The 2019 Master Agreement includes a new community hospital inpatient program (CHIP) to compensate community family physicians who provide care to their patients while in hospital.
Fee-for-service is not always an ideal funding model for family physicians who provide inpatient care. Doctors Nova Scotia, the Department of Health and Wellness (DHW) and the Nova Scotia Health Authority (NHSA) have developed a new funding model, which provides a daily stipend and on-call funding for each eligible site to remunerate physicians who provide on-site comprehensive care for all inpatients (attached and unattached) at larger community hospitals.
Who is eligible?
The new inpatient funding model is only available to family physicians providing inpatient care in following community hospitals:
- Inverness Consolidated Memorial
- Strait Richmond
- New Waterford Consolidated
- Northside General
- Fishermen’s Memorial
- Soldiers Memorial
- Queens General
- Hants Community
What work would be involved under the new model?
The work involved would be largely the same work already provided at the site. Physicians can choose the way they provide inpatient care (either hospitalist-style or caring for your own patients or a mixture of both) within the model as long as the physician group accepts responsibility for:
- Providing on-site comprehensive care for all inpatients (attached and unattached) in the hospital (24/7/365 coverage)
- Providing comprehensive on-call coverage for all hours where physicians are not on-site
- Collaborating with other providers as needed to provide patient care
- Participating in effective discharge planning with an interprofessional team
- Participating in quality improvement and patient safety reviews, programs and activities
- Completing best practice documentation in the clinical record for all visits, admissions and discharges, as well as best practice physician daily “hand-off” structure and process
- Providing assistance to site leads to support bed utilization management, including supporting the timely transfer of patients from regional hospitals when appropriate
- Physician groups that choose to implement the CHIP funding model will have to develop a site delivery plan that ensures that all inpatients at the facility are covered 24/7/365.
- Shadow billing will be required for all inpatient services offered.
How would we convert to the CHIP funding model?
All physicians providing inpatient care at the hospital would have to agree to move to the CHIP funding model, together, for inpatient care before the model will be implemented for a site.
The group would have to develop a site delivery plan that ensures all inpatients at the facility are covered 24/7/365. Site delivery plans must be approved by the NSHA’s Zone Head for Family Medicine, Zone Medical Executive Director and Senior Medical Director of Medicine and must also be signed off by DHW prior to implementation.
How much would we be paid for providing inpatient care?
The CHIP funding model provides a daily stipend for the provision of inpatient care, as well as Level 1 on-call funding of $300/day for weekdays, and $400/day for all weekends and holidays, for the provision of 24-hour call availability.
Each site’s daily stipend is calculated based on formulas that use a weighted bed calculation and the site’s average admissions and discharges rates (information on these formulas can be found on page 8 of the CHIP MOA.
What would converting to CHIP mean for our inpatient pay?
Fee-for-service physicians participating in the CHIP model no longer need to submit fee-for-service claims for inpatient care they provide between 0800h and 1700h, but are required to shadow bill these services. Services provided between 1700h and 0800h the following day can be claimed fee-for-service in addition to the physician’s daily and on-call stipends.
Physicians on an APP will see a reduction in their contract FTE equivalent to the portion of their deliverables related to inpatient services or the total shadow-billing amount related to inpatient services during the prior year, whichever is less.
More detail can be found in the Memorandum of Agreement Regarding the Community Hospital Inpatient Program