COVID-19 Update – August 5

Situation Update

Since last Thursday, there have been 35 new COVID-19 cases reported. This included 18 cases on Sunday alone, though this was followed by lower counts in the following days including only two cases today. This brings the running total of cases to 444. There are 94 active cases, including nine in hospital with five in ICU. You can view today’s public health bulletin for more details.

The five-day test positivity rate is 0.44%, as of today.

Provincial officials reassured Manitobans that generally, new cases are related and traceable. Most cases have been outside of Winnipeg recently, in the Interlake, Southern and Prairie Mountain health regions. The two cases today were both from Winnipeg.

New App for COVID Contact Tracing

The federal government has launched a new smart phone app called “COVID Alert” and Canadians are encouraged to download it. Physicians may be interested in downloading the app themselves, and your patients may ask for your advice about the app. See our summary below to help you assess the potential of this app in the fight against COVID-19. The more people who use it, the more effective it will be.

The app will keep track of nearby phones you’ve been in close contact with over a 14-day period. If anyone tests positive, they confirm their diagnosis in the app and this notifies any devices who had close contact.

  • The app can be downloaded for free on both Apple and Android devices
  • Dr. Theresa Tam, Canada’s Chief Public Health Officer, recommends the app
  • The app is just one part of public health and does not replace formal contact tracing by provincial authorities or the need for other precautions like physical distancing and hand hygiene
  • Privacy watchdogs have endorsed the app

While the app is available across Canada, Ontario is leading a full pilot with integration to its public health teams. Manitobans can download the app today, in anticipation that it will be rolled out here in the future.

Catch Up on Patient Care

For many reasons, patients’ health care was put on hold during the first wave of the pandemic. In some cases, the health system limited access or canceled procedures. In other cases, patients made decisions to defer their care rather than call their doctor.

There are an increasing number of studies and articles documenting just how much health care was put on hold, including a study published earlier this week that found a significant drop in cancer diagnoses during the spring. The American study found a 46.4% decrease in new cancer diagnoses, similar to studies in other countries. The researchers raise concerns about delays in diagnosis leading to poorer outcomes.

In Manitoba, we already know some of the impacts. Some cancer services, like screening mammograms, were suspended in the spring. More broadly, physicians reported a 56% drop in patient visits during the first wave, while health system restrictions resulted in 7,000 canceled surgeries, 8,000 fewer MRIs, 12,500 fewer CTs and 15,600 fewer ultrasounds.

Summer is a good time to “catch up” on patient care, where capacity allows you to do so. This could involve annual physicals, immunizations, preventive care and chronic disease monitoring, while also seeing referrals that had to be held due to pandemic restrictions. We shared some guidance on this a few weeks ago. You can also use our “don’t put your health on hold” resources to contact your patients and encourage them to reconnect with you.

Auditor General Letter to Physicians

Some physicians have received a survey from the Office of the Auditor General (OAG) of Manitoba and have asked us for additional information. We have prepared the following questions and answers to provide background and to help you decide if you should participate. There is no requirement to participate in the survey; it is completely optional.

What is this audit into fee-for-service about?

The OAG is conducting an audit of the fee-for-service (FFS) billing system in Manitoba, and the processes in place to ensure the rules of the system are being followed. This is not an audit into your individual practice. While we do not know why the OAG is auditing the FFS system, it is possible it was triggered by the media coverage of the government’s proposed legislation last year, which would have stripped physicians of their right to a fair audit process.

The audit could comment on how Manitoba Health runs its Insured Benefits Branch and if it has the proper checks and balances in place to assure appropriate FFS billing, or the audit could focus on whether or not physicians are “knowingly” overbilling or incorrectly billing.

Should I complete the survey?

This is entirely up to you. Your participation is not required; it is voluntary.

The OAG says they want to understand physicians’ experiences with the FFS system used by Manitoba Health. Some physicians have raised concerns about participating because the questions seem to focus less on the service physicians receive from the department, and more on whether or not Manitoba Health audits enough or recovers enough money from physicians, or may seek to identify physicians who have “knowingly overbilled.” At this point, it is not possible for us to reassure you about how the OAG will use this information, however you can always submit additional comments about your experiences with Manitoba Health.

Will my participation create any problems?

Because it is anonymous, we do not believe participating will create any problems for you individually. For example, your participation and response shouldn’t be shared with Manitoba Health, so it should not result in the department auditing your billings.

It is important to consider the impact on the medical profession more broadly. Manitobans have a high degree of trust in physicians, and we believe that trust extends to the steps physicians take to bill appropriately and your respect for taxpayers’ money. The government has already signaled its intent to audit physicians more frequently, and Doctors Manitoba will be there to assist you should you ever be audited.

What is the role of the Auditor General?

The Auditor General is considered an officer of the Manitoba Legislative Assembly, which means they are independent from the government and accountable to all of the elected Members of the Legislative Assembly, from all political parties. The OAG improves accountability by auditing and reporting on government operations. It is a common role in democratic systems of government.

In addition to auditing the books of the government and its departments, the OAG also conducts project and special audits into the operations of any government organization.

Is the survey really anonymous?

The OAG is independent from government, and they are using an independent third party research firm (Prairie Research Associates) to conduct the audit so physicians feel comfortable sharing their views confidentially and anonymously. The surveys do have a unique tracking number for each physician. While we cannot comment on this specific process, it is common to use a tracking number to help monitor responses and send reminders to those who have not yet participated. We do not believe the tracking number will be used to share your personal responses with the auditor or with the government.

What if I have questions about FFS billings?

Doctors Manitoba is here to help. We offer regular billing seminars to help you understand appropriate billing practices, including several webinars this spring and summer on new virtual visit tariffs. Staff is also available to answer and billing questions you might have. Should you ever be audited, we are here to help you through that process. Contact Roger, Ian or Braden with our negotiations team at general@doctorsmanitoba.ca for help.

Does this audit also cover resident physician over-payments?

No. This process is focused on fee-for-service billings only. Resident physicians and others who are salaried are not within the scope of this audit.

Did the Minister ever restore physicians’ rights in the FFS audit process?

Not yet. After hundreds of physicians wrote expressing their concerns, Health Minister Cameron Friesen issued a press release in January promising to amend his legislation in the Spring to restore physicians’ right to an appeal in the audit process. He has not yet introduced these amendments, but to be fair the COVID-19 pandemic disrupted the legislative agenda. We continue to monitor this process closely to ensure the Minister follows through on his commitment.

Do-it-Yourself Folklorama

While the annual summer tradition was canceled this year, they have turned the festival into a food tour and scavenger hunt! You can download the 2020 Folklorama Favourites guide and visit local restaurants and landmarks connected to familiar pavilions. By participating, you can also enter to win prizes, like free access to 2021 pavilions and gift baskets with cultural goodies.