Member Message July 15, 2021
In today’s Member Message you fill find:
- COVID Situation Update
- New Vaccine Hesitancy Tariff
- Restriction Changes
- Virtual Care vs. In-Person Care Guidance
- Hiring new staff? There’s a grant for that.
- Doctors Manitoba wants to help if you’re being audited
- Last Chance for PPE Sale
Since our last update on July 8:
- Daily cases continue to decrease: 361 new cases of COVID-19 have been identified since last Wednesday, a daily average of 52 (down from 62 the previous week). This includes 42 new cases today. The total case count in Manitoba now stands at 57,028.
- Test positivity down: the five-day test positivity rate is 3.4%, down from 5.4%. It is 3.1% in Winnipeg, down from 5.2%.
- Active cases continue on a downward trend: There are 973 active COVID-19 cases province-wide, down from 1,016 last Thursday.
- Hospitalizations are coming down: There are 126 people in Manitoba hospitals due to COVID-19, down from 137. This includes 29 COVID-related patients in Manitoba ICUs, down from 34. There are also two Manitoba patients still in Ontario ICUs, down from five.
- Seven more people have died from COVID-19, including one today. The total of COVID-19 related deaths to 1,164.
The improving COVID-19 situation has resulted in restrictions being eased sooner than planned. You can see a summary of the changes further down in this update.
Earlier this week, it was revealed that Manitoba’s Court of Queen’s Bench Chief Justice, Glenn Joyal, was being followed by a private investigator in an attempt to catch him breaking public health orders. The investigator had been hired by the Justice Centre for Constitutional Freedoms, which launched a court challenge about the public health restrictions on behalf of seven Manitoba churches. Justice Joyal is presiding over the case. It was also reported that other public figures may have been followed.
Dr. Brent Roussin is not aware if he was being watched, but he did reveal more about the threats he and his family has faced during the pandemic. While it started as daily or weekly “low-level” threats, he said things have escalated during the third wave.
Despite the threats, Dr. Roussin was gracious is recognizing the pandemic and restrictions have take a huge toll Manitobans.
While threats and private investigations are not something most physicians need to be concerned about, you’ve likely faced many tough questions from patients during the pandemic. Most of you have had to defend public health restrictions or promote the vaccine with hesitant patients. We know this has been hard on many doctors as you’ve sought to be guided by the evidence in advising your patients, and we want to take the this opportunity to say thank you.
New Vaccine Hesitancy Tariff
Based on feedback from many physicians, we’ve successfully negotiated a new tariff for addressing vaccine hesitancy! This is another tool available to you, as you support your patients in getting protected against COVID-19.
Many doctors — both family physicians and specialists — are now raising vaccination during every patient visit to help support their patients and answer their vaccine questions. However, there has not been a tariff available when that engagement turns into an extended discussion about the risks and benefits of immunization against COVID-19. This new vaccine hesitancy tariff allows physicians to bill a second visit on the same day in these situations.
Here’s a quick summary of what physicians can claim related to COVID-19 vaccines and addressing hesitancy:
- Vaccine injections ($20): this covers the injection itself, as well as confirming patient eligibility and the standard informed consent one would expect with a vaccine confident individual. Please note that each vaccine product has its own tariff (Pfizer, Moderna, etc.).
- Addressing vaccine hesitancy (standard visit tariffs): When patient advice and counselling is needed beyond standard consent, you can claim the appropriate existing visit tariff. However, standard rules do not allow you to bill a second visit on the same day as a separate unrelated visit.
- NEW Vaccine hesitancy visit ($37.80): This visit tariff can be claimed on the same day as an another visit unrelated to immunization. Physicians are now raising vaccination with patients they are seeing for other issues, like annual physicals, follow-ups or consultations. When this turns into a longer discussion — over 10 minutes — to address concerns and hesitancy about vaccination, this new tariff should be claimed. If the patient then opts to get the vaccine in your office, you would also submit the appropriate vaccine injection tariff.
We have updated our vaccine billing guide with details about the new tariff, including specific notes about when it can and cannot be billed. Please review this carefully. The tariff is available to use effective July 12, 2021, but a tariff number has not yet been assigned. Please track and hold claims until a billing number is available.
Even if your clinic is not offering the vaccine, you can still offer vaccine advice and claim the appropriate visit for this. Please consider referring patients to a nearby medical clinic to get their shot. We maintain a list of clinics accepting appointments at ManitobaVaccine.ca.
We hope this new tariff removes barriers to engaging your patients about the benefits of immunization.
Questions? If you have questions about the new vaccine hesitancy tariff or vaccine-related billing, please contact us at firstname.lastname@example.org.
Vaccine Update: The Next 10%
There are signs everywhere — vaccine uptake is slowing down. 50+ medical clinics are now listed online as taking appointments. A provincial vax-a-thon yesterday at supersites saw less than 50% of doses used. Physicians are reporting to us that it’s getting harder to find enough patients to use all the doses in a single vial.
