Erin Burrell 0

Change MSP reimbursement rules to support outpatient collaborative care

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Physicians in BC: Please read and sign this request if you agree:

We are a group of physicians asking the Tariff Committee to change the MSP Payment Schedule rules to allow multiple physicians to be paid for seeing a patient in the community as an outpatient on the same day. We understand that if this letter is received by November 29, 2019, then this matter can be added to the agenda for the Tariff Committee meeting to be held on December 6, 2019.

Presently, multiple physicians are reimbursed for treating the same patient in hospital on the same day and even at the same time (e.g., an anesthetist and a surgeon; two specialists, even from the same specialty). However, only one physician is reimbursed if multiple physicians see an outpatient on the same day. Thus, a family doctor and specialist are not reimbursed if they see the same outpatient on the same day or at the same time. Likewise, if an outpatient sees a physician and attends an outpatient treatment group billed by a physician on the same day, only one physician is reimbursed.

These payment rules mean that patients are inconvenienced in having to make multiple trips to receive assessment and treatment, and physicians are not able to work together as a team in real time.

Atul Gawande [1] suggests that care will be more efficient and comprehensive if all required physicians meet together in one place, with the patient, to assess illness and plan treatment. This is essentially what happens in an inpatient setting, but the current billing rules prohibit this kind of care for outpatients.

In BC, specialists working simultaneously with family doctors in an outpatient setting has been found to be highly effective [2]. The family doctor is able to elaborate on symptoms and clarify difficulties to the specialist, as well as assess the feasibility of a patient following through with recommended treatment protocols. The patient is able to be seen in a familiar setting, accompanied by the trusted family doctor. The specialist is able to provide more accurate input about diagnosis and treatment in a timely, efficient manner, hopefully preventing the need for a visit to the emergency department and even hospitalization. The patient’s confidence in the family physician to direct the treatment plan is reinforced, which improves adherence. In a similar way, group medical visits have been found to be efficient and effective, especially when education and behavioural strategies are an integral part of treatment [3]. At times, patients in such groups need to see a family doctor or specialist individually on the same day. Presently these options are only reimbursed if one of the physicians is on an alternative payment plan.

As the province of BC moves toward Patient Medical Homes with the hope of providing community-based care, physicians will require a change in reimbursement of services. Already, before Patient Medical Homes are fully mapped out, physicians are interested in working collaboratively to see outpatients but cannot be reimbursed unless one physician is on an alternative payment plan.

We are asking that MSP reimburse multiple physicians who see and treat outpatients simultaneously and/or consecutively on the same day when such assessment and treatment is required in order to provide more accurate, efficient care.

Thank you for your consideration,

Signed by family physicians and specialists in BC
(When signing, please include your name and specialty in the name field)

[1] Atul Gawande. 2012 TED talk: How do we heal medicine?
[2] Thorpe M, Monkman H, Singh P et al. Assessment by pit appointment as an alternative to a full psychiatric consultation. BCMJ 2018; 60(6): 300-309.
[3] Cheek J, Burrell E, Tomori C. Self-management training in cognitive behavioural therapy skills: a project to address unmet mental health needs in Victoria, BC. BCMJ 2019; 61(8):316-323

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