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April 8, 2022

In today’s member message you will find:

Getting Ready for COVID Testing in Primary Care

As mentioned in our newsletter last week, provincial COVID-19 test sites will close on April 15. While most patients are now using self-administered rapid tests, some patients will continue to require a rapid or PCR test administered by a physician or health care professional. This is primarily to inform medical management and treatment decisions only. The responsibility for this testing is shifting to primary care. 

These changes to testing reflect the dramatic decrease the province has seen in PCR testing in recent weeks, as Omicron fades. With increased use of RATs, test sites were administering about 200 PCR tests a day.

We have created a COVID-19 Testing and Treatment resource page to help physicians get ready for this change. This includes:

  • Clinical guidance and a clinical algorithm to ensure you and your staff are ready for patients who call in with COVID-19 or influenza-like symptoms, and may need a test
  • Instructions on ordering free rapid tests or PCR testing supplies
  • Patient information resources
  • Remuneration information for rapid tests or PCR tests administered by a physician
  • Patient notification responsibilities
  • COVID-19 treatment information, referral forms and resources

WEBINAR

We have also arranged for a webinar with an expert panel to offer an overview and take your questions. A recording will also be available for those unable to attend the live broadcast.

DATE: Thursday, April 14, 2022
TIME: 12:00 noon to 12:45 PM
REGISTER: Register now!

New Isolation and Return to Work Guidance for Health Care Workers

Shared Health has updated their return-to-work guidance effective April 6, 2022. Health-care workers who have tested positive for COVID-19 must perform a self-administered rapid antigen test on day seven following symptom onset or positive test result (if asymptomatic). If the result is negative, the health-care worker can return to work on day eight, provided they answer yes to all of the following:

  • Any lingering symptoms are mild and improving and the health-care worker must feel well enough to complete their duties.
  • Any lingering symptoms will not interfere with their ability to maintain the PPE standards that are required in their work setting/​activities.
  • They have been without fever for 24 hours, without any use of fever-reducing medication.
  • They can successfully pass the staff self-screening questionnaire.

If the day seven result is positive, the health-care worker should continue to isolate through to day 10. They can return to work on day 11 if they can answer yes to all of the questions above. No additional rapid test is required. 

→ Read the memo outlining the changes here.
→ See the one-page overview of changes here.
→ Return-to-Work Screening Questionnaire

New Endoscopy Referral Form and Guidelines

A new endoscopy referral process has been implemented, which will also help with the introduction of Fecal Immunochemical Test (FIT). This was announced by the provincial Diagnostic and Surgical Recovery Task Force as one of the solutions to address the pandemic backlog.

This new process and new referral forms must be used starting April 19.

New forms will standardize requests for endoscopy procedures and introduce the FIT test for eligible cases.

  • A new ​“Provincial Endoscopy Intake Referral Form”, standardizes referral criteria for new endoscopy referrals in all regions and aligns with and includes the recently approved ColonCheck Colorectal Cancer (CRC) screening and surveillance guidelines.
  • An updated ​“ColonCheck Manitoba Fecal Occult Blood Test Requisition Form” highlights the utilization of the Fecal Immunochemical Test (FIT) in patients with low increased risk of CRC, which is intended to replace low-yield colonoscopies.
  • All cases on the current elective endoscopy waitlist will be reviewed and triaged to determine whether they are eligible to be redirected for a FIT according to the new ​“Provincial Endoscopy Checklist”. 

Beginning April 19, 2022, providers will be required to use the new forms and delete all old forms from your systems. Both forms will be available in the Electronic Medical Record (EMR) on April 19, 2022. These new measures will ensure equitable service delivery, and improved prioritization and scheduling of colonoscopy procedures in Manitoba. 

Please review the Clinical Practice Change. Additional information can be found on Shared Health Provincial Clinical Project Standards and Guidelines.

In this month’s issue of CancerTalk, you can read more about the new changes to colorectal cancer surveillance, read CervixCheck and ColonCheck Prevention and Screening updates, and learn about Hepatocellular Cancer.

Help Shape our Prevention Awareness Campaign

Based on feedback from physicians, Doctors Manitoba is planning to focus future public awareness campaigns on prevention and healthy living. We are looking for physicians to join an advisory group to help with developing these campaigns.

