FAQs

The Fee Code Program will compensate physicians for collaborative, team-based care as well as activities such as conferencing with other professionals regarding a patient’s care or providing care to a patient by telephone, which are not currently paid for by the Newfoundland and Labrador Medical Care Plan. Future codes may also address compensation for improved management of patients with chronic diseases.

• Provides participating physicians with compensation for two-way telephone communication between the physician (or other health care provider employed within the physician’s office) and the patient (or the patient’s medical representative).
• Payable at $10 per 5 minutes (i.e. one unit).
• Payable for 2 units per patient per day.
• Payable to a maximum of 225 units per physician annually.
• Not payable for simple prescription renewals, notification of normal test results, or notification of office, referral, or other appointments.

• All provinces compensate physicians, to a greater or lesser degree, for non-face-to-face telephone consultation with other health care providers within a variety of health programs.
• Non-face-to-face care service can mean greater access to quality care, better management of chronic disease, and a solution to critical physician shortages in both urban and rural areas. These can also save patient transportation costs and missed work income.
• These services can also avoid unnecessary in-person visits (saving the patient time and cost), and create new practice capacity.

• Physicians across Canada, and their representative associations, are very concerned about issues of privacy, confidentiality and security and regard this to be among the greatest barrier to email/messaging.
• All indications are that our primary care system in NL is not at a point that can support reasonable uptake of an email code.

• Provides participating physicians with compensation for two-way collaborative conferencing with other healthcare providers for development of a patient care plan.
• If the patient is present, payable at $30 per 15 minutes (i.e. one unit).
• If the patient is not present, payable at $30 per 15 minutes or greater part of 15 minutes.
• Payable to a maximum of 2 units per patient per day.
• Payable to a maximum of 100 units per physician annually.

The Fee-For-Service Family Physician who:

1. Has a valid practitioner number for practice in Newfoundland and Labrador. 
2. As designated primary care physician have indicated and recorded your commitment to established longitudinal relationships with your patients whereby you commit to the overall responsibility of the coordination of patient care needs. If you do not provide a particular service needed at any given time (e.g. Obstetrics), you will coordinate the referral to a colleague who is able to provide that service in a shared care arrangement with the patient’s family physician.
3. Has either adopted an Electronic Medical Record (EMR) in practice or has signed an EMR Physician Participation Agreement.
   Note:
   For physicians for which this is true, they must meet at least 4 of the requirements in Question 4.
4. Currently performs the below service at the stated level OR can demonstrate a clear and consistent pattern, which, if continued, would meet the requirement(s) of the stated service level(s).
   
   1. Provides after-hours care/extended hours in his/her practice (i.e. before 9:00 am or after 5:00 pm on weekdays, or a weekend clinic) for at least 90 hours annually.
   2. Participates in a structured after-hours (i.e. before 9:00 am or after 5:00 pm on weekdays, or a weekend clinic) rotation with a group of family physicians, whereby each physician sees the patients of any physician within the group, for at least 90 hours annually OR is part of an RHA-sponsored after-hours primary care clinic with a prescribed limit on the number of hours that can be worked.
   3. Provides hospital services (e.g. care to own patients when admitted to an acute care facility, participation in a structured rotation to provide care for admitted patients, Emergency Department coverage, Chemotherapy Management, surgical assists, etc. within RHA facilities).
   4. Regularly performs medical care visits to own patients residing in long-term care facilities or personal care homes.
   5. Regularly conducts medical care visits to own patients in the patient’s personal residence, completing a minimum of 50 visits annually.
   6. Provides access to a minimum of 5 same-day appointments in his/her practice per full office day or equivalent thereof.
   7. Employs and collaborates with an LPN, RN, NP, or other primary health care professional in their practice in a multi-disciplinary or interdisciplinary team environment OR Regularly collaborates with an RHA-employed LPN, RN, NP, or other primary health care professional in a multi-disciplinary or interdisciplinary team environment.
   8. Is a member of a group family practice, defined as two or more family physicians participating in a shared practice, whereby each physician sees the patients of any physician, when their designated physician is unavailable.  
   9. Regularly provides labour and delivery services (i.e. with a clear and consistent pattern, considering birth rates in the practice area).  
   10. Participates in physician leadership initiatives that encourage and facilitate primary care renewal and system change. Examples may be FPRP or RHA leadership roles (e.g. participating in Family Practice Network leadership group or Community Medical Advisory Committee) OR Performs a preceptor role with the MUN Faculty of Medicine’s Undergraduate or Postgraduate programs OR Performs a Clinical Chief role within his/her RHA.
   11. Manages office-based emergencies or performs minor procedures that would otherwise necessitate emergency room visits or specialist referrals.  These may include:
       • abscess draining;
       • biopsies;
       • casting;
       • electrocardiograms;
       • excisions;
       • IUD insertions;
       • removal of corneal foreign bodies;
       • spirometry;
       • suturing of lacerations; and
       • vasectomies.
5. Has either adopted an Electronic Medical Record (EMR) in his/her practice or has signed an EMR Physician Participation Agreement. If, at the time the EMR process is to be initiated, the physician decides to withdraw, he/she will need to meet two (2) additional criteria from the above list of requirements.  

The Fee Code Program is designed to encourage comprehensive patient care, with the eligibility criteria reflecting that goal.  The list includes some mandatory and an optional list of 4 out of 11 criteria.   We expect that many physicians with long-term relationships with their patients will satisfy the minimum, if not more, of the qualifying list. In cases where a physician needs supports to meet eligibility requirements, our program will be happy to work with that physician to provide the appropriate supports.

New fee codes are chosen in consideration of the following: 

• Codes that encourage and facilitate comprehensive care, improved patient access, increased coordination and collaboration between family physicians and other primary health care providers, improved health outcomes, improved recruitment and retention of family physicians, and improved patient-physician longitudinal attachment, particularly for those living with chronic disease(s).
• Codes that have either proven their effectiveness in other jurisdictions or are widely believed to carry significant opportunity for positive impact in our province.
• Codes that reflect the reality of our current system, and which have a true potential for uptake.
• Codes that provide opportunities for early “proof of concept”, so that value of the program can be established.

• We are already working on our next fee code for development, for enhanced care of patients with Chronic Obstructive Pulmonary Disease (COPD). Evidence shows that a code focused on COPD carries significant opportunity for improvements in patient care in our province. 
• We are consulting with our Clinical Advisory Group, and other front-line clinicians, as we design the code.

• The most robust evaluation data is available for BC. Chronic Disease Management (CDM) incentives in BC were associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for several of the groups for which CDM incentives were introduced: hypertension, chronic obstructive pulmonary disease, and congestive heart failure. [1]
• After controlling for patients’ age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with chronic obstructive pulmonary disease (by Can$496), hypertension (by approximately Can$308 per patient), congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). [2]

[1] Hollander, Kadlec, 2015

[2] Hollander, Kadlec, 2015

• The evidence from BC suggests that the Complex Care Initiative (CCI) has yet to show positive results. An evaluation by Hollander (2010) has shown that costs of care were inversely related to attachment to practice for those who received CCI incentive based care and those who did not. Costs increased on a consistent basis, with the number of registries a patient was on. [1]
• BC is working on a redesign of its Complex Care Initiative.

[1] Hollander & Tessaro, 2010

Absolutely!  We always want to hear your ideas.  Please contact Glenda Nash, Program Director, at (709) 726-7424, ext 321 or gnash@nlma.nl.ca.