BC Family Doctors was asked to provide a response to Dr Horton’s letter regarding the article “Re-embracing physical activity after COVID-19: What is the physician’s role?” The article highlighted the critical role that family physicians play in promoting a return to physical activity and other health promotion activities. Dr Horton correctly pointed out, however, that this care, as with many health promotion activities, is currently not payable by MSP as an insured service.
This discussion highlights a disconnect between the practice of medicine and the current fee-for-service system in BC. Under the General Preamble of the MSC Payment Schedule, the fees are for “services which are medically required for the diagnosis and/or treatment of a patient.” The Preamble further states that, “when services are provided for simple education alone … such services are not appropriately claimed under fee-for-service listings.” As a result, the uninsured fee A00054 exists in the Doctors of BC Fee Guide for Uninsured Services to enable private billing for preventive medicine counseling of all forms.
Community-based longitudinal family physicians can bill chronic disease management fees for providing guideline-informed care, including encouragement of physical activity, for patients with specific health conditions (diabetes, hypertension, COPD, and congestive heart failure). Similarly, this small cohort of physicians can also provide personal health risk assessment visits with at-risk patients, including patients with physical inactivity. However, this fee is limited to 100 patients per calendar year per physician.
These fee code limitations make it almost impossible to provide primary care that is inclusive of health promotion activities recommended by Doctors of BC’s Council on Health Promotion. The current Payment Schedule is a complex, antiquated document that does not reflect modern medical practice or support patient-centred appropriate care. Despite the agreed-upon direction for primary care transformation, family physicians have limited ability to provide comprehensive, equitable, high-quality care due to current fee-code constraints.
BC Family Doctors believes that we need to modernize and create equity in physician compensation. This requires a comprehensive review of the MSC Payment Schedule, including updating the General Preamble. Together with the introduction of alternate payment models, fee-for-service modernization will align current medical practice with the values and goals of our health care system. As we emerge from the pandemic, we need to consider how we build a stronger, more equitable health care system that meets the needs of all British Columbians.
—Renee Fernandez, MD, CCFP
Executive Director, BC Family Doctors
This letter was submitted in response to “Re: Re-embracing physical activity after COVID-19.”
Read the author’s response in “Re: Re-embracing physical activity after COVID-19. Author replies.”
1. Ministry of Health. Medical Services Commission payment schedule, May 1, 2021. Accessed 10 November 2021. www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/msc-payment-schedule-may-2021.pdf.
2. Doctors of BC. Fee guide for uninsured services. Accessed 10 November 2021. www.doctorsofbc.ca/managing-your-practice/compensation/fee-guide. [login required]
3. General Practice Services Committee. Chronic disease management incentives. Accessed 10 November 2021. https://gpscbc.ca/sites/default/files/uploads/GPSC_CDM-Billing-Guide_20211001.pdf.
4. General Practice Services Committee. Prevention fee. Accessed 10 November 2021. https://gpscbc.ca/sites/default/files/uploads/GPSC_Prevention-Billing-Guide_20211001.pdf.
5. General Practice Services Committee. Let’s create a path to care. Accessed 10 November 2021. https://gpscbc.ca/what-we-do/system-change.
6. BC Family Doctors. Choices for a new tomorrow. Accessed 10 November 2021. https://bcfamilydocs.ca/change-starts-here/choices-for-a-new-tomorrow.
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