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In today’s message you will find:

• Simpler Billing: Automated Visit Premiums
• New Supports for New to Practice Doctors
• Gender-Affirming Care in Manitoba
• Appreciation for Resident Doctors
• Get UpToDate Subscription for Free
• Advocating for HIV Drug Coverage
  
• Getting Healthy — the Home Stretch
• Oral Health for Children
• Nominate a Health Leader for Induction into the Canadian Medical Hall of Fame
• Health System Updates
• ICYMI
• Upcoming Events
• Tax Changes for 2024 — MD Sponsored Content

Simpler Billing: Automated Visit Premiums

Based on feedback from physicians, we have worked with Manitoba Health to automate two commonly used visit premiums: age premiums under the general practice schedule, and the new hospital premium. This change is expected to reduce the administrative time required to submit your claims. 

Hospital Premiums

The new Physician Services Agreement introduced a 15% premium for all hospital visits, including in-patient and ER. This is a significant remuneration enhancement for hospital-based physicians.

When the premium started on October 1, tariff 5515 was introduced and had to be claimed along with the visit tariff to receive the 15%. 

Effective February 15, 2024, you will no longer have to add the hospital premium tariff to each visit tariff. Instead, Manitoba Health’s claims system will now automatically add the 15% premium on to eligible hospital-based visits. 

Please ensure you continue to claim 5515 on visits before February 15, 2024. If you submit a claim with 5515 on or after February 15, the 5515 claim will be returned as rejected with the following Explanation of Benefit (EOB) code attached: 6H – Hospital premium automatically applied. 

Please note: Doctors Manitoba continues to work with Manitoba Health officials on a solution to address some difficulty experienced by members claiming tariff 5515 for ER services from Oct 1 to Dec 15.

We have updated our billing advice for hospital premiums to reflect this change. 

Age Premiums – General Practice 

The new Physician Services Agreement introduced a new ​“simplified” visit page for family physicians, which moved away from over 15 different tariffs depending on the visit type, age, and pelvic exam to a smaller set of visit tariffs with premiums or add-ons. This includes a 10% premium for patients between 65 and 69 years of age and 20% for patients aged 70 and older. 

We heard from some physicians that while the new structure was indeed providing increased remuneration, it also increased their administrative burden associated with billing. 

Effective February 15, 2024, you will no longer have to add the tariffs 8462 or 8463 to each visit tariff for patients in the designated age band. Instead, Manitoba Health’s claims system will now automatically add these premiums on to visits. 

Please ensure you continue to claim tariffs 8462 and 8463 for visits before February 15. Claims for these tariffs on or after that date will be returned as rejected with the following Explanation of Benefit (EOB) code attached: 6G – age premium already applied.

We have updated our billing advice for the simplified visit page to reflect this change. 

If you have questions or concerns, please contact us at practiceadvice@​doctorsmanitoba.​ca.

New Supports for New to Practice Docs

Yesterday we announced the introduction of our New to Practice Program, a partnership we negotiated with the government of Manitoba.

Designed to help improve retention of early career physicians, the New to Practice program will be available to physicians in their first five years of practice in Manitoba, whether they are a recent local graduate or an established doctor who has moved from another jurisdiction. Some of the program’s offerings may include assistance with settling into practice, offering orientation to practicing in Manitoba’s health care system, building connections with other physicians and the community they serve, and mentorship. The new program will also extend help to a new physician’s family with making connections to help with their transition to a new community, because this also helps to increase the chances of the physician thriving and staying for longer. 

“Our members are concerned about the doctor shortage in Manitoba, and this is one more way we can help make a difference,” said Doctors Manitoba president Dr. Michael Boroditsky. ​“For people to stay in Manitoba, we need them to build roots. Not only will that benefit physicians to retain them so three years in they’re not leaving, but then that’ll also trickle down to benefit the population in Manitoba because you’ll have more satisfied, happy and productive physicians.”

Dr. Nichelle Desilets, the Representative on the Doctors Manitoba Board from the Assiniboine District, agrees, explaining ​“this new program has so many benefits. We want our future colleagues to feel welcome and supported and, if they have that, hopefully they will stay here.”

