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Nurse practitioners shocked by Higgs government decision to charge for medical tests
Nurse practitioners say new rule that charges 'private' providers will hurt orphan patients the most
Chantal Richard, president-elect of Nurse Practitioners of New Brunswick, said the move to charge for any medically required tests ordered for patients is another blow to those without a primary care provider. (Submitted by Chantal Ricard)
A new rule introduced by the Blaine Higgs government is raising concern among nurse practitioners, who believe it will introduce yet another barrier for the more than 44,000 New Brunswickers who do not have a primary care provider.
Under the policy, which came into effect April 1, any medical practitioner who is operating outside of the public system and charging patients directly, will be billed by the regional health authority for any diagnostic or laboratory tests ordered.
Chantal Ricard, president-elect of Nurse Practitioners of New Brunswick, said the decision is "impeding access to care."
"We believe that these tests should be insured because they're medically necessary and ordered for patients with valid Medicare cards and ordered by licensed health professionals."
Nurse practitioners can diagnose illnesses and injuries, order and interpret tests, and prescribe medications. They are also able to refer patients to a specialist or transfer care to a physician if required.
No explanation for policy
CBC News requested an interview with Health Minister Dorothy Shephard but she was not available to explain the rationale for the decision.
"We've met with them on a few occasions," nurse practitioner and association president Raelyn Lagace said when asked if she knew why health officials made the change, "But we haven't come to any conclusion as to what they're trying to accomplish."
Health Minister Dorothy Shephard was not available for an interview. A government spokesperson says her department does not keep track of the number of doctors or nurse practitioners seeing patients outside of the public system. (Ed Hunter/CBC)
In a letter obtained by CBC News dated June 19, 2020, and addressed to the Vitalité and Horizon Health board chairs, then-health minister Ted Flemming writes that the change is meant to establish "consistent policies and bylaws related to the granting and use of privileges for ordering tests and diagnostic services."
He said government has been made aware "in recent months" of instances where nurse practitioners and doctors are "utilizing publicly funded resources such as laboratory tests and diagnostic services, while charging patients fees."
Lagace said about 150 nurse practitioners are working in New Brunswick. Many are salaried employees with the health authorities, and others work independently, charging patients directly for their visits.
'I'm not quite sure what's going on'
Nurse practitioners who billed patients for a consultation in the past could then order medically necessary tests, which would be covered by Medicare. Lagace said nurse practitioners wouldn't charge anything for tests, only for the consultation.
"If you are a citizen in New Brunswick and require medically necessary tests, you already are paying taxes and should have access to these publicly funded systems that your tax dollars pay for."
Health policy expert Gregory Marchildon agreed. The Ontario research chair in health policy and system design said the move by government strikes him as "a bit of a shift."
In New Brunswick, an increasing number of patients have been forced to seek care outside the public system because they can't get access to a family doctor, or to specialists with long wait lists.
"The fact that these residents are charged for their medically necessary, primary care services only because they can't get access to a physician or nurse practitioner with a Medicare billing number seems contrary to the whole purpose of Medicare," Marchildon said.
Gregory Marchildon, Ontario research chair in health policy and system design, said all residents with a health card are entitled to 'every medically necessary hospital, diagnostic and physician service.' (Submitted by Gregory Marchildon)
"I'm not quite sure what's going on here in New Brunswick, but the rule is that every Canadian should have access … to every medically necessary hospital, diagnostic and physician service. And it seems to me that there is no loophole for that."
Marchildon said if a test isn't medically required — for instance, if someone just wants an MRI "to see if there's possibly anything wrong"— the hospital shouldn't charge for that test. Rather, "they should be just simply refusing to do it."
"The way in which this is being dealt with doesn't sound helpful or constructive," he said. "And it could be very much contrary to the Canada Health Act."
The Department of Health said it does not track how many physicians are working outside the public system in New Brunswick.
Policy impedes access
A March 2021 memo to Horizon Health physicians and nurse practitioners, from two Horizon vice-presidents outlines a range of examples of when physicians or nurse practitioners would "receive a bill directly from Horizon Finance Department."
The list includes services that would be considered medically necessary such as "a patient who requires investigation for anemia," and those that wouldn't, such as "a patient who requires a chest X-ray for a scuba diving licence."
