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Reducing Physicians’ Administrative Burdens

Earlier today, our President Dr. Candace Bradshaw attended an event with the provincial government to announce a new Joint Task Force to Reduce Physician Administrative Burden. The announcement follows our advocacy last fall on this issue, and it will report jointly to the government and Doctors Manitoba.

“Doctors go into medicine to care for patients but we are increasingly being diverted away from patient care by excessive and unnecessary administrative work,” explained Dr. Bradshaw. ​“We are pleased the government of Manitoba has listened to physicians and agreed to launch this task force. This initiative is truly a win-win because it will help to reduce physician burnout and free up physicians to spend more time with our patients.”

The task force will identify unnecessary administrative burdens placed on physicians, setting measurable goals and then working with relevant organizations to streamline or eliminate the excessive administrative burden faced by physicians. The task force will also provide guidance and recommendations on how to avoid creating excessive administrative burdens for physicians in the future. Membership is currently being finalized and will include co-chairs, one appointed by the province and one by Doctors Manitoba, three physician members, and representatives from the health system and Canadian Federation of Independent Business (CFIB).

“Doctors often face excessive administrative requirements that place a burden on their time and take them away from their most important role — providing care to Manitobans when they need it the most,” said Health Minister Audrey Gordon. ​“The launch of this joint task force with Doctors Manitoba to find solutions that will benefit doctors, patients, and our health care system as a whole during Red Tape Awareness Week aligns with our government’s health human resource action plan to retain doctors within the province.”

Today’s announcement follows a report released on Monday by the CFIB, an initiative supported by Doctors Manitoba. The study estimates that Manitoba physicians spend 10 – 11 hours per week on administrative tasks, and 38% could be eliminated or delegated to another member of the care team. That means in Manitoba, there are 591,000 hours spent by doctors each year on unnecessary administrative tasks. That’s equivalent to 1.8 million patient visits. Dr. Bradshaw spoke with media on Monday to emphasize the magnitude of this issue and to urge the government to take action. 

We will be reaching out to physicians in the coming weeks to engage you in identifying unnecessary administrative burdens to help shape the work for the task force. 

Making Progress on Improving Primary Care 

We continue to hear from so many physicians about the crisis in primary care. We want you to know we hear you, and we are pushing for more resources and innovative changes so you can get the support you need to thrive in your practice.

Here are a few updates on where we have made some progress:

  • Extended Hours Premium: Starting Feb 1, family physicians and pediatricians working in primary care will have the option of a 20% premium for ​“extended hours” operations, including early mornings, weeknights and weekends. You can learn more about the initiative in the update last month, and we invite you to join us for a webinar next week on Wednesday, February 8 to learn more about how to use this new option to support your practice. Register for the webinar here.
  • Community Health Clinic After Hours: We resolved an issue for physicians working in community health clinics, to ensure they are remunerated for their work after hours. 
  • Administrative Burden: As announced today (link to story), the government has agreed to launch a task force to reduce administrative burdens for physicians. Family physicians will have a strong voice in this, as we know there is a unique administrative burden in primary care.
  • Family Medicine/​Pediatric Forum: The shortage of physicians is risking primary care access for Manitoba’s youngest citizens. This is a source of distress for both pediatricians and family physicians. We brought representatives from both groups together earlier this week for a forum to discuss the issue and identify potential solutions to focus our advocacy with health system leaders. 
  • Closely monitoring the physician shortage: Using local and national data, we are monitoring and reporting on the shortage of family physicians and specialists, to help inform health system planning and focus on advocacy to support better retention and recruitment initiatives. 
  • Supporting physician health: We have expanded our physician health resources and simplified accessing these services with a new phone number. Available 24/7, you can now call the Physician and Family Support Program at 1−844−433−3762. This line offers free counselling plus a range of other services, along with connecting you to other services like Physicians At Risk and MDCare.

We know these solutions are not enough. Primary care is in crisis as are various specialty areas and hospital based services. Patients have been getting more complex for years and now there’s three years of care that was delayed during the pandemic. Inflation is affecting the bottom line, and the physician shortage and challenges in recruiting aren’t helping either. These are all central considerations for us in our current negotiations for the next Master Agreement. 

We understand there is no one-size-fits-all solution in particular for primary care. That’s why we are pursuing a number of innovative improvements, in addition to general rate increases, to ensure family physicians are better supported with more resources than ever before. This work isn’t easy, and it won’t happen overnight. But we are working on it each and every day.

What about a blended remuneration model, like in BC?

There’s a lot of excitement about the new blended remuneration model in BC, and we see a lot of potential. Launched as an alternative to strictly fee-for-service remuneration, it is designed to support longitudinal family medicine care. It officially launched just this week, and the government announced that about 15% of primary care physicians have signed up.

We continue to monitor for developments and further details on the BC longitudinal family practice model. This has become an important component in our negotiations. Here’s where we are:

  • We have formally tabled a submission in our negotiations with government proposing a blended remuneration model, using BC’s model as a starting point. 
  • We are meeting with our Section of Family Practice and its economic committee, as well as with the Manitoba College of Family Physicians, to seek feedback and guidance about this new model.
  • We are carefully analyzing details about the BC model as they continue to emerge.