The Manitoba government is contributing $300,000 in annual funding to the program, designed to mentor and support physicians in the first five years of their practice in Manitoba. The program’s content will be developed together with established physicians, University of Manitoba staff, clinic managers, health authorities, the College of Physicians and Surgeons of Manitoba and others within the health-care system.

The program is not yet in place, but recruitment is underway to build the new services. We’re looking for the right person to lead this work. Do you know someone who might be a good fit? Please share the New to Practice Advisor job posting with them. The deadline for applications is February 26.

You can read the full New to Practice Program news release here.

You can also see related news coverage here:

• Province funding program to support new doctors (Winnipeg Free Press)
• New program aims to help establish new doctors (Brandon Sun)
• Manitoba wide program aims to support and retain new doctors (Global News)

Gender-Affirming Care in Manitoba

Since the Alberta government announced changes to gender-affirming care for transgender youth last week, we’ve heard from our colleagues there who are distressed by these developments and how they are taking action to prevent proposed restrictions from coming into effect.

Seeing this politicization take hold in Canada, one of the most gender-affirming countries in the world, has been disheartening, said Dr. Kristen Creek, a member of the Board of Directors with Doctors Manitoba.

“Gender-affirming care for adolescents is a collaborative decision made in consultation between the patient and their healthcare provider. The undue politicization of gender serves only to create unwarranted fear and attempts to impose restrictions or bans on such care lack a foundation in healthcare principles. Substantial evidence supports the positive impact of gender-affirming care on the overall health of patients. Failing to acknowledge and meet this healthcare necessity poses a significant risk to the well-being of children, adolescents, and adults, hindering their ability to become healthy, thriving members of society.”

While access to gender-affirming care in Manitoba is not enmeshed in the same heightened political atmosphere and immediate risk as in Alberta, this type of care presents a different set of challenges here.

Kara Nacci (RN AP) is the Nurse Coordinator at the Trans Health Klinic at Klinic Community Health. She said that the program is currently receiving approximately 10 to 15 referrals each week and has more than 400 people on the waiting list. The wait time to get in to the program is one year.

There are other avenues to help make a difference, including those via primary care physicians.

“Gender-affirming hormones can be safely initiated and monitored in the primary care setting. Primary care providers are well-positioned to support patients longitudinally through a gender transition, and there are many resources available to support prescribing,” said Dr. Steve Melnyk, a physician with Klinic Community Health.

Doctors may reference the following recommended guidelines, including the Guidelines for Gender-affirming Primary Care with Trans and Non-Binary Patients, 4^th edition. The guidelines reflect primary care practice with trans patients as approached by providers at Sherbourne Health, an urban health agency in downtown Toronto, and the World Professional Association for Transgender Health’s (WPATH) Standards of Care. In addition to these, Dr. Creek also recommends Trans Care BC as a source of information for both physicians and patients.

Primary care physicians can learn more about the Trans Health Klinic on the page for health care providers here, or contact via econsult or the Klinic fax number 204−784−4013.

The difference between beginning treatment versus referring a patient where they face a lengthy wait can reduce the risks to mental health and self-harm among youth during a fraught time of their lives. A recent study published in the Canadian Medical Association Journal (CMAJ) found that transgender youth are five times more likely to think about suicide, and 7.6 times more likely to attempt it. 

“Patients deserve to feel safe and respected and receive the care they need,” said Dr. Creek, adding that Doctors Manitoba offers two simple ways to foster inclusive environments:

• Free pronoun ID badges. Sharing or displaying your pronouns can be especially impactful in making people of all genders feel safe and welcome. Learn more about the importance of pronouns and order your ID badge here.
• Safe Space decals. Display a Safe Space decal in your practice. You can order up to five decals here.

Get UpToDate Subscription for Free

Your membership with Doctors Manitoba provides free access to UptoDate, an online, continuously updated clinical decision support resource for medical knowledge at the point of care. With UpToDate, you can access evidence-based clinical information around the clock and find the answers you need when and where you need them — quickly and easily. 