While the new policy charges the medical practitioner who orders the tests, Ricard and Lagace said the costs would ultimately be passed on to the patient.
Lagace said nurse practitioners charge between $29 and $49 for a consultation with a patient, and it's not feasible for them to then pay between $128 and $600 for diagnostic tests.
Raelyn Lagace, president of Nurse Practitioners of New Brunswick, said her members want more flexible options to provide care and ultimately would like to have Medicare billing numbers, similar to doctors. (Submitted by Raelyn Lagace)
"We don't want to pass that bill on to the patient," said Ricard. "We've been working with government for the last two years trying to make changes that would improve access for patients and remove barriers for care, but government chose to take this direction.
"In essence it ties our hands. It shuts us down."
Government goes ahead, despite 'gaps' in care
At the end of the day, Lagace said, the Higgs government is hurting those without access to primary health care the most.
That's something Flemming recognized in his letter from June 2020.
"Please note, Government is also aware of gaps in access to primary health care that would occur should [nurse practitioners] no longer be able to see their existing patients as part of a private practice," Flemming wrote. "This is evidenced in our commitment to fund the establishment of [nurse practitioner] staffed clinics in the province."
Former health minister Ted Flemming said in June 2020 letter that changes to the policy for diagnostic tests and laboratory tests were being made to 'ensure publicly funded health resources are both utilized appropriately and applied equitably.' (Jacques Poitras/CBC)
Lagace said new clinics, staffed by nurse practitioners, are set to open in Moncton, Saint John and Fredericton. Each nurse practitioner will eventually be able to take between 800 and 1,000 patients and will operate within the Medicare system.
While that is good news, she still questioned the direction the government is heading and pointed out the new policy doesn't fit with other goals.
"We want to increase the population of New Brunswick." she said. "But if we can't provide health care, then that's not an option. People are not going to stay if they cannot get access to care.
"People in New Brunswick in the Fredericton region have been on these wait lists for five, seven, 10 years and are not able to get access to care."
Call to revise policy
Ricard and Lagace are calling on the government to change the new policy, arguing New Brunswick citizens are entitled to these tests through the Hospital Services Act.
"There's a need and there's room for all of us and I think that all available health care providers should be on deck," Ricard said.
"We don't understand why government would choose to take away this only option for many patients before having something better to offer them."
Marchildon said New Brunswick should immediately contract with whatever health providers it can, including independent nurse practitioners, to offer care to everyone, "rather than penalizing New Brunswick residents for something they have no control over."
Information Morning - Moncton0:00Health practitioners working outside the public system to be charged for lab testsABOUT THE AUTHOR
In my view, if Higgs is unwilling to fix the core problem of not enough family doctors, then he should be thankful for the private practitioners who are trying to fill that void and he should pay for any legitimate tests
Meanwhile, over a year and a half ago, "the problem" was identified, by the then Minister of Health, good old Teddy Flemming.
https://www.cbc.ca/news/canada/new-brunswick/billing-numbers-eliminated-family-doctors-1.5303180
But, I'm guessing, good old Higgs and company, can't grind a few bucks out of that, so we'll just sweep it under the rug, and forget about it.
Health minister focused on finding everyone a doctor or nurse practitioner within 6 months
Dorothy Shephard says her department has taken over recruitment to get rid of waitlist
"Every physician and nurse practitioner should be working within the Medicare system," the minister said. "We have 18 vacant nurse practitioner positions that we would dearly love to fill."
In New Brunswick, an increasing number of patients have been forced to seek care outside the public system because they can't get access to a family doctor, or to specialists with long wait lists.
As of Dec. 31, there were 44,226 people registered with Patient Connect New Brunswick which pairs residents with a family doctor.
But Shephard believes that by doing a comprehensive review of the names on the Patient Connect list and by hiring 18 full-time nurse practitioners, she will be able to eliminate that wait list within six months.
- Nurse practitioners shocked by Higgs government decision to charge for medical tests
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"I will hire them today," Shephard said. "And out of those 18 positions, we will take 18,000 patients off the Patient Connect list and connect them with a primary caregiver, a permanent one. That's what we need to have happen. We don't need one-off appointments."
Nurse practitioners argue that long wait list, combined with a new rule introduced by the Blaine Higgs government April 1, which charges medical practitioners for diagnostic or laboratory tests ordered for patients they see outside of the publicly funded system, is making it more difficult for patients who need care.
