Community-Based Clinical Services (ER Diversion)
Doctors’ offices can be an alternative for patients with certain conditions, such as minor injuries or illnesses, that otherwise could end up in Emergency Departments (EDs) or Urgent Care Centres (UCC) for treatment. An analysis by the WRHA previously noted that nearly 40% of their ED and UCC volumes could be seen at a community clinic or family doctors’ office.
The new Physician Services Agreement introduced 10 new tariffs to recognize the skill set of physicians in a primary care setting treating specific lower acuity presentations.
These tariffs along with the community-based practice support (tariff 8380*) and extended clinic hours premium for family physicians and pediatricians (tariffs 5530 and 5531) are excellent tools to assist physicians as they provide alternatives for ERs and UCCs through-out the province.
The full rate table for these services is below:
2651
Procedural sedation by physician
$51
0800
Simple reduction, e.g. radial head
$76.50
0252
Removal of sutures and/or staples from lacerations or surgical incisions of any length by any physician Note: Surgical Rules apply.
$17.85
1004
Incarcerated ring removal
$25.50
0436
Dressing for wounds not due to burns
$35.70
0479
Debridement of wounds not on lower extremity
$71.40
0070
Local anesthesia for pediatric patients (tariff 40000 not eligible in addition)
$15.30
5350
Ring and/or hematoma block
$25.50
8464
Administration of Fluorescein drops for corneal abrasion
$15.30
8469
Administration of Inhalation medication (Ventolin) for acute asthma presentation
$51
1. Where medically indicated, a visit may be claimed in addition to the service.
* 0252 (removal of sutures): Surgical Rules apply.
* 0070 (local anesthesia for pediatric patients): Tariff 40000 not eligible in addition
Builds on Existing Tariffs
The Physician’s Manual already has specific tariffs for certain low acuity health concerns related to minor injuries and illnesses. Examples include:
• Foreign body removal (e.g., 0130*, 1907*, 2070*, 5741*, 5445* and 5980*);
• Suturing minor wounds (0251*),
• Applying casts (e.g.,1862 – 1899*)
• Burn dressings without GA (0354*, 0355* and 0356*) but not for other common dressing changes,
• Debridement of foot and leg ulcers (0259*, 0260*) but not debridement elsewhere.
Community-based clinical services provided outside of regular clinic hours could be eligible for Extended Hours Premiums. Learn more.