UpToDate includes thousands of topics covering everything from general internal medicine to more than 220 specialties, a drug interaction tool, patient education topics and a wealth of additional references and medical calculators. It also is an avenue for earning continuing medical education and continuing professional development credits. 

Subscriptions to the service are valued at more than $500 annually. Here’s how you can access the service free of charge via Manitoba’s Health Information and Knowledge Network (MHIKNET), a service provided by the University of Manitoba’s Health Sciences Libraries to staff of Manitoba Health, staff of participating Regional Health Authorities, and fee-for-service physicians in Manitoba:

1. Register for a MHIKNET library card. Complete and return the borrower registration form at: https://​libguides​.lib​.uman​i​to​ba​.ca/​m​h​i​k​n​e​t​/​l​i​b​r​a​r​y​a​c​count

2. Once you have a MHIKNET library card, you can access UpToDate from the MHIKNET homepage: https://​libguides​.lib​.uman​i​to​ba​.ca/​m​h​iknet

Step-by-step instructions are included in this PDF Guide for health care providers in Manitoba.

Advocating for HIV Drug Coverage

In today’s Winnipeg Free Press, you will find a story about advocacy to see HIV prevention and treatment medications offered at no cost for all patients. Manitoba has some of the fastest-rising infection rates in the country, so advocates have been pushing the province to fully cover the medications.

Manitoba was the last province to cover HIV treatment and pre-exposure prophylaxis (PrEP) drugs under pharmacare in 2021, but pharmacare has an income-based deductible. Several physicians, including Dr. Laurie Ireland from Nine Circles Community Health Centre and Dr. Robert Obara, have been pressing to remove this deductible, making these vital medications available to patients at no cost. Dr. Ireland has noted that financial barriers result in some patients forgoing PrEP or other medications.

Doctors Manitoba has reached out in the past to the Minister’s office to support the coverage for PrEP, and we applaud the continued advocacy of Dr. Ireland, Dr. Obara and others on this issue. We will continue to add our voice to the call for full coverage of these medications at no cost to patients. 

You can read the Winnipeg Free Press story here.

Getting Healthy – The Home Stretch!

Since our winter edition of the Getting Healthy campaign opened on January 15, over 15,000 Manitobans have made a pledge towards getting healthy, which enters them a chance to win great prizes! This week board President, Dr. Michael Boroditsky wrote a guest blog post for Travel Manitoba, who we collaborated with on social media.

With just under a week in the campaign, Manitobans are invited to visit Get​tingHealthy​.ca for tips and advice from physicians on the simple steps Manitobans can take towards Getting Healthy this winter. Plus, we’ve created a fun, exuberantly positive contest with a chance to win 6 months of free groceries ($5,000 value) for anyone who pledges to do one thing towards getting healthy this winter. We encourage you to enter too. 

How can you help? Spread the word by:

• Sharing the campaign on social media.
• Adding the campaign to your practice or clinic website.
• Take a photo of yourself doing something to get healthy and share it on social media or send it to us to share on our social media. Any posts should encourage Manitobans to join you in getting healthy this month and invite them to enter our free contest at GettingHealthy​.ca.
• Posting signs in your clinic or practice about the campaign.
• Talking about the campaign with your patients.

You can see sample posts and download images to use on this page. Posters have been sent out to dozens of clinics in the province, and should arrive in the next few days. You can request posters by contacting our office at general@​doctorsmanitoba.​ca. You can learn more about the campaign and how to spread the word here.

Our hope is this campaign fills a real need for public awareness information about disease prevention and healthy lifestyles, while also reminding Manitobans that doctors care about their health and well-being.

Cancer Screening 101 for Patients

Please consider sharing the following free webinar about cancer screening with your patients! 

Closing the Care Gap: What You Need to Know About Cancer Screening — February 12, 2024 at 6:30pm — Virtual

Join a free webinar to learn how cancer screening can make a difference in preventing and detecting cancer early. Hear about CancerCare Manitoba’s BreastCheck, CervixCheck, and ColonCheck programs. This webinar will feature Dr. Donna Turner, Dr. Murray Wilson, Dr. Sarah Kean, and Dr. Ross Stimpson, followed by a Q & A period. Register now.