Shephard said she has no plans to reverse that policy, and is "not going to encourage that people should have to pay for a Medicare service" by providing any public resources to those doctors or nurse practitioners who are charging patients directly for appointments.
Focus is on hiring
In New Brunswick, patients are able to pay between $30 and $50 to see a family doctor or nurse practitioner operating outside of the public system.
Shephard said that's not a solution to the shortage of people who can provide primary care, and it's not something she is going to spend any energy on supporting.
"They're doing one-time appointments," she said. "They may have some followup, but this individual using their service does not have a primary-care provider full time. And that's our goal. Our goal is to ensure that every New Brunswick gets a primary health-care provider."
We're working on a two-tiered system — that's not what we want in New Brunswick. We want dependable, affordable health care. And there's ways to do it.
- Minister of Health Dorothy Shephard
Shephard said staff are going through the list of people waiting for doctors and are contacting them by phone and through the mail to determine who is still in need of a primary caregiver.
She said officials have not been able to reach a "significant number," and their names will be removed from the list.
"Then we will have a very clear, concise idea of how many people in this province need a primary caregiver."
Chantal Ricard, president-elect of the Nurse Practitioners of New Brunswick, said her members would like to work within the Medicare system for one of the regional health authorities, but not everyone wants to work full time.
Shephard said she understands that, and is willing to hire part-time nurse practitioners.
Chantal
Ricard, president-elect of Nurse Practitioners of New Brunswick, has
asked numerous times for the details of available positions so her
association can help the province recruit more nurse practitioners to
the public system. (Submitted by Chantal Ricard)
Ricard also provided an email exchange with a "talent acquisition specialist" with Horizon Health that began on Feb. 26, when she asked for the postings for the available nurse practitioner positions so she could share with her members and help the province with its recruitment.
She was promised the information in an email dated March 2, but Ricard said it never materialized, even after following up as recently as April 9.
Not happy with recruitment
When asked about that, Shephard said she has heard other complaints from health-care providers who want to work in New Brunswick.
"I've also been told that I have family physicians who want to come home to practise here, and they can't even get a call back, she said.
"That's why we've taken recruitment into the Department of Health to lead it, working with our partners at the [regional health authorities] and the medical society and our associations. I have not been satisfied with our recruitment process."
Shephard did not provide any suggestions for those who are currently without a family doctor or nurse practitioner, and in need of care.
"We're working on a two-tiered system — that's not what we want in New Brunswick. We want dependable, affordable health care. And there's ways to do it."
ABOUT THE AUTHOR
https://www.cbc.ca/news/canada/new-brunswick/healthcare-new-brunswick-doctor-1.5990854
Horizon chair 'perturbed' by province saying it will take over doctor recruitment
Horizon Health Network says province gave no heads-up it would take lead on recruitment efforts
During a Horizon board of directors meeting Friday, John McGarry questioned the Department of Health's ability to do a better job than the health networks at recruiting doctors to New Brunswick.
McGarry said he could imagine scenarios that would work at recruiting doctors, such as one doctor calling another and asking if they'd like to join or take over their practice. He also suggested the health network's CEO could successfully recruit doctors by contacting them directly.
"I'm thinking, what physician is even going to have a discussion with a bureaucrat in the Department of Health about taking a position?" McGarry said.
"Because they know they must come back to the [regional health authorities] about privileges; 'What group am I going to be with? What services am I going to do? If I'm a specialty person, what kind of resources am I going to have to do those?'
"It all begins and ends with the hospital and the physicians groups, so I'm really perturbed with this statement of government saying we're taking over recruitment, and [I'm] thinking, 'Well, good luck'."
McGarry's comments came after Health Minister Dorothy Shephard said earlier this week her department was taking the lead on the recruitment of family physicians and nurse practitioners in the province, adding she hasn't been satisfied with the process so far.
As of Dec. 31, there were 44,226 people registered with Patient Connect New Brunswick, which pairs residents with a family doctor.
Shephard also said she has heard complaints from health-care providers about not receiving a call back after expressing interest in working in New Brunswick.
No consultation from Department of Health: CEO
During Horizon's board meeting Friday, CEO Karen McGrath said the Department of Health never communicated to Horizon any issues of prospective healthcare providers not being called back.
