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Alberta government extends deadline for changes to doctor fees

Alberta Medical Association says health minister’s tweets on doctor billing fees paint inaccurate picture
WATCH: Health Minister Tyler Shandro took to Twitter Monday night to highlight claims that Alberta doctors bill higher fees compared to several other Canadian provinces. As Silvana Benolich reports, the Alberta Medical Association says that comparison is not accurate.

Alberta’s health minister says the government will delay bringing in changes to the fees doctors collect so that the province can continue to consult with physicians.

Tyler Shandro said he’s encouraged by talks so far, but adds that ultimately there need to be reforms on how doctors bill for patient visits.

READ MORE: Doctors worried about Alberta government’s proposed cuts, changes to compensation

“That process needs to be streamlined … so we’re working on what that framework would look like,” Shandro said Tuesday in an interview.

“(But) this is definitely not something that is happening Feb. 1.”

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Last November, the United Conservative government asked doctors for feedback on 11 proposed changes, some of which were tentatively set for next month.

The main bone of contention is changes to billing rules.

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Doctor, NDP and health minister on proposed changes to Alberta physician compensation
Doctor, NDP and health minister on proposed changes to Alberta physician compensation

READ MORE: Doctors call new pay plan being proposed in Alberta legislature cynical, heavy-handed

Alberta’s current fee-for-service model allows family doctors to bill $41 as a base fee for each patient visit no matter how short or how long.

The province added an extra fee a decade ago, called a complex modifier, to recognize that some patients have multiple or complex issues and doctors should be compensated for overly long visits.

Doctors now are allowed to add 10 minutes to a 15-minute visit and bill the province another $18 for a total of $59.

The government is proposing that the extra fee not kick in until the 25-minute mark. It argues that 15 minutes is not enough for complex cases and that some doctors are abusing the rules.

Alberta has highest-paid doctors in Canada
Alberta has highest-paid doctors in Canada

The Alberta Medical Association said extending the length of a visit before the extra fee could be billed would reduce fees by a total of $200 million and devastate many family and rural practices.

Shandro’s ministry, in an email, said data suggests the extra fee is being misused. It said too many doctors apply the $59 right at the 15-minute mark, making it the de facto base fee, and allowing them to potentially charge the higher fee four times in an hour.

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The ministry said the complex modifier was meant to be for exceptional cases, but is being applied to half of all visits to a general physician and sometimes is applied to all visits.

Shandro said the numbers suggest the current fee-for-service model is broken.

“I’m happy to look at other alternatives with these physicians, so that it works for them and it works for the patients and people can spend the (appropriate) amount of time (per visit).”

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READ MORE: AMA president ‘hopeful’ for ‘effective dialogue’ with Alberta health minister about controlling costs

Dr. Christine Molnar, head of the medical association, said in an interview last week there may be a small number of doctors abusing the fees, but “it’s certainly not a large component as far as we can tell from our data.”

Minister takes to Twitter

Late Monday night and again on Tuesday, Shandro took to Twitter to criticize how much Alberta doctors bill compared to some of their provincial counterparts.

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The head of the AMA said comparing billing like this paints an inaccurate picture because fees in different provinces have different things they pay for.

“When’s the last time you saw a really difficult problem solved on Twitter?” Molnar asked.

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“The cost of everything in terms of employment in Alberta is higher. We know that number is over 10 per cent above other provinces and maybe even more. So everything costs more in Alberta right now.”

According to Molnar, overhead costs for family doctors comprise approximately 40 per cent or more of their business.

“When you’re looking at gross payments, you’re looking at that number before the overhead costs are adjusted, and I think it’s important to remember that isn’t what the doctors are taking home,” Molnar said.

“It’s what they’re paid to support and hire Albertans.”

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Some of the other changes the province wants include an end to double billing for overhead, no more duplicate billing for diagnostic imaging, and a cap on how many patients a doctor can see and bill for in a day.

READ MORE: Alberta doctors not ruling out court challenge in response to billing changes

The AMA said the government is on shaky legal ground by imposing policy changes affecting finances that are supposed to be negotiated at the bargaining table.

Shandro said his ministry’s legal advice said otherwise.

Alberta is paying $5.3 billion this year for physicians. Premier Jason Kenney has said there is room to find savings in government to reduce the deficit while making health care more efficient.

– With files from Global News’ Silvana Benolich