Oral Health for Children

“Doctors, take action!” is the clear message of this medical student project.

Sue Zhang is a 4^th-year medical student who was on a public health study elective supervised by Dr. Natalie Casaclang, Medical Officer of Health with Manitoba Health. The research culminated in an infographic on the topic of childhood oral health.

While dental and health care have long been treated as separate, dental problems often lead to kids needing medical care, including in-hospital surgery. Children also start seeing health providers at a younger age and more consistently than they see dentists.

The infographic promotes oral health outside of dental settings, particularly in primary care. It highlights the important role of medical providers and identifies three steps providers can take to promote oral health in their clinics:

• Educate parents and families about good oral health practices.
• Examine children’s teeth using the Canadian Caries Risk Assessment Tool.
• Intervene if needed by referring to a dental provider, applying fluoride varnish in the clinic, and connecting parents and families to important dental benefits. 

The project is timely as it coincided with the recent announcement of the new Canada Dental Care Plan. By encouraging and assisting families with maintaining up-to-date tax files and mailing addresses with the Canada Revenue Agency, doctors can help eligible patients access this benefit. Given the profound effects of social determinants, this helps address oral health disparities in individuals and families experiencing poverty and marginalization.

Nominate a Health Leader for Induction into the Canadian Medical Hall of Fame

The Canadian Medical Hall of Fame, recognizes that diversity, equity and inclusion strengthen the health sciences, health systems and health care communities and leads to enhanced quality, social relevance and impact of health-related disciplines. Canadian Medical Hall of Fame Laureates are Canadian citizens whose outstanding leadership and contributions to medicine and the health sciences, in Canada or abroad, have led to extraordinary improvements in human health.

1. Their work may be a single meritorious contribution or a lifetime of superior accomplishments. Pioneers in their field, they are role models who inspire young Canadians to pursue careers in the health sciences.
2. The CMHF perceives health leadership to be inclusive of many professions and roles including doctors, researchers, nurses, dentists, pharmacists, policy makers — to name only a few. Nominations of Canadians, living or posthumous, who meet the criteria from the many aspects of health are encouraged.
3. The CMHF recognizes that contributions deemed worthy of Laureate status evolve over time and differ across diverse communities, requiring that the selection process recognize excellence in the context of time and place.
4. Up to six individuals may be selected for induction annually; only one individual may be inducted posthumously each year.

Canadian citizens from across health professions within Canada and across the globe may be recognized for their work in one or more of the following categories:

1. Leadership in building excellence in health for Canadians & the world 
2. Leadership in health promotion, illness prevention and care 
3. Leadership in research with national and international recognition for a scientific contribution 

The Canadian Medical Hall of Fame relies on the community to nominate candidates for induction. Annually, the CMHF Laureate Selection Committee — appointed by the board but operating at arm’s length from the board — reviews all nominations received. Inductees are selected from the pool of nominees that includes those nominated this year and the previous two years. Unfortunately, the current nomination pool is not as diverse as it should be, nor is it reflective of current health leadership in Canada. Please help us increase the diversity of CMHF Laureates through more nominations of individuals who identify as female or non-binary, and/​or who are Black, Indigenous or People of Colour. 

Nomination deadline for the 2025 Induction: MONDAY, JUNE 10, 2024

Nomination FAQ

Tips for creating a compelling nomination package

Health System Updates

Meningococcal Vaccine

Infant Meningococcal Vaccine Program Change

Effective March 1, 2024 Manitoba is updating its recommended meningococcal vaccine for infants at 12 months of age from the Men-C‑C vaccine (i.e., NeisVac‑C™) to a Men-C-ACYW- 135 vaccine, specifically Nimenrix®. This is the recommended product as it does not decrease the immune response to the pneumococcal vaccine (i.e., Prevnar® 13) that is also recommended at this age.

You are encouraged to ensure you have a supply of Nimenrix® to support this program change.