In our annual member survey earlier this year, your feedback said a focus on prevention and well-being is the priority. This includes raising awareness about supporting:

  • Healthy eating, exercise and smoking cessation
  • Routine screening (e.g. cancer screening)
  • Prevention and management of common chronic diseases (e.g. heart disease, cancer, kidney disease, etc.)
  • Regular immunizations
  • Mental health and resiliency

We heard from physicians that you want help educating the public about these topics, building on the success of our COVID-19 vaccine campaign. 

Doctors Manitoba started public awareness campaigns during the pandemic, responding to physicians’ concerns about their patients. Last year, your feedback was clear that we should continue public awareness campaigns after the pandemic. Our focus should be on helping Manitobans to maintain and improve their health while demonstrating that physicians care about the well-being of the people of Manitoba. 

Are you interested in helping? We are looking for physicians with a passion for, and expertise in, healthy living and prevention. You can help shape our public awareness campaigns, ensuring we are using the latest evidence and medical advice in a way that supports Manitobans in being healthier while also helping your colleagues in supporting their patients in this area as well. The advisory committee will be ​“ad-hoc” and meet weeknights on an as-needed basis, likely two or three times over then next six months. This is similar to our vaccine advisory committee that supported our COVID-19 immunization campaign. 

If you are interested or have further questions, please email our Director of Strategy and Communications, Keir Johnson, at kjohnson@​doctorsmanitoba.​ca. We are looking for a diverse group of members, including family physicians and specialists from both Winnipeg and rural/​Northern Manitoba. 

CPSM and Government Consultations — Our Analysis

Last week, we sent a brief update about two separate consultations launched by CPSM and Manitoba Health. We were initially concerned about the impact of these proposed changes on physicians’ documentation burden, among other concerns, and we committed to sharing our analysis this week. You’ll find our analysis and concerns about both consultations below, with instructions about how to share your views.

Manitoba Health’s Proposed Regulatory Changes

SITUATION: Manitoba Health has announced a public consultation on proposed new Regulations respecting physician billings. Doctors Manitoba is concerned about the implications of increased documentation burden on physicians and the potential negative impact on patient care. 

BACKGROUND:

  • The government states that the new regulations under The Health Services Insurance Act will ​“establish requirements for practitioner record keeping for the purposes of establishing eligibility for payment of claims, under the provincial health services insurance plan, for insured medical services and other health services.”
  • They say the changes are needed because current regulations are unclear about what documentation is required, and this uncertainty has led to ​“complexities and inefficiencies” in the claims review and audit process.
  • Much of the regulations require records that physicians already maintain under the documentation requirements prescribed by CPSM and in the Physician’s Manual. However, the regulations go a step further, requiring ​“information to support the insurability of the service under the Act” and ​“any additional information required to support payment of the insured service.” 
  • You can review the draft Regulations and Manitoba Health’s explanation here.

ASSESSMENT:

  • We are concerned these Regulations will increase charting requirements for all physicians billing fee-for-service, without accomplishing the government’s stated objective.
  • We believe the real purpose of these Regulations is to make it easier for Manitoba Health to deny physician billings, and for Manitoba Finance to pursue physician audits, even where physicians are following the interpretation of tariffs established and accepted by Manitoba Health long ago.
  • We disagree with some of the government’s own analysis of the potential positive or neutral impacts, such as suggesting the changes:
    - Will ​“result in potential improvement in efficiency, and will have minimal administrative impact on the private practice of medicine.” We believe this will increase administrative and documentation burden for physicians.
    - ​“Will not negatively impact the province’s overall competitiveness” as documentation burden is a concern for physicians considering where to practice.
  • After auditing physician remuneration and the government’s audit processes, the Auditor-General concluded that the government already has ​“systems and procedures in place to ensure that fees paid to and recovered from physicians are in accordance with applicable legislation, regulations and agreements”. The Auditor-General made it clear that new Regulations are NOT necessary.
  • The Physician’s Manual, fairly and exhaustively negotiated between Doctors Manitoba and the Government of Manitoba, is THE source of fee-for-service billings in Manitoba. In our view, the Government of Manitoba wants new Regulations to avoid its obligations to pay for medical services as agreed in the Physician’s Manual.
  • If the Manitoba Government wants to change the rules for fee-for-service billing, there is only one appropriate place to have that conversation: the bargaining table.

