembly (RA) – made up of 35 specialty section representatives, 34 GP representatives, and more than 20 district representatives and others met for the first time the day before. In this all-day meeting of the RA, 10 minutes were allowed for the RA to bring up any issues. So, what did they say? They passed a resolution requesting another RA meeting before the next scheduled one in the February to talk about such important issues as:

  • creating an agenda committee
  • having observers from the RA on the Board
  • automatic section and society membership
  • impact and strategies around the mid-term review of the Physician Master Agreement
  • review the Committee structure of the Doctors of BC
  • work of Divisions integration into Doctors of BC
  • UBC having observer seat
  • review regional problems, e.g. Nanaimo computer order entry issues
  • review lack of GPs, mix of specialists
  • deciding on moving forward with committee reports
  • follow up of committee reports
  • how much of board agenda and reports go to RA
  • react to college issues

Since the newly elected Doctors of BC Board had their first meeting the day after, members may not have had opportunity to consider the RA resolution for another meeting fully. Let’s hope future RA meetings have more time for discussion.

Phone Consults

There is a fee code (10001) for specialists responding within 45 minutes to a request from another doctor for telephone advice. SSC fee codes such as 10001 require some documentation. Our Neurology group has found that dictating even a brief note helps to document the call and support billing, while providing tremendous communication for medical care of each patient. Wouldn’t you love to see in writing what your colleague had to say about a patient that they did a short telephone consult on? Next time you are giving some phone advice, take a minute and dictate a note.

Why should specialists care about the dramatic shortage of GPs in BC?

Recently, I have been supporting a BC Interior community and catchment area neurology service via Telehealth in their time of need. Much to my surprise, up to 50% of these patients have no GP. I have neither the experience nor skill to manage their general care, and yet here I am. These patients have to scramble for a walk-in GP appointment, plead for refills of their other medicines, and have no one to supervise their total care. As a consultant, I rely on family doctors to be involved in longitudinal care, even more so when I am doing a video conference from a distant community.

What is the long-term plan for family doctors? Specialists in general, and the Specialists of BC in particular, would be happy to try to support the Doctors of BC and Ministry of Health in any way we can.

The Overhead and Income Study

Since spring we have been offered an opportunity to participate in a randomized study of our overheads and income. A few sections have had a good participation, but unfortunately quite a few sections have not. The overhead study committee is still hoping that post-survey analysis may correct for a non-participation by some sections and some doctors. We certainly have concerns that non-random lack of participation may make decisions based on this study very difficult. We’ll have to wait and see…

Posted 2018/11/16 & filed under Updates.

Representation in the new Representative Assembly

As you know, the Doctors of BC will have a new governance structure September 14, 2017. This new structure will consist of a smaller board and a large Representative Assembly (RA). The old board was truly representational, with all members able to vote in their districts . The new RA has around a dozen district representatives and 77 members appointed by their sections and societies. While this arrangement sounds good, there is a fundamental flaw – only 20 to 40 per cent of Doctors of BC members join their sections. As it stands the doctors on the RA will be representing a minority of members. I would like to propose a simple remedy: When you join or rejoin the Doctors of BC, you automatically get membership in your section or society. Every member would be able to have a say, and the new governance structure would be more representative. Please let me know what you think.

MSP wants to reset fees based on dollars a minute

MSP has given notice that it wants to review any and all fees that in aggregate account for more than $1,000,000 a year in billings, and that appear to earn doctors more than $10 a minute. MSP has proposed that any such fees be halved or more, down to no more than $5 a minute.

Aside from the obvious problems of cutting any fee by such a large amount, I am unclear on how anyone can know how many minutes of work are in a fee code. When I see a patient for a neurology consult, the time I work is considerably greater than the 45 to 60 minutes I typically spend talking with and examining a patient. I put in hours triaging referrals, ordering and reviewing tests, answering phone calls, participating in hospital committees, teaching students and so on.

If I could bill $5 a minute for my patient-related activities (10 hours x 60 minutes x $5 a minute = $3,000 a day) I’d say, bring it on MSP! I imagine, however, MSP is thinking the minutes are from when you pick up a scalpel until you put it down. Can you imagine if we expected lawyers to only bill the 30 minutes you spoke with them, with no charge for the hours of preparing papers and submissions?