• If you have a supply of Nimenrix® on site before March 1, 2024 you may administer it. 
• If you do not have a supply on site and a child is scheduled to receive their 12-month vaccines before March 1, 2024, you should advise the parent or caregiver about deferring the administration of the meningococcal vaccine only until you are able to provide Nimenrix®. There is no need to defer the administration of other routine vaccines recommended at 12 months.

Catch up Campaign

Manitoba public health officials are updating the routine immunization program to better protect infants and children from meningococcal disease with broader immunity that will help prevent serious outcomes from these infections. Children under the age of four are at the greatest risk of serious illness from meningococcal disease. As part of this change and a catch-up campaign, the quadrivalent vaccine will be available to:

• 12-month-old infants who have not yet received a meningococcal vaccine;
• children born between Jan. 1, 2020, and Feb. 28, 2023, who have not yet been immunized against meningococcal disease, recognizing the COVID-19 pandemic interrupted routine immunizations; and
• children born between Jan. 1, 2020, and Feb. 28, 2023, who were previously vaccinated against the meningococcal bacteria type C so they have the additional protection offered by this vaccine. It is safe for these children to receive a quadrivalent vaccine, which should be spaced at least four weeks apart from their last dose.

Read the full news release.

AIM Update

Have you ever encountered a problematic process and didn’t know where to begin?

Process mapping is a key tool when tackling complex processes, especially when they are unclear or inconsistent. A process map breaks down a process into individual steps, identifies who is responsible for each task/​decision, and outlines expected timelines. These visual tools facilitate effective communication among stakeholders and pinpoint areas for improvement. Most process maps start with a broad overview and then offer more detailed information, as needed.

It is crucial to acknowledge that those who perform the work are the ones who can change it effectively. Anyone involved in the process must actively participate in creating the process map.

Join our Access Improvement Model training, where experienced facilitators will guide you through processes that may have been a source of frustration for your clinic.

If you would like to explore AIM in further detail, please visit the AIM website and be sure to contact the team at aim@​umanitoba.​ca.

In Case You Missed It

Here’s our most popular recent posts, in case you missed them:

• We’re Making Progress on Admin Burden
• CBTm for Physicians and Medical Learners
• Group-Based Peer Support Opportunities
• Our board met with Health Minister Asagwara at our January 17 Board Meeting to Provide Advice
• We’ve improved the Maternal/​Parental Leave Benefit
• Listening Tour — Share Your Views

Events

Black Physician & Medical Learner Connection Event — February 23, 2024 6 – 9pm

Black Manitobans are a diverse and rich group in the province with origins in Africa, the Caribbean and the United States. Doctors, at all stages of training, reflect the Black population that we serve, and provide exceptional care to our communities. Despite our many achievements, Black doctors and medical learners often feel isolated and underrepresented in medicine. Black History Month provides an opportunity to highlight Black doctors’ contributions in Manitoba and for us to meet, establish connections with each other, provide mentorship and share our stories.

Join us as Black Doctors and medical learners on February 23 as we celebrate Black excellence. Register now.

Elevating Patient Voices in Medicine — February 17, 2024 from 8:30am-4pm

Join us at the University of Manitoba’s second annual EDI Medical Conference. Discover the power of patient advocacy in medicine through diverse insights from both healthcare professionals and patients. Register now.

Hippocratic High Notes

Do you secretly sing in the shower? Do you proudly sing on stage? Or are you somewhere in between? Well, then join us as we launch a new choir comprising of female physicians, active and retired, residents and medical learners.

This promises to be a fun, bucket-filling activity also aimed at building bridges and making connections! All are welcome! No auditions! No experience needed! Just bring enthusiasm, a desire to sing and to have fun!!

Start date January 30^th 2024! Register ASAP here!

Transplant Manitoba Quiz Night!

Transplant Manitoba – Gift of Life is hosting a fun and entertaining evening of trivia with our friends at Quizmasters this spring and we are inviting you and your organization to join the action.

This fundraising event is an early kick-off to National Organ and Tissue Donation Awareness Week (NOTDAW 2024 runs from April 21 – 27) and proceeds will support our continued efforts to raise organ and tissue donation awareness within the community.