The numbers confirm this to be true. Over the last week, things have improved but uptake has slowed. Of the 70,413 doses administered over the last week (10,059 per day), just 13,145 (19%) were first doses. This means most of the improved rates are among second doses:
- First dose uptake among Manitobans age 12 and older increased from 75.6% a week ago to 76.9% today.
- Second dose uptake increased from 54% to 59.3%
Our own public poll, from April, found that about 76% of Manitobans were willing to get the vaccine — very close to the level of uptake today. We have known for some time that while there’s perhaps 5 – 8% of people who are extremely unlikely to get the vaccine, there is a “moveable” middle that is open to it. Our research found that nearly half of those hesitant to be immunized would be more willing if they could get the shot at a doctor’s office. For many, talking to a physician is key to making a decision about getting the vaccine.
The next 10% to 15% of Manitobans will be difficult to reach, but doctors are in the best position to reach people based on the trust you’ve built with the public and your own patients. But, many of these patients will likely not call you looking for this advice. This means creative approaches to reaching patients are needed, many of which are likely out of the normal operations for your practice.
Doctors Manitoba is here to help you come up with creative ways to reach out to Manitobans, whether they are your existing patients or unattached, to help support them in making informed vaccine choices. There are tariffs available for both the injection and visits related to providing vaccine advice. Provincial grants are available for new approaches outside of normal clinic operations. Could any of the following activities be a fit for your practice?
- Holding a “vaccine information clinic” to answer questions and, if accepted, provide the shot
- Coordinating with other clinics to hold a vaccine event, offering both advice and the shot, at a central location
- Developing strategies to contact unvaccinated patients in your practice. Need help incorporating outreach into your clinic work flow? Want help writing an email or phone script?
Contact us at email@example.com if you want to play a bigger role in reaching the next 10%.
If you are not offering the shot in your practice, please consider referring patients to medical clinics, many of which can offer appointments within a few days. We are maintaining a list and searchable map of medical clinics with vaccine in stock at ManitobaVaccine.ca.
With improving vaccination rates and lower case counts, the government announced changes yesterday to public health restrictions. This was largely made possible because the province reached the August long weekend vaccination target of 75% first dose and 50% second dose for those age 12 and older was reached nearly a month ahead of schedule.
Several major changes are being made, all effective this Saturday, July 17, at 12:01 a.m. This includes larger indoor and outdoor gatherings, larger capacity limits in businesses and services and more privileges for fully-vaccinated individuals.
|Private and Public Gatherings|
|Indoor Gatherings at Private Residences||Up from 0 to 5 visitors in addition to those who reside there.|
|Outdoor Gatherings at Private Residences||Up to 25 people (increased from 10) are permitted outdoors on private property. Visitors may briefly enter the home for essential reasons.|
|Indoor Gatherings in Public Spaces||Up to 25 (up from 5).|
|Outdoor Gatherings in Public Spaces||Up to 150 people (up from 25) permitted outdoors in public spaces.|
|Weddings and Funerals||Open to 150 (from 25) participants for outdoor ceremonies, in addition to photographer and officiants. Indoor weddings and funerals expand to 25 people (from 10), in addition to photographer and officiants.|
|Indoor Community, Cultural and Religious Gatherings||Open to 50% (from 25%) capacity to a limit of 150 people, with masks worn at all times.|
|Outdoor Community, Cultural and Religious Gatherings||Open to 150 people (up from 50). Drive-in services continue to be permitted.|
|Services and Businesses|
|Restaurants, licensed premises and food courts||Open at 50% (up from 25%) capacity for indoor and 50% (no change) for outdoor dining; for indoor dining patrons seated together must be from the same household unless all patrons at the table are fully immunized; for outdoor dining table sizes are limited to eight people; opening hours are expanded to midnight and the requirement to purchase food when consuming alcohol no longer applies. VLTs in licensed establishments may be operated with two metres of physical distancing and all other restaurant/bar rules applying; VLTs in unlicensed establishments will follow the casino rules allowing only vaccinated people.|
|Personal Services||Open at 50% capacity (no change) but appointments are no longer required.|
|Libraries||Libraries, which were previously closed, may open to 50% capacity to a maximum of 150 people.|
|Horse and Auto Racing||Approved at the discretion of the medical officer of health.|
|Retail, Markets, Garden Centres and Malls||Open with increased capacity at 50% (up from 25%) to a limit of 500 people (up from 250), no additional restrictions. Mall capacity limited to the aggregate capacity of its stores.|
|Fitness and Activities|
|Gyms and Fitness Centres||Open at 50% (up from 25%) capacity with three metres distance maintained between patrons for both individual and group fitness. Mask use is required.|
|Indoor Sports and Recreation||Open with 25 people per group; groups may not interact and no tournaments are allowed. Previously 25% capacity to a max of 5 people.|