McGrath also said the department hasn't offered any directive with respect to it taking a lead on physician recruitment, adding she only heard about the plan through the news media.
Horizon
Health Network CEO and president Karen McGrath said it would be
impossible for someone in the Department of Health to properly identify
the need for doctors within the health authorities. (Zoom)
She also added to McGarry's concerns about the department's ability to effectively recruit doctors, saying it would be "virtually impossible" for someone in government to be able to identify specific needs within the health authorities.
"We need to be careful about adding layers of complexity," McGrath said.
"So if indeed there is someone in government calling somebody who says yes I'd like to work in anesthesia in X community, and there is actually nobody needed in X community, then we need to be careful about individuals who are not associated with the health authority and know the need and know also the fit."
Horizon gained 38 family doctors since 2019
In further contrast to Shephard's claims, McGrath said she thinks Horizon has been "significantly successful" in its recruitment efforts in the past two-and-a-half years.
"I think it's been nothing short of miraculous quite frankly in terms of the recruitment team in the medicine department."
As part of the meeting, Horizon vice-president of medical, academic and research affairs Dr. Édouard Hendriks highlighted recent statistics on doctor recruitment by Horizon.
He said since July 2019, Horizon has gained 78 new family doctors, and lost 40, for a net gain of 38 across the entire health network.
Of those new doctors, he said less than 10 per cent were brought in with help from the Department of Health.
Hendriks said there's currently "fierce" competition among Canadian provinces to attract family doctors, adding Horizon has partnered with Medicare, the Department of Health and the New Brunswick Medical Society "to make sure we have a common approach for recruitment."
https://www.cbc.ca/news/canada/new-brunswick/horizon-health-new-brunswick-1.6000591
Health minister fires vocal chair of Horizon Health board
John McGarry first joined as CEO in 2013, then as board chair in 2019
Health Minister Dorothy Shephard made the decision to remove John McGarry from his position, Bruce Macfarlane, spokesperson for the Department of Health, said in an email Friday.
Shephard wasn't made available for an interview Friday afternoon, and Horizon deferred all comment to the provincial government.
CBC was unable to reach McGarry for comment Friday.
The move comes just a week after McGarry criticized the Department of Health when Shephard said it would take the lead on recruiting physicians to work in New Brunswick.
During a board of directors meeting last Friday, McGarry said he was "perturbed" by that plan, and he cast doubt on the Department of Health's ability to successfully recruit doctors.
"It all begins and ends with the hospital and the physicians groups, so I'm really perturbed with this statement of government saying we're taking over recruitment, and [I'm] thinking, 'Well, good luck'," McGarry said, at the time.
McGarry first joined Horizon as its CEO in February 2013, and in April 2016, he announced he would not be renewing his four-year contract.
In January 2019, McGarry was brought in again under former health minister Ted Flemming, this time as Horizon's board chair.
Vocal about ideas on health-care reform
During his time as CEO, McGarry was outspoken about the need for major reforms to New Brunswick's health-care system to fix issues around wait times and hospital overcrowding.
In 2015, McGarry raised eyebrows when he tweeted about what he called a "crisis" of congestion in New Brunswick hospitals.
"Horizon Health network called for urgent action in January, Nurses Association of New Brunswick is now, all regional hospitals are facing intolerable congestion," he posted on Twitter.
"When will system sit down as one and fix the worsening situation of alternative levels of care and long term care for patients who need their hospital care? Please someone tell us what it will take?"
Then in a commentary piece he wrote in January 2016, McGarry said it was time to move away from the concept that all care must occur in hospitals, and embrace a model with fewer emergency rooms and improved care in communities.
By closing some hospitals and freeing up money, more could be invested in community health care, he said, at the time.
That same year, then-premier Brian Gallant declared there would be no major cuts to health care, which McGarry publicly disagreed with, saying smaller hospitals needed to close.
And last year, it was revealed that Horizon's board had approved a plan by Premier Blaine Higgs to close the nighttime operations of emergency departments at six small hospitals.
That plan was quickly scrapped following swift backlash from the public.
Former Horizon chair takes firing in stride — but not health minister's 'cheap shot'
John McGarry says tension between Horizon and Dorothy Shephard has grown since she took over
At 69, John McGarry said he is fine with being fired by the health minister from his position as chair last month.
