Section on General Family Practice (SGFP) Response to FHN by alllona


									                   Section on General & Family Practice (SGFP)
                            Response to FHN Templates
                                  January 2003

The Section recommends that the PCN Pilot Contracts be offered to all physicians in the

The SGFP has the following suggestions and recommendations on the current FHN

1. Allow payments to individual physicians (regardless of whether they are incorporated
   or not) as an alternative option to the current method of payment.

2. Costs of information technology require clarification. The government to cover the
   costs of all hardware and software costs since these are business costs that service the
   MOHLTC and the patient. These costs should not come out of payments that
   physicians receive for medical care of patients.

3. Section supports the introduction of “Core Data Set Management Payment”. This
   would involve an initiation fee and an ongoing maintenance fee. The SGFP is
   currently developing the definition of this fee code.

4. Introduce a practice income guarantee (for a three year period). Three-year guarantee
   to be based on physicians’ FHN revenue analysis.

5. All global fee increases applying to the family physician/general practitioner fee-for-
   service OHIP pool to also be reflected in FHN contracts.

6. Coverage for breach of contract (failure to provide contractual care) regarding patient
   access must be addressed.

7. A Dispute Resolution Mechanism needs to be established.

8. The Section recommends that the OHIP codes for Periodic Visual Assessments be
   removed from the basket of services (A110, A111, A112, A114).

9. Family doctors providing mental health services must be eligible for additional
   bonuses. Currently, based on OHIP payment data, roughly 40% of fee-for-service
   payments for mental health psychotherapy codes are billed by general and family
   practitioners. This service delivery must be encouraged as research shows that these
   services benefit patients, keeping them working and functioning as productive
   members of society and out of hospital.

10. Physicians be permitted to work collaboratively with appropriate allied health
    professionals they select/recruit based on the needs of the Family Health Network.
    Government must adequately compensates physicians for the added overhead costs
    and consultation time required to direct, coordinate and manage the allied health
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    professionals’ service, time and infrastructure. In addition, there has to be recognition
    and compensation for the investment that the physician has already made for the
    infrastructure, goodwill and reputation of the practice from which the allied health
    professionals will benefit.

11. The Section on General and Family Practice does not accept physician financial
    accountability unless there is a corresponding monetary accountability for patients
    seeking the same primary care services elsewhere within the ‘catchment area’ of the
    FHN (outside use). There should, however, be a reasonable allowance for patients to
    seek outside medical attention (i.e. when they are 100 kilometers from their primary
    residences) without a corresponding financial penalty.

12. Physicians should receive compensation outside of the base rate payment for
    mandatory extended office hours. This takes into consideration the increased
    overhead costs as well as issues of physician personal safety and security. We would
    recommend that the A888 code definition (Emergency Dept. Equivalent – Partial
    Assessment) be extended to include evenings on weekdays.

13. A complex care modifier code must be introduced for individuals who require high
    levels of care for health status maintenance, prevention of complications and to
    reduce hospitalizations. This modifier, which is not based on age and sex, could be
    based on chronic diseases states, such as diabetes, Congestive Heart Failure, COPD
    and Multiple Sclerosis as well as socio-economic status.

14. Additional benefits (such as pensions and retention bonuses) must be included in the
    FHN contracts. See attached examples of such retention/recruitment programs
    (“Proposal for a Physician Retention Program in Manitoba”and the “SMA Retention
    fund”) received following communication of our Section Executive both the
    Manitoba Medical Association and the Saskatchewan Medical Association.

15. All physicians practicing in FHNs be permitted to receive the same incentive
    payments from all bonus group codes regardless of where they practice. Eliminate
    differences between FHN models that allow differential bonus code schemes.
    Remove the requirement in the current Blue Rio template that fifty percent of all
    physicians in a FHN have hospital privileges.

16. Increase the current cap on roster size to 3,000 patients.

17. Improve the mechanism to track bonus codes. The criteria of patient eligibility need
    to be examined.

18. Establishing premium codes for physicians providing care for patients in homes for
    the aged and nursing homes needs to be addressed. The Section supports a nursing
    home cap rate. This must not be based on the current woefully low OHIP “W” fee

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