|Outdoor Sports and Recreation||Open to 50 people (up from 25); no tournaments allowed. Spectators are permitted without counting towards this capacity limit.|
|Dance, Theatre and Music Schools||Open at 50% capacity to a limit of 25 people indoors. Previously 25% to a max of 5 people indoors and 25 outdoors.|
|Day Camps||Open to a maximum of 25 participants (up form 20) in groups, joint activities between groups and overnight camps are prohibited.|
|Expanded Privileges for Fully Vaccinated Individuals|
|Casinos, Bingo Halls and VLTs||Previously closed, casinos, bingo halls and VLT lounges will open to 50% capacity to fully immunized people only. VLTs in licensed establishments may be operated with two metres of physical distancing and all other restaurant/bar rules applying; VLTs in unlicensed establishments will follow the Casino rules for fully immunized people only.|
|Museums and Galleries||Previously closed, can now open to 50% capacity to fully immunized people only. Unvaccinated children under 12 may attend if accompanied by fully vaccinated members of their household. Museums operate under the fully vaccinated requirement when open to the public as a museum, both indoors and out. If the museum is used as a private venue for another purpose (e.g. wedding), then the appropriate orders apply.|
|Professional sports or performing arts events||Open up to 100% (up from 50%) for fully vaccinated people, with a plan approved by public health.|
|Movies Theatres and Concert Halls||Previously closed and now open to 50% capacity to fully immunized people only. Unvaccinated children under 12 may attend if accompanied by fully vaccinated members of their household.|
Practice Guidance: Virtual vs. In-Person Visits
As restrictions are eased for businesses and services, many physicians are asking what this means for their practice.
As of today, the province is now at orange (restricted) on the pandemic response system. According to the provincial guidance for primary care and outpatient settings, it is appropriate to increase in-person visits. Virtual visits should still be used as much as possible to reduce traffic in your practice, but it is also important to start catching up now on in-person visits for issues that cannot be done virtually. A mix of roughly two thirds in-person, and one third virtual is offered as a guideline.
In fact, some patients have contacted us with concerns about being turned away for in-person care. In other provinces, we’ve heard their regulators are receiving formal complaints about physicians offering “too much virtual care.”
“I encourage all physicians to re-engage patients for in-person visits, especially for preventative care,” said Dr. Jose Francois, Provincial Lead for Family Medicine. “Generally, physicians should not be turning away or delaying annual physicals, routine immunizations, pap smears, period health exams and other care that must be offered in-person.”
Your Input Invited on Future Precautions for ClinicsShared Health is currently reviewing their guidance on precautions for the primary care and outpatient setting for the re-opening period. What should waiting room capacity look like? Should distancing be required? What are the PPE recommendations for providers? Should patients wear masks in clinics, even if they aren’t required in the future in retail settings? When should virtual care be recommended?
We would be happy to share your advice or questions about this with Shared Health as they update their guidance. Send your feedback to firstname.lastname@example.org by Friday, July 23.
Are you hiring new staff this summer?
The Healthy Hire Manitoba Program, allows local employers to apply for up to $50,000 in provincial support to help cover the wages of new employees who can attest they have been vaccinated, intend to be vaccinated or are unable to be vaccinated. Eligible employers will receive a grant equivalent to 50% of wages for a maximum of 10 employees, with a maximum of $5,000 per employee. The wage support covers full pay periods for employees hired on or after June 10, 2021 with the last pay period ending October 15, 2021.
To learn more about the program click here or to apply for the grant click here.
Getting audited? Doctors Manitoba should be your first call.
A number of physicians have received letters informing them of audits. We continue to monitor physician billing audits, now conducted by the Comptrollership and Compliance Unit within the Department of Finance. If you receive an“audit letter” advising that there is some concern/interest in a particular aspect of billing, please do not hesitate to contact us. There is generally a 30 day time limit to respond and we will help you navigate the process. We can offer advice on your response, and we will assist you should the matter go any further. Contacting us for assistance with your audit also helps us to monitor the practice areas and billing profiles of physicians being selected for audits.
Please contact Allison Crolly email@example.com (204) 985‑5856 or Andrew Swan firstname.lastname@example.org (204) 985‑5860 if you receive an audit letter.
Last Chance PPE Sale — Over 50% Off!
We are offering our remaining stock of personal protective equipment (PPE) at major discounts of 50% off or more. Early in the pandemic, when supplies were scarce, Doctors Manitoba was able to secure a large stock of medical grade PPE that we have been providing to members on a cost-recovery basis. We have seen a reduction in demand over the last few months as the supply and demand has been restored in the market.
|PPE Item||Sale Price||Original Price|
|3‑Ply Medical Grade Masks (package of 100)||$40 (65% off)||$115|
|Medical Grade Nitrile Gloves (package of 100)||$8 (53% off)||$17|
|Dasheng DTC3Z N95 (box of 20)||$30 (50% off)||$60|