Hospital care could suffer due to fee cuts, Alberta doctors warn

Alberta doctors are warning the provincial government's move to replace key billing codes for physicians working inside publicly funded facilities — and reduce their pay — is creating uncertainty and could negatively affect patient care at the province's hospitals.

Health Minister Tyler Shandro announced last week he would terminate the master agreement between the province and the Alberta Medical Association and push ahead with a number of sweeping changes to the way doctors are paid.

The move triggered an angry backlash from many family doctors, who said new limits on how much they get paid for appointments longer than 15 minutes could devastate their practices.

But worry is swelling within the ranks of hospital-based doctors as well.

"My biggest concern is for patients," said  Dr. Paul Ratti, a psychiatrist at Calgary's Foothills Medical Centre.

"We already have problems with patients falling through the cracks. And the risk and uncertainty created by the government's statements and actions — if it continues as is — are very likely to create large gaps, not just cracks" 

Overhead costs

One of the changes announced by the province last week will reduce pay for physicians who work inside hospitals and other publicly funded facilities, such as nursing homes.

As of March 31, physicians in hospitals will no longer be able to bill the same amount as their counterparts who work in community-based clinics for a number of key services such as consultations and assessments.

The Alberta government argues it's reducing the fees for hospital-based doctors because they don't pay overhead costs the way their counterparts with private, community-based practices do, leading to "inappropriate compensation for services provided in a publicly funded facility."

"I disagree with that because that's actually, frankly, false in many physicians' cases," said Dr. Dominica Gidrewicz, a pediatric gastroenterologist at the South Health Campus, who says roughly 20 per cent of her pay goes to Alberta Health Services (AHS) for overhead expenses.

Because the province hasn't publicized specific details about the fee decrease, she doesn't know how the change will impact her ability to practise. According to Gidrewicz, patient cases in hospital are complex, take longer to assess and treat, and she's unsure how she will be able to absorb the cuts.

"The biggest risk … is it disincentivizes physicians from working within a hospital," she said.

"I think there's some doctors — not speaking personally — but some doctors who will look to see if working in a hospital clinic is even feasible for them."

Gidrewicz is not alone.

"We don't know how much we're going to be cut. But it may be so much that we don't make enough in a given clinic to cover our overhead," said Dr. Dhea Wallace-Chau, one of five obstetrician gynecologists who have clinics at Calgary's Rockyview Hospital.

Wallace-Chau says she pays higher overhead costs than her colleagues with private, community-based practices and her margins are so slim she may have to shorten appointments to squeeze in more patients in a given day.

"What that means for patients is decreased quality of care. If you wait six months or a year to see me and I only have 10 or 15 minutes to spend time with you, I'm not going to be able to provide the same quality of care," she said.

And Wallace-Chau says if the cuts are deep enough, she may consider moving her practice out of the hospital, and even out of Alberta.

The long-term implications of a physician exodus of that nature could put more strain on a system that's already under stress, according to Ratti.

"The effect that it could have certainly is less availability to have our patients in hospital seen on a timely basis. Maybe we won't get supports for our in-patient consults. It may take longer for people to be seen through the emergency department if there's less movement through the wards. That absolutely could mean much longer wait-times," he said.

"It may mean that there's less access to surgery … absolutely those are real, real risks."

The Alberta Medical Association says many physicians pay overhead recovery amounts to Alberta Health Services and universities, and that these agreements vary considerably around the province.

In a statement, AMA president Dr. Christine Molnar says the government appears to be using out-of-date estimates of overhead costs.

"Until such time as a comprehensive review is undertaken and new overhead estimates are available, the AMA has no confidence that these changes will capture the complexity of current payment arrangements. As such, they have a significant potential to lead to unintended consequences, such as loss of services in hospital," Molnar said.

No clear numbers yet

In a statement emailed to CBC News, a spokesperson for the health minister said: "We're making a common-sense change to pay physicians for the cost of running their office practices when they work in those practices, not when they work in hospitals or other public facilities where taxpayers pay those costs."

According to press secretary Steve Buick, the change is expected to net a savings of roughly $80 million a year. While the fee decreases will vary, he cited one example of a fee code dropping by 21.5 per cent for a hospital-based doctor.

The province is now acknowledging that some physicians working in publicly funded facilities have arrangements with Alberta Health Services where they pay overhead costs such as office space for the privileges of working in the hospital.

"We want to treat physicians fairly. Physicians with individual arrangements with AHS should contact their local AHS medical director to ensure they're compensated for costs they incur. As with any change in payment, physicians with questions about how the change will affect them should contact Alberta Health," Buick said.

For his part, Ratti says doctors have largely been kept in the dark about the details of this change and as a result they simply don't know what their practices will look like starting April 1.

"The issue is not about lower fees.… The issue is creating a vast amount of uncertainty and that, frankly, is creating a very dangerous situation for patients," said Ratti.

"It's not financial. These are people's lives and this is a dangerous game."