He is not fine, he said, with Shephard criticizing the health authority for failing to recruit doctors, and with her telling the media her department would now lead recruitment rather than Horizon and Vitalité.
In April, Shephard told CBC News there are "family physicians who want to come home" to practise in New Brunswick but "can't even get a call back" from the regional health authorities.
"That's why we've taken recruitment into the Department of Health to lead it," the minister said. "I have not been satisfied with our recruitment process."
McGarry took exception to that statement, in part because neither Shephard nor anyone from her department called Horizon first to raise those concerns.
"That's just a cheap shot to say those things without really coming to the [regional health authorities] themselves and say, 'Tell me the story here. Why are people saying this?'" McGarry said. "That's what upset me — I find that it's maligning our recruitment people, who are doing a good job."
Minister has never met with board
Longtime board member André Veniot decided to speak out after McGarry was fired April 23.
Veniot believes the minister is unnecessarily undercutting and "throwing shade" on Horizon staff.
"I think it's been for some time that the Department of Health, and this minister in particular, has been almost throwing Horizon … and this board under the bus — and the decisions we make under the bus," he said.
"And that, I think, caused a lot of friction."
Since she was appointed health minister at the end of September 2020, Shephard has not met with the Horizon board, said Veniot and McGarry.
Andre
Veniot questions whether the health boards should continue. He said
successive governments have directed members not to cut services at
rural hospitals, which is preventing meaningful reform. (Submitted by Andre Veniot)
"Your board … represents the people of New Brunswick. We have a ton of experience and it would be nice to be appreciated for the work we do," Veniot said.
McGarry, who has worked with other health ministers in his time as board chair, said he expected to have a good working relationship with Shephard where they could challenge one another, but he hasn't met with her or her deputy since last fall.
"There's usually more regular board chair-minister meetings. I had a lot of them with minister [Ted] Fleming," he said, referring to Shephard's predecessor in the Progressive Conservative government.
"I think I've only met once with the minister and the deputy probably in October or November."
Health-care 'vision' questioned
McGarry was fired after he publicly criticized the health minister at a Horizon board meeting on April 16, saying he was "perturbed" by Shephard's assertion that her department would be taking over doctor recruitment. He questioned whether the Department of Health could do a better job.
McGarry understands why the minister dismissed him, but he said Shephard's comments during a legislative committee hearing April 29, one week later, left him scratching his head.
Health
Minister Dorothy Shephard told a legislative committee on April 29 that
her vision for New Brunswick is 'to have a health-care network of
excellence.' (Legislative Assembly of New Brunswick)
At that meeting Shephard responded to questions from Liberal MLA Jean-Claude D'Amours about McGarry's firing saying, "I'm not going to explain myself to the member opposite with regards to a position that is held at the pleasure of the minister."
She went on to say that her objective was to "begin putting in place people who share my vision, our vision, government's vision, for the direction we need to take the Department of Health."
Shephard never explained how that vision differed from McGarry's.
McGarry said when he heard Shephard's comments he thought, "What is she talking about?"
"Is there something that I'm missing here? No. You're upset that I criticized you for taking broadsides at the recruitment process. And then you decided that I should go — which is fine I have no problem with that — but own up to it."
CBC requested an interview with Shephard but she refused. Instead her spokesperson sent a statement that reads in part, "the minister of health would like to thank Mr. McGarry for his hard work and dedication to the people of New Brunswick."
During the legislative committee meeting, Shephard was asked about her vision for health care in New Brunswick.
"We have to have vision," she replied. "I see a health-care network, networks, in this province where patients are as equally satisfied as the medical professionals who serve them. What a goal. There's my vision."
Health Department not equipped to recruit doctors
McGarry continued to cast doubt on the idea of the Department of Health leading doctor recruitment, saying it is a "delicate" process.
"It shouldn't be led by the government — the government should be creating an environment in the province that is open to physicians and welcoming to physicians."
You don't have some assistant deputy minister start calling people and saying, 'Hey, would you like to have a job in Fredericton?'
- John McGarry
McGarry explained that physicians have an important role when it comes to recruiting doctors who will be a good fit for the province and their existing teams.
"They do the calling in most cases and say, 'Listen, Dr. X, we'd like you to come here and come on up for the weekend and … talk to us and come out to dinner with us and see if you like Saint John or Fredericton or Moncton … see if you're compatible with us because we're really interested in talking to you," he said.