OUR RECOMMENDATION:

  • At this point, we want to hear from you to inform our further submission to the provincial government about these proposed regulatory changes. Let us know how this would impact your practice by emailing us at practiceadvice@​doctorsmanitoba.​ca.
  • Based on your feedback, we may encourage physicians to share their views with the government directly. 
  • If you want to provide feedback to the government in the meantime, you can submit it using their Consultation Portal. Please send us a copy of your submission to practiceadvice@​doctorsmanitoba.​ca.


CPSM’s Proposed Standard for Episodic Care

SITUATION: CPSM is undertaking a consultation on a proposed a new Standard for Episodic Care, which would add new obligations on any physician working in​“episodic care”, including walk-in clinics, sports medicine clinics, house calls, and other locations.

BACKGROUND:

  • The Standard aims to improve continuity of care, recognizing the risks created by fragmented care. CPSM engaged an advisory group of physicians in developing the new Standard. 
  • The new Standard would add requirements for the standard of care provided, the relationship with regular primary care providers, continuity of care and follow-up and prescribing matters. 
  • It applies to community-based episodic care providers, but not to ERs, long term care, palliative care or consultations. 
  • Where the patient has a family physician, a summary of the visit and copies of any test results must be provided to the family physician.
  • CPSM’s notice about the consultation, along with a link to the draft standard of practice, is available here.

ANALYSIS:

  • The impact of the new Standard likely varies for different physicians, particularly those providing episodic care. For some, it could mean little to no change, while for others it could introduce significant changes to their practice. The populations served by episodic care providers could also determine how much of an impact the new Standard could have. 
  • We have already heard from some physicians with a range of opinions about CPSM’s proposed new Standard. Some are concerned about additional administrative burdens, others see some benefit to improving continuity of care, and many have questions about what this would mean in practice. 

RECOMMENDATION:

COVID Updates

Public Health now posts weekly COVID-19 Surveillance Reports on Thursdays. The report posted yesterday, covers the week ending on April 2. Highlights include:

  • Severe outcomes from COVID-19 remain ​“moderately low.” There were 141 hospital admissions, up from 111 last week. This includes 11 ICU admissions, down from 16 the previous week. There were 6 deaths recorded, down from 8 the previous week. 
  • There were 1,359 lab-confirmed cases reported in Manitoba over the week, up from 979 the previous week. The test positivity rate was 18.6%, up from 13.9%

Dr. Brent Roussin gave a COVID-19 update yesterday, and reported that wastewater testing signals an upward trend in transmission and confirmed that the Omicron subvariant BA.2 is now the dominant strain in Manitoba, with lab test positivity rates increasing. The province sequences about 200 positive PCR tests per week to identify variants of concern and interest. The latest update suggests about 60% of cases are BA.2 infections. BA.2 has been found to be more transmissible than the original Omicron BA.1 variant, though it does not seem to be more virulent. While there is an increase in hospital admissions, it is among the 80+ population and we are seeing fewer severe outcomes. 

Dr. Roussin urged Manitobans who are at risk of severe outcomes to take greater precautions. As with any virus circulating, those more at risk should limit contacts, wear a mask, wash/​sanitize hands. He encouraged all Manitobans to get fully up to date on the vaccine dose for which they are eligible. Dr. Roussin suggested the modeling shows hospital and ICU admissions on a plateau and forecasts the same for severe outcomes in the coming weeks. When asked if there would be a return to more frequent data on hospitalizations and outbreaks, Dr. Roussin said Public Health is monitoring closely and if trends change, the province will adjust the approach if needed. He stressed that we are in a transition from the pandemic to endemic stage of COVID-19. 

When asked why Paxlovid is being used more in other provinces, Dr. Roussin discussed the complexities of the timing of treatment, given those eligible would need to start treatment within 5 days of symptoms. Drug interactions for patients is also an issue.

Dr. Roussin thanked Dr. Joss Reimer for her dedication to the vaccine rollout and congratulated her on her new role as CMO at the WRHA. No one has been named to replace Dr. Reimer in the role of Medical Lead of the Manitoba Vaccine Task Force. 

Elsewhere in Canada…

As the country heads toward a sixth wave, experts continue to stress the importance of masking and vaccine boosting. PHAC’s modelling showed a 34 per cent increase in daily case counts as of March 30. Given the limited use of PCR testing, the number of cases across the country is likely much higher. Fourth dose eligibility expanded in some provinces by recommendation of NACI. 