For just $10 a ticket (that’s $60 — $80 a table) this signup​for​life​.ca Quiz Night fundraiser offers participants an interactive event alongside our Transplant Manitoba – Gift of Life teams, fantastic volunteers and partners to compete over the course of eight rounds of questions about current events, general knowledge, music, visual, speed and of course, organ and tissue donation. At the end of the night, the team with the highest score wins. There will be snacks and prizes!

Details:

• When: Wednesday, April 17, 2024 from 6:30 – 9:30 pm
• Where: Garden City Community Centre, 725 Kingsbury Ave. Plenty of free parking in the surrounding lots!
• How: Pull together a team of six-eight, select a team name and a captain, and have them confirm your table and cash payment before March 1 with Roberta Koscielny, 204−787−1897 or rkoscielny2@​hsc.​mb.​ca. Space is limited, so don’t delay!

It is going to be a fun night and this relaxed evening offers you the opportunity to meet some of our staff and learn more about Leave Well, the latest national awareness campaign launched in partnership with Canadian Blood Services and meet the Orgamites, a CBS resource developed for early learning. Hope to see you there!

Tired but Wired: Tools for Insomnia Relief — February 29, 2024 Time: 7:00 — 8:30 pm

Join us for a virtual interactive workshop focused on practical strategies to help support healthy sleep for Doctors Manitoba members in every career stage. Register here.

Learning Objectives:

1. Review principles and core components of Cognitive Behavioural Therapy for Insomnia (CBT‑I)
2. Understand factors that might predispose medical learners and physicians to insomnia
3. Identify available resources related to CBT‑I
4. Explore additional strategies to support healthy sleep

Navigating Your First Home Purchase in Canada- February 21, 2024 — 6 – 7pmCST

A home is one of the biggest purchases you’ll make in your lifetime – and it’s a personal one. This early career physician focused discussion with MD Financial Management will equip you with the knowledge to support your home buying decisions and will help ensure the process is as seamless and exciting as possible. Register here.

During this webinar with MD Financial Management we will dicuss:

• a brief market update 
• financial considerations for homeownership
• renting vs. buying
• investments as a source of financing
• mortgage considerations
• what to expect during the pre-approval process
• choosing an interest rate that’s right for you

DRMB Book Club — March 7, 2024 — 7 — 8pm

A memoir about intergenerational trauma, healing, and connection. Facing up to a story nearly erased by the designs of history, father and son journey together back to the trapline at Black Water and through the past to create a new future. Join us for our fourth virtual book meeting on Thursday, March 7, 2024, from 7:00pm – 8:30pm as we read the Globe and Mail Top 100 Book of the year,​“Blackwater” by David A Robertson. We are thrilled to announce that the author will be joining our virtual book club for a Q+A. There will also be a chance for the group to discuss the book and share thoughts. Register Here!

The Doctors Manitoba Physician Health and Wellness committee is committed to providing opportunities for building connection and community in medicine.

Mindful Practice in Medicine Workshop ‑ February 21 — 24, 2024 in Banff

Direct from the renowned University of Rochester, the Mindful Practice in Medicine Core Workshop, developed by physicians to help medical practitioners and educators respond to the erosion of joy in their work, provides an experiential and interactive learning environment. The approach is evidence based – as it lessens the effects of burnout and improves well-being, engagement with work, and patient-centered compassionate care. 

Register for a retreat-like workshop designed to energize your clinical work while helping you find joy and resilience, through honing your self-awareness and deep listening skills that are keys to navigating stressful and demanding situations you face daily. 

Learn how to:

• Find meaning in your work
• Effectively manage challenges in clinical work
• Improve communication
• Experience clarity and focus
• Be part of a larger community
• Be more resilient
• Listen more deeply
• Cultivate compassion and gratitude
• Become more self-aware

Registration deadline is January 21^st, 2024. Register here.

Tax changes for 2024 

Sponsored Content from MD Financial and Scotiabank

With the new year upon us, it’s a good time to review the major personal income tax changes for the 2024 tax year. MD Financial Management has given a rundown of the adjusted tax figures, including income tax brackets, basic personal amounts and more, as well as some new rules taking effect this year. Read more.