"You don't have some assistant deputy minister start calling people and saying, 'Hey, would you like to have a job in Fredericton?'"
McGarry
maintains that doctor recruitment should remain the responsibility of
Horizon because it is a 'delicate' process that should involve doctors
already working in the province. (Hannah McKay/Reuters/Pool)
Adding insult to the injury of Shephard's initial comments, McGarry said, was that nothing actually changed at Horizon after Shephard said her department was taking the lead on recruiting doctors.
"Did she send a letter afterwards saying, here's what I mean — here's what we're going to do, and here's what you're going to do? No. So it was just a throwaway in a media scrum that slammed the [regional health authorities] without any basis."
Veniot said it feels to him that Minister Shephard is making up policy as she goes, pointing again to a CBC interview where she promised to eliminate the wait list for primary care in New Brunswick within six months.
"Good luck. I wish you well. I'd love to see it," he said. "It's just I don't think it's going to happen."
Future of health boards questioned
Veniot, who is an appointed member of the board, expects he may also be fired for criticizing the minister but said the board's job of charting a course for health care in the long term is not easy, and government should expect to be challenged.
Seriously, I mean if all the board is going to be doing is tinkering at the edges, that to me is not the proper functioning and good use of the board.
- Andre Veniot, Horizon Health board member
He said if the minister isn't prepared for the board chair and the board members to "speak truth to power," then perhaps there isn't any point of having health boards.
"You're not dealing with the problem. You're not dealing with the issues."
In his six years on the board, Veniot said, successive governments have directed members to leave rural hospitals out of any reform plans, and that is hamstringing any real reform.
"Seriously, I mean if all the board is going to be doing is tinkering at the edges, that to me is not the proper functioning and good use of the board."
Veniot still believes the health reforms introduced last year that would have seen emergency rooms in six rural hospitals closed overnight is the right way forward.
"I still stand by that. But the government chose otherwise. And that's their role, but at some point down the road, and in a not too distant future, it's going to come back."
Veniot said working with Horizon has been a privilege and given him "a real insight" into the $1.2 billion health corporation with 13,000 "dedicated, professional, highly trained" employees.
The
Horizon Health Network, which includes the Moncton Hospital, is the
second largest health authority in Atlantic Canada. It includes 12
hospitals, has 13,000 employees and an annual budget of $1.2 billion. (CBC)
Shephard recently finished 46 community engagement sessions across the province talking about the future of health care in New Brunswick as her department works on a health care plan that she has said will not include the closure or reduction in hours of any emergency rooms.
McGarry believes Shephard needs to listen to, not ignore, members of the Horizon board.
"Board people, they don't do this because they want to get bashed around, they do it because they love their communities, and they want to do the best job they can and they want to build a good health system."
There are seven appointed members of the Horizon board, and eight elected. In the upcoming election, 26 candidates are running for those eight positions, including six incumbents.
ABOUT THE AUTHOR
https://www.cbc.ca/news/canada/new-brunswick/horizon-health-chair-john-mcgarry-ceo-1.4992788
Former vocal Horizon CEO John McGarry returns as board chair
Health-care system will benefit from his 'leadership, insight and expertise,' minister says
McGarry, the former president and CEO of the regional health authority, has been appointed chair of the board of directors, effective immediately, Health Minister Ted Flemming announced on Friday.
McGarry, who retired in January 2017 at the age of 64, "brings a wealth of knowledge" to the position, with more than 35 years of experience in health care administration, Flemming said in a statement.
"The province's health-care system will greatly benefit from his leadership, insight and expertise," he said.
McGarry said in the government release that New Brunswick faces many pressures on its social systems, including demographic, fiscal and human resource-related challenges.
"I look forward to working with CEO Karen McGrath and the board of directors in helping keep our health-care system accessible to everyone who needs care, and sustainable in the long-term," he said.
McGarry first joined Horizon in February 2013. In April 2016, he announced he would not to be renewing his four-year contract.
He told reporters at the time that his decision to step down had nothing to do with any disagreement with the provincial government over policy.
But he did say he was disappointed with continuing turf issues among the regions Horizon covers, and with the francophone health network, Vitalité.
He also said his successor would have to continue making difficult decisions, managing public expectations with limited provincial resources.
