Reviving comprehensive family medicine in Nova Scotia is a priority for Doctors Nova Scotia (DNS), as articulated in the association’s report, Healing Nova Scotia: Recommendations for a thriving physician workforce.
On Mar. 19, 2018 Premier Stephen McNeil announced a new primary care initiative to enable full-scope family medicine in Nova Scotia and improve the physician retention and recruitment efforts in our province.
At the Premier’s request, DNS provided some immediate short-term solutions to the government to help stabilize the primary care system in Nova Scotia. Based on those recommendations, Premier Stephen McNeil announced a number of investments in primary care to help support comprehensive family practice in this province.
Details of the investment package
03:03 Fee Enhancement
Although the enhanced rates outlined below are effective April 1, the MSI system will not be updated until mid-May. Please continue to submit your claims to MSI as usual. You will be paid at the current rates until the MSI system has been updated. An additional payment will be made in August or September to ensure you have received the full value of the enhanced fees for your billings from April 1 onward.
These enhanced fees are only available to family physicians who are responsible for the comprehensive and continuous care of their patients (see definition in the FAQ-1).
- An investment of $8.3 million to increase the base visit fee for family physicians who are responsible for the comprehensive and continuous care of their patients. This differentiates this level of care from episodic care.
- This investment increases the base visit fee by 13.5 percent (03.03 health service codes priced from $31.72 to $36.00 will all increase to $36.00, while 03.03 services priced below $31.72 are increased by 13.5 per cent).
- An additional investment of $3.0 million to increase the geriatric office visit fee to $44.54, recognizing the time and effort involved in ensuring comprehensive and continuous care for the senior population.
- All codes that are increased by this investment will also be eligible for the 1.5 percent increase on April 1, 2018. 03.03 services priced above $36.00 and all other GP fees, including 03.04, are unaltered by this investment but remain eligible for the 1.5 percent increase on April 1, 2018.
- This investment represents an overall increase of 5.6 percent to the overall family physician fee-for-service (FFS) expenditures.
Alternative Payment Plan (APP) and Collaborative Emergency Cenre (CEC) Contracts
- An investment of $2.6 million into Alternative Payment Plan (APP) contracts, which gives family physicians compensated through APP contracts the opportunity to increase their compensation by 5.6 percent, this percentage increase is consistent with the increase for fee-for-service family physicians overall. The percentage increase is a reflection of the overall increase to the family physician fee-for-service (FFS) expenditures noted above and is intended to ensure APP family practice compensation remains consistent with FFS. This applies to APPs regardless of the full or part-time nature of the arrangement.
- This increase does not take effect until April 1, 2018. This means the first payments will be made based on shadow billings in fiscal year 2018/19 (April 1, 2018 - March 31, 2019)
- This increase is available to APP family physicians including solo, collaborative, palliative, geriatric, group and family physicians on APPs working in CECs who meet a minimum threshold of shadow billed claims equivalent to 80 percent of the annual contract value at the end of the fiscal year.
- Any CEC physician who shadow bills above 80 percent of their contract rate will receive the 5.6% increase pro-rated according to their FTE. The 80 percent target will be calculated on the basis of individual shadow billings.
- The Department of Health and Wellness will provide APP physicians with quarterly updates and will work with both the physicians and Nova Scotia Health Authority (NSHA) to enable physicians to reach the shadow billing threshold.
- An investment of $6.6 million for a one-time flat enrolment fee of $7.50 per current patient to enable the creation of panels for family physicians providing continuous and comprehensive care, as a first step towards moving to a blended payment model.
- This incentive is effective April 1, 2018. Initial/preliminary patient panel lists will developed as soon as possible and distributed to family physicians for verification.
- This is a building block that enables a future new family physician compensation model.
- This enrolment initiative is a voluntary, interim process. It will enable family physicians to gain experience and provide input on how a formal enrolment process may be structured in the future. This is important given that both DNS and the Department of Health and Wellness have a stated interest in pursuing negotiations on a blended capitation compensation model in the upcoming Master Agreement negotiations process.
Orphan Patient Attachment Fee
- An investment of $6.4 million for a one-time flat enrolment fee of $150 per patient for unattached patients to improve access to primary care for Nova Scotians.
- The expanded rules for the unattached patient bonus are effective April 1, 2018. These fees should be billed at the time of the initial visit.
- These fees cannot be claimed if you are a new physician still building your practice (see FAQ-2 for more information).
- Available to APP and fee-for-service physicians for taking on patients from the 811 Find a Family Practice list as well as other patients who were previously unattached at the time they are enrolled or who may become unattached, such as patients referred from the Emergency Department and patients from a practice where the physician is retiring or relocating and who no longer have a family physician as a result of that change.
- The criteria for accessing the existing Orphan Unattached Patient Bonus will be broadened and the process for claiming the fee simplified.
Technology Stipend - Virtual Care
- An investment of $4.2 million to allow family physicians to better leverage technology by repositioning telephone services along with eVisits in a reconstituted pilot consisting of a block payment structure for physicians who are prepared to leverage MyHealthNS and telephone visits to provide care to their patients.
- A stipend of up to $12,000 per physician will be available to all family physicians (APP, AFP, and FFS) who enroll their patients in MyHealthNS, enable patient access to laboratory results and other key platform features as well as agree to participate in the pilot evaluation process. This investment aims to improve access to care for patients and compensate physician participants for the time telephone and eVisits take. Compensation will be pro-rated for physicians working part-time or who have small patient panels.
- Current non-face-to-face fees being piloted under the current Master Agreement will continue for specialists and the DHW will simplify the billing code requirements. Family physicians who choose not to participate in the MyHealthNS pilot are eligible to bill the non-face-to-face fees within simplified requirements.
- The investment provides a bridge to the development of a new compensation model enabling physicians to build a continuous, meaningful relationship with patients.
Technology Stipend - Electronic Medical Record (EMR)
- An investment of up to $8.5M in three initiatives to support the use of electronic medical records and to facilitate a one-time migration of EMRs for those physicians who are changing EMR providers.
- This investment recognizes that EMR migration is required for those physicians currently using the Nightingale on Demand system due to a decision by Telus to discontinue support for that system as of December 31, 2019.
- The investment will also include EMR financial support for all EMR users.
Additional details can be found in the full proposal and schedules.