This transparent attempt at a relative value fee guide is misinformed. Even if our current fees aren’t as equitable as we might like, cherry picking particular items and reducing them by 50-90% without taking into account all we do for patients is not going to work.

Physician Master Agreement negotiations for a new contract start soon

Paul Straszak, Doctors of BC chief negotiator, will be starting consultations with all of us very soon. What do you want as a priority? General increases, targeted increases, new programs, something else? Mr Straszak can’t please everyone all the time but he has been very open to talking with us, and is a talented negotiator. He can’t try to get you what you need unless he knows what that is!

Telehealth – just do it

Patients often travel a long way to consult with us as specialists. If we need to see them in follow up, they have to travel again. I have been increasingly using telehealth, sometimes for first consults, and sometimes for follow up visits. In my health authority, Interior Health, we have a telehealth room in most facilities. I can use my own desk top computer or an iPad to have a face-to-face neurology visit with my patient. Most sections have good telehealth fee codes. In IH, one of our biggest users is Thoracic Surgery; one third of their billings is telehealth. Are those of you that aren’t using telehealth interested in a CME event to get you comfortable doing it? Let me know!

Posted 2018/11/16 & filed under Updates.

SSC Fee Codes – fixed budgets and constructive fee codes

The Specialist Services Committee (SSC) is allocated a fixed budget, some of which was used to create telephone fees for specialists (10001, 10002, 10003, 10004). The intent was to compensate specialists for giving telephone advice to a GP or other health professional, which could prevent a patient needing to be seen in person. These codes have been so successful that their use has exceeded the total budget available. A number of meetings between specialists and the SSC have been held, leading to the SSC tightening up the allowed use of these codes. For example, the 10001 will not be billable if the patient has been seen within 180 days, the 10002 not billable if patient seen within 30 days, and so on. A possible resulting paradox could be that, rather than billing $60 for successfully advising a GP on managing a patient, the specialist may end up consulting in person on a patient for a much higher cost. Alternatively,  specialists may be expected to provide some services for free. The original idea of compensating specialists for work they do may be less helpful than we would have hoped.

SSC telephone advice codes

Restrictions on billing telephone advice codes include limiting fee codes if patients have been seen within 180 days (10001) or 30 days (10002), but only for the same condition, that is, the same ICD code. For example, a patient first seen with abdominal pain (ICD code 7890) may then be seen within the restricted time period (180 days – 10001/30 days – 10002),  and telephone advice may again sought by a GP. Perhaps now, however, the diagnosis of Cholelithiasis is able to be made (ICD Code 5740). Because it is a different ICD code, the 10001 or 10002 may still be billed. So be careful, and accurate. The first visit’s more general diagnosis may legitimately be fine-tuned, leading to removing a possible restriction on giving telephone advice, and allowing appropriate specialist compensation after all.

Be a representative

The new governance structure at the Doctors of BC commences September 2017 – this fall! The Specialists of BC has worked very hard to ensure there would be 50% specialist representation on the new nine-member Board, and also on the approximately 100-member Representative Assembly (RA). The RA will meet just three times per year, and we really want our hard-won 50% representative seats for specialists to be filled. Specialist to specialist, I ask you to consider running for a district or rural seat as appropriate for where you live and practice. Your travel expenses and a sessional stipend would be paid. Please put your name forward and participate in the future direction of all doctors in BC.

Did you know?

The Specialists of BC is separate from the Specialist Services Committee and the Doctors of BC, though we work closely with both.  We’re a registered non-profit society working for the specialist doctors of the province since 1990, and we rely on your dues to do this work. If you want to support specialists, please considering joining the Specialists of BC now . We are currently offering 50% off membership, and you can join for $225 at https://www.doctorsofbc.ca/account/dues (the reduction will be applied automatically).

Posted 2018/11/16 & 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 2018/11/16 & 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 2018/11/16 & 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 2018/11/16 & filed under Updates.

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 2018/11/16 & filed under Updates.

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!