'Crisis' of hospital congestion
Earlier that year, McGarry had written a commentary, saying it was time to move away from the concept that all care must occur in hospitals and embrace a model with fewer emergency rooms and improved care in communities.
In 2015, McGarry had raised eyebrows when he tweeted about what he called a "crisis" of congestion in New Brunswick hospitals.
"Horizon Health network called for urgent action in January, Nurses Association of New Brunswick is now, all regional hospitals are facing intolerable congestion," he posted on Twitter.
"When will system sit down as one and fix the worsening situation of alternative levels of care and long term care for patients who need their hospital care? Please someone tell us what it will take?"
Frustrated by inaction
The tweets came on the heels of numerous surgeries being delayed because hospital beds were blocked by patients who should have been in other facilities.
McGarry told reporters he was frustrated by years of inaction by successive governments and felt he had no choice but to go public.
Then-health minister Victor Boudreau said he wished McGarry had called him to discuss the matter first and offer solutions rather than just complain. But he agreed there was a problem and said the government was working on it.
Horizon operates 12 hospitals and more than 100 medical facilities, clinics and offices.
McGarry previously served as co-CEO for the Office of Health Renewal and acting assistant deputy minister for the Department of Heath.
He has also served as vice-president of finance at Kitchener-Waterloo Hospital, senior vice-president of the Dr. Everett Chalmers Regional Hospital and CEO of River Valley Health.
Deja Vu Anyone???
https://www.cbc.ca/news/canada/new-brunswick/province-phase-out-physician-billing-system-1.5301606
Province to eliminate physician billing number system
New Brunswick Medical Society working on alternative
"The physician billing number system no longer works for the province," Health Minister Ted Flemming said in a media release Saturday.
"It is flawed because it restricts the number of physicians practising, restricts the mobility of physicians and impedes recruitment."
Flemming made the announcement during the New Brunswick Medical Society's annual general meeting in Moncton.
During the throne speech in November, Premier Blaine Higgs said one of his major commitments while in government was to eliminate the physician billing number system.
The billing number system was introduced in 1992 and controls where and how many physicians can practise in the province.
Doctors are assigned a billing number as a way to maintain an even distribution of doctors throughout the province, specifically in rural areas.
"After 30 years, we've come to understand that it's a failed experiment," said Dr. Serge Melanson, the president of the New Brunswick Medical Society, in an interview.
"By removing it, we're essentially streamlining the process such so we can recruit physicians to the province faster and actually give more flexibility and options to physicians who are looking to set up practice in the province."
Melanson said he hopes this change will provide New Brunswickers with more access to doctors.
Dr. Serge Melanson, president of the New Brunswick Medical Society, said he hopes the elimination of the billing number system will improve access to health care. (CBC News)
"We're hoping this will increase recruitment which will, in turn, improve access to health care to our patients," he said.
The system is expected to be phased out by mid-December.
The New Brunswick Medical Society is working with the regional health authorities and the Department of Health to develop an alternative to the billing number system that works on rural recruitment and access to primary care.
"We're empowering the regional health authorities, Vitalité and Horizon, which already have mandates and abilities to hire physicians," Melanson said. "We're actually providing them with more tools to do so in an effective manner."
https://www.cbc.ca/news/canada/new-brunswick/billing-numbers-eliminated-family-doctors-1.5303180
Scrapping billing numbers could ease urban family doctor shortage, minister says
Northern leaders fear move could cost smaller, rural communities their doctors
The challenge of finding family doctors for smaller communities and rural areas will be relatively easy to solve by paying them more money to practise there, Ted Flemming said Monday.
"The shortage, the wait list, in rural New Brunswick is very, very low compared to urban New Brunswick. The rural issue is just not serious in the sense of numbers."
Of the 32,000 New Brunswickers on waiting lists for doctors, 27,500 are in urban centres.
Fewer than 1,000 people are on waiting lists for family doctors in some northern zones, while the lists in the largest cities have passed the five-figure mark, Flemming said.
Health Minister Ted Flemming announced on the weekend that the government will abandon the billing-number system. (Jacques Poitras/CBC)
Flemming announced on the weekend that the government will abandon the billing-number system, a mechanism created in 1992 to rein in soaring health-care costs.