Wastewater surveillance in Ontario suggests that about 100,000 people are being infected daily. Health-care worker absenteeism is the highest it’s ever been and experts are concerned they will not have staff to manage an increase in hospitalization.

Quebec and Prince Edward Island have both extended their mask mandates until the end of April. BC, Saskatchewan, New Brunswick, Nova Scotia, and PEI have all shifted to weekly COVID updates.

Last week Canada’s Chief Public Health Officer, Dr. Theresa Tam cautioned all Canadians, no matter where they live, to continue wearing masks and ensure their vaccinations are up to date. She noted that because of vaccination rates and previous infections, the rate of hospitalization for this subvariant and wave is likely to be lower, but not guaranteed. Future waves are likely as we transition from pandemic to endemic. She encouraged provinces and territories to keep up with testing capacity and to continue to offer tests.Last month, Dr. Tam, stressed the importance of looking at the amount of COVID-19 in your community and what activity you are undertaking and taking into account your personal health situation and whether you are around people who are at greater risk. 

Vaccine Updates

A reminder that Manitoba has introduced a second booster dose for specific high risk groups. Please see this message for more information.

2022 Federal Budget

Yesterday the federal government announced its 2022 budget and Public Health Care was on its list of priorities.

The budget restated last month’s announcement of an additional one time $2 billion transfer to the provinces to assist with reducing surgical and diagnostic backlogs. Doctors Manitoba will continue its advocacy to ensure Manitoba’s share is invested in key priorities.

The federal government has also committed to increasing the Canada Health Transfer — the amount it pays to provinces as a contribution to health care — by 4.8% over last year. Again, Doctors Manitoba will advocate for all of this additional money to be invested in key priorities. 

The biggest foundational changes in health care funding will be the creation of a new national dental care program, to start this year for children under 12 in lower-income households and expand in the years to come, and preparing the way for a universal national pharmacare program. The maximum Canada Student Loan forgiveness for physicians practicing in underserved rural and remote communities will increase from $40,000 to $60,000. You can find more details about the federal government’s plans for the health care system which will also include researching long-term impacts of COVID, and improving and supporting dementia and brain health research and innovation.

Supporting mental health and well-being made the list of budgetary priorities. This will include further funding for the Wellness Together Canada Portal, addressing the opioid crisis with harm reduction, treatment and prevention programs, and better mental health support for Black federal public servants. 

Investing in public health will include strengthening Canada’s ability to detect and respond to public health events and emergencies, maintaining the National Emergency Strategic Stockpile, piloting a menstrual equity fund for those in need, assistance for Canadians wanting to become parents, and taxing vaping products.
CMA’s President, Dr. Katharine Smart believes much more is needed to help a health care system in crisis and calls for more tangible solutions to rebuild the system. She also called for a pan-Canadian health workforce plan and investments to rebuild the system.

Webinar with MD Financial next week!

As physicians, you know that without your input, many patients might be missing proactive ways to improve their health outcomes. The insurance team at Doctors Manitoba, and the team at MD Financial, want to ensure you have all the information you need to make an informed decision about your insurance needs. Insurance helps to manage risks in our personal and professional lives, protecting us and those we care for against life’s unexpected events, such as disability or premature death. It’s also a unique asset class that enables the ability to protect, grow, and distribute wealth in unique ways. However, the total range of available insurance strategies is often complex or unclear. As such, investors may not be taking full advantage of everything that insurance can offer. In this presentation, MD Financial and Doctors Manitoba will be highlighting the key areas of ambiguity around insurance, how to overcome common insurance misconceptions, and the most strategic and cost-effective tactics to implement to ensure you’re protecting not only you and your family, but also your wealth. Join us:

New Ambulatory Care Clinic

HSC’s new ambulatory clinic at 700 Elgin Avenue will open on Monday, April 11. The new outpatient clinic will be home to 12 adult internal medicine clinics currently located in seven different areas of the HSC campus. Clinics will open to adult patients in phases.

