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 province. The SGFP has the following suggestions and recommendations on the current FHN templates: 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 Page 2 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 codes.
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