He made the announcement at a meeting of the New Brunswick Medical Society, which endorsed the move. The Progressive Conservative government promised the change in its throne speech last fall.
Each doctor practising in the province gets a billing number they use to invoice Medicare for the services they provide. But the individual billing number is linked to where the doctor practises, restricting their movements.
If no billing number is available in a community, a new doctor can't set up a practise there.
Bigger the place, longer the wait
Anthony Knight, the CEO of the New Brunswick Medical Society, said billing numbers in urban centres have not grown at the same pace as their populations, or their family-doctor wait lists.
"That number should align with patient needs and patient expectations in terms of their health status, the size of their communities, and the demographic changes we see in our province with the shift of people in certain communities moving to more urban centres," he said.
By eliminating the billing numbers, it will be easier to get more doctors into cities where the longest wait lists exist, Flemming said.
As an illustration, the minister pointed out that in the Bathurst-Acadian Peninsula zone of the Vitalité health authority, 932 people are on the waiting list for a family doctor — fewer than the normal patient load of one physician. In the Campbellton zone, 412 are on the waiting list.
But in the Moncton area, the wait list is 10,272 people, and in Fredericton it's 11,874, Flemming said.
"Finding coverage for 412 people is an easier task than 10,300," he said.
"The demand for primary health care is in the cities. It's not in rural areas. That doesn't mean we don't need to find that [northern] position. That's not insurmountable. That's one nurse practitioner."
Concern over effect on rural communities
Some leaders in northern New Brunswick are already expressing concern about the loss of the billing numbers.
"Those numbers in my mind guaranteed positions in the regions," said Denis Savoie, the mayor of Eel River Crossing and the chair of the Regional Service Commission in the Restigouche area.
"In the current system, it was one of the tools we had to make sure doctors came to the area."
Flemming said the regional health authorities and the medical society will work toward a new system, including financial incentives, to fill the gaps in northern and rural communities.
"If you want someone to locate in certain areas, you have to give particular incentives," he said.
Knight said that without billing numbers restricting mobility, doctors based in urban centres could rotate into rural communities for short periods, perhaps for extra pay.
"We know that certain incentives do work," he said. "They help to encourage physicians to work in communities, maybe not permanently but for periods of time. They could shift in and out with a team of doctors."
Anthony Knight, CEO of the New Brunswick Medical Society, says that incentives can help attract doctors to rural communities. (Michael Gorman/CBC)
That would be better than leaving a billing number vacant because a new doctor is unwilling to permanently establish themselves in that rural or northern community, he said.
New doctors are looking for work-life balance and many of them prefer an urban setting, yet billing numbers are often not available in cities, Knight said. And persuading them to practise elsewhere can be "a hard sell."
Another flaw with billing numbers is they distort the calculation of how many patients are being seen.
One doctor may have 2,000 patients while another easing toward retirement may be seeing far fewer. "I'm not saying the work is not valuable," Flemming said. "What I'm saying is a billing number does not represent the same delivery of medical service."
Into 'the deep end'
The province is aiming to have a new system in place by Dec. 15.
Knight said the new regime "may not be fully ready but there should be, I'll call it, a landing pad for anyone that's interested in establishing a practice on that date."
Flemming said he leapt into "the deep end" without a clear replacement because it's been clear for years the billing-number system was flawed and he didn't want to delay changes any longer.
"You can study and you can do this and this and this," he said. "This is something that had to be done. I had no appetite for another study and another review. It's the right decision."
With files from Information Morning Fredericton
http://davidraymondamos3.blogspot.com/2020/02/inaction-on-health-care-crisis-hurts.html
Saturday, 22 February 2020
Inaction on health-care crisis hurts everyone, economist says
https://twitter.com/DavidRayAmos/with_replies
David Raymond Amos @DavidRayAmos
Replying to @DavidRayAmos @alllibertynews and 49 others
FYI I still have no Health Care Card but I just PAID another
big bill for emergency room services and STILL Higgy and the economist Richard Saillant don't care N'esy Pas?
http://davidraymondamos3.blogspot.com/2018/08/cbc-and-their-economist-buddy-richard.html
https://www.cbc.ca/news/canada/new-brunswick/higgs-health-reforms-cancellation-analysis-1.5466815
https://ihpme.utoronto.ca/faculty/gregory-marchildon/
Gregory P. Marchildon
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