Local doctor fears loss of hospital pediatrics over billing changes

McKenzie says several barriers make it difficult to recruit pediatricians to work at Red Deer Regional Hospital.

“There’s a financial incentive to work outside of the hospital,” he explains. “The hospital work itself tends to require a little bit more training. It’s more fatiguing because it’s nights and weekends, it’s a bit higher stress because the kids are more sick and despite that, (and) it pays about the same or slightly less per hour than you get in clinic.”

McKenzie says, for example, he would be paid the same amount for working a 15 hour overnight shift at the hospital as he would for an eight hour daytime shift at his clinic.

“People work the hospital because they want to be able to help the sick kids,” he says. “But the fact is, I just reduced my hospital time because I have a family and I found it fatiguing. I have actually seen an increase in my income since I stopped working the hospital.”

The problem is, McKenzie notes, the hospital is where the demand is for pediatricians.

“So when I saw that one of the targeted cutbacks was a 31 per cent reduction in pediatric hospital billing, I became quite irritated,” he admits. “We’ve been working very hard to achieve our current state of stability and I felt like our ability to recruit had been hobbled. Pediatricians who are training or working in bigger centres are going to be less-inclined to come and work here in our hospital because they would have to take a pay cut in order to work nights and weekends.”

Although targeted funding reductions to health care might seem to make sense on the surface, McKenzie feels the government has gone about their cost-saving initiative the wrong way.

“They said, ‘these guys are working in the hospital, they’re not paying overhead, so let’s not subsidize them overhead,’ which makes sense. I don’t criticize them for that, but what they’re not considering is that when I’m working the hospital I also have a clinic that’s open, I’m paying staff and so I’m still paying overhead.”

In his letter, McKenzie claims the government’s new physician billing changes will exacerbate a difficult situation, and almost certainly result in a loss of pediatric service in most of Alberta’s small or regional hospitals.

“This will result in the closure of the pediatric wards, and the neonatal intensive care units (NICU’S) in these locations,” he wrote. “The only hospitals in the province that will be able to treat sick babies and kids will be the children’s hospitals in Calgary and Edmonton. All high-risk pregnancies in these small communities (premature babies, twins, known birth defects) will be forced to deliver in Calgary and Edmonton, further straining their limited capacity.”

McKenzie says the Alberta Medical Association (AMA) previously proposed a set of funding reductions for the government to consider, but feels the government obviously didn’t think those proposed cuts were enough.

“What the AMA has told me, is that the government was not willing to move off of their 11 consultation items that were proposed in November,” says McKenzie. “They did move off of one of them, the complex modifiers, but they didn’t want to move off of the others. So the government then took a fairly heavy-handed approach and decided to impose them, even without an agreement.”

On March 31, the government implemented 11 changes to physician rules and fees in Alberta. The changes impacted complex modifiers, comprehensive annual care plans, senior’s driving exams, diagnostic imaging referrals, diagnostic imaging, patient visits, overhead, clinical stipends, submission of claims, non-invasive diagnostic tests, and non- emergency good-faith claims.

On March 17, the government announced planned changes to complex modifiers – intended to provide incentives to doctors to spend more time with patients who have complex medical needs – would not be going ahead at this time due to the COVID-19 pandemic.

The AMA has since filed a lawsuit against the provincial government’s ministry of health for terminating their previous agreement.

McKenzie says the government now has to bare a moral responsibility for the changes they’ve imposed.

“They chose to ignore our recommendation that what they were proposing wasn’t necessarily going to be good for the system and they’ve targeted very precise areas,” he points out. “Where I fault them is that they didn’t listen. They didn’t come to us and say, do you know what the effect of this will be on pediatrics?”

McKenzie met with MLA Stephan on Wednesday and described their discussion as ‘quite civil.’ He suggests the two of them feel some compromise from both government and the AMA would likely produce better outcomes.

In a statement to rdnewsNOW, Stephan describes his meeting with Dr. McKenzie as open and courteous.

“I like Dr. McKenzie and I appreciate the service he provides as a physician, as well as all physicians in our community who I admire and respect,” says Stephan. “Dr. McKenzie shared some concerns relating to pediatrics. All of us, including Government, should always strive to be better and seek opportunities for continuous improvement.”

“As it relates to physician compensation matters,” he continued, “I shared my sincere hope that the Alberta Medical Association, which has the stewardship to represent the interests of physicians, can draw on the insights of its members, and offer innovative solutions which also respect fiscal realities, especially in these very challenging economic times for so many Albertans, that address Dr. McKenzie’s concerns and any others, working with Government with a shared focus on serving the public interest with a sustainable health care system.”

by Sheldon Spackman

Local doctor fears loss of hospital pediatrics over billing changes

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