On April 11, Level 1 will open, including:

  • Rheumatology
    Phone: 204−787−2392
    NEW FAX NUMBER: 204−940−1985
  • Neurology (Stroke, Multiple Sclerosis (MS), and General Neurology clinics)
    Phone: 204−787−5111
    NEW FAX NUMBER: 204−940−2157

On May 30, Level 0 will open, including:

  • General Internal Medicine
  • Hypertension
  • Respirology

On June 27, Level 2 will open, including: 

  • Allergy
  • Cardiology
  • Dermatology (moving to Level 1)
  • Endocrinology
  • Gastroenterology
  • Hepatology
  • Infectious Diseases

Leadership Through Connection Panel Discussion Series

This series is an opportunity for members to hear perspectives on leadership from their colleagues. Themes will be connection with others, connection with self and connection in balance. Each panel will have a medical student, a resident and an attending physician, and be co-facilitated with a medical student representative and Dr. Ming-Ka Chan, Office of Leadership Education, Rady Faculty of Health.

Choosing Wisely — Lab Resource Shortage

The following message is being sent on behalf of Choosing Wisely to help manage and avoid lab resource shortages in Manitoba. COVID-19 has put an extraordinary strain on laboratory medicine in Canada due to critical shortages in blood tubes, devices, and lab staffing. Shared Health Diagnostic Services is managing its resources effectively and is closely monitoring supply. While Manitoba is not experiencing any of the shortages seen at a national level, it is important for providers to continue to use best practices in management of laboratory resources and supplies.Physicians, nurses, and other providers are key partners with the laboratory in preserving supplies for testing where they are needed most. Before ordering tests, please consider:

  • How and if this test result will change patient management.
  • Strategies to minimize blood collections.
  • Avoiding test or request duplications, e.g., check EMR or eChart for previous results.
  • Talking to your local lab professionals about how you can help conserve tubes.

To address the need to conserve tubes and critical laboratory resources, the Canadian Society of Clinical Chemists and the Canadian Association of Medical Biochemists have assembled two sets of relevant Choosing Wisely Canada recommendations — for hospitals and primary care.How you can get involved:

  • Download the recommendations relevant to primary care and hospitals.
  • Share these resources through your network to help raise awareness about the urgent need to use lab resources wisely.

Cosmetic Pesticide Ban Rolled Back?

Last month, the provincial government introduced legislation that would role back a ban on cosmetic pesticides on lawns and municipal boulevards. The ban came into effect in 2014 based on environmental and health concerns. The existing ban has exemptions for agriculture, golf courses, personal gardens or other areas with high-risk noxious weeds of invasive species. Natural sprays were permitted and promoted in place of chemical or synthetic pesticides.

Some Manitobans are concerned about the government’s plan to undo this ban, and have started a campaign. The group, Cosmetic Pesticide Ban Manitoba, has invited concerned physicians to share their views. You can learn more about their efforts and how to share your concerns with your MLA at their website.

It’s Ramadan

April 1 – 30, 2022 is Ramadan, observed by Muslims around the world. It is a month of fasting, prayer, community and reflection. The fasting part of this celebration is of great spiritual importance to those of the Muslim faith. According to this article from eatright​.org, fasting during Ramadan means abstinence from all food or drink including water and chewing gum from dawn to sunset. The fast is to remind Muslims of those less fortunate and to reinforce the need to be thankful. Fasting in this way can come with challenges, as much of our productivity is geared to the daylight hours. It is important that we accommodate our Muslim learners, colleagues and staff. 

Aya Khalil and Huda Fahmy provide some tips about accommodating those of the Muslim faith during Ramadan in this tweet. Some of the great tips from this infographic include:

  • Acknowledging Ramadan
  • Allowing for flexible work hours
  • Not scheduling networking lunches or events during this month
  • Simply asking what works best for our Muslim students, colleagues and staff during this time.

For those working directly with Muslim patients and families, there are several great resources about accommodating these patients during the holy month of Ramadan. These include Cultural Competence in the care of Muslim patients and their families from the National Centre for Biotechnology Information and Treating Patients During Ramadan from Stanford Medicine. These tips are adapted with permission from Dr. Saroo Sharda, Antiracism EDI lead from CPSO. Wishing all those observing, Ramadan Mubarak.

Celebrating Diversity

April is ​‘Celebrating Diversity’ in ComPsych. You can read more about Workplace Diversity and Identifying our Hidden Biases here.

ICYMI — Recent Updates

Here’s some of the most popular and most important recent updates, in case you missed them:

Upcoming Events

Bookmark our Events Calendar to be sure you don’t miss any events or learning opportunities that interest you.
Save the date for our 2022 Doctors Manitoba AGM & Awards Gala on Thursday, May 19!

Some other notable upcoming events include

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