Stay tuned for more education and consultation. In the next few weeks, we will be launching more information and education about the BC blended remuneration model and we will be seeking the view of family physicians about this model, and how we can best adapt it into a Manitoba blended model that builds on our successes here and recognizes our realities. Your feedback will be absolutely vital to guiding our advocacy and negotiations work.

In the meantime, there were additional details about the BC model released in the last few weeks, just before physicians could officially adopt the new model starting February 1. In a nutshell, the model blends three types of remuneration:

  • Hourly remuneration of $130/​hour
  • Remuneration for each patient interaction, but at rates lower than a solely fee-for-service schedule
  • Annual panel payment, with the exact methodology still to be confirmed. Initially, an approach similar to BC’s Majority Source of Care (MSOC) methodology will be used to estimate the number of patients. This methodology only counts patients who have had 3 family physician visits in the last 12 months, with at least half of their visits with the family physician claiming the patient. 

Physicians must contribute to the operating costs of the clinic to participate in BC’s blended model. 

It’s natural to look at this new model and calculate what you or a colleague might receive compared to your current remuneration. However, it is quite complex and may not be as straightforward as it appears. There are some caps and limits in the BC model, and some of the unique Manitoba ​“extras” available to family physicians now may not be included under the BC’s model. These issues include:

  • The BC model includes caps and limits on the hours that can be claimed daily and bi-weekly, and on the number of patient interactions that can be claimed daily. 
  • Remuneration for panels and rosters often comes with some rules, and we are watching closely to see what BC proposes. For example, if a patient from a physician’s panel accesses a walk-in clinic or ERs for primary care, is there a penalty of some kind? 
  • The patient interaction remuneration does not appear to have any modifiers for age and complexity, as we have in Manitoba (e.g. modifiers for elderly patients, CCM tariffs, etc.)
  • How do physicians on a blended model access or fund nurses and allied health providers? Would funded supports similar to our MyHealthTeams and ITDI continue to be funded separately, or would they be only be funded through the blended remuneration model?
  • There appears to be additional administrative burdens in terms of tracking start and stop times. While it’s encouraging to see the BC plan recognize clinical administrative time as remunerated work, they do state that for most physicians this should ​“be in the range of 5% of the time claimed.”
  • Services for patients not on your panel cannot surpass 30% of the total.

Based on our analysis, we continue to see a lot of potential for a blended model. Please be reassured that we have raised it with provincial government negotiators and senior health leaders. We are pursuing it. While we do not believe it will be a model of choice for all family physicians, it does offer potential for some that could transform your practice. This is why it is important to have different options available to support different approaches to primary care practice. 

Important Reminders about Virtual Visits

We’ve received several questions and concerns lately about virtual visits, so we are sending an update to all members with some important reminders. 

Virtual visits have become well-established as an option for patients and physicians in Manitoba, with nearly 7 million virtual visits claimed since they were introduced at the beginning of the pandemic. Today, virtual visits are offered through a variety of channels, including through existing physician practices as an extension or alternative to their primarily in-person practice, and through virtual care platforms like Maple and QDoc. Regardless of how virtual visits are offered, it is important that all physicians understand the rules and requirements for virtual visits, both from Manitoba Health and CPSM. Ultimately, it is the responsibility of individual physicians to ensure their practice is compliant.

Doctors Manitoba is always here to assist you in navigating virtual medicine requirements. Please contact us at practiceadvice@​doctorsmanitoba.​ca if you have any questions.

Reminder 1: Virtual Visit Billing Rules

We maintain a virtual visit billing page with a list of tariffs, rates, rate table, claim requirements and billing advice. 

Based on your questions, here are some important key reminders:

  • After hour premiums should only be claimed for urgent or emergent care. 
  • Both the patient and the physician must be in Manitoba for the virtual visit to be claimed with Manitoba Health. Exceptions have been approved by Manitoba Health for patients residing in Nunavut, Saskatchewan and Northwestern Ontario.
  • Pay special attention to claiming the correct virtual visit tariff for the patient visit based on the tariff rules set by Manitoba Health, just as you would for in-person care:
  • A regional or exam for in-person care is equivalent to a ​“virtual visit by telephone or video” (8321).
  • A complete exam for in-person care is equivalent to a ​“comprehensive virtual assessment by telephone or video” (8442 or 8447). Comprehensive virtual assessments involve a full patient history with the same documentation requirements as a complete in-person exam. A comprehensive virtual assessment should not be claimed if an in-person visit follows the virtual visit. Based on the Manitoba Health tariff rules and feedback from physicians, for most episodic primary care encounters we would anticipate a virtual visit (tariff 8321) being the appropriate claim most of the time rather than a comprehensive virtual assessment. 

Reminder 2: Virtual Visit Tariffs Are Not Permanent

After years of advocacy, virtual visits were introduced early in the pandemic as a temporary measure to support continued patient care. Nearly three years later, the pandemic continues and virtual visit tariffs are still only in place on a limited temporary basis, until we negotiate a permanent approach with the government. We are actively negotiating a new Master Agreement with the province right now, and making virtual visits permanent is an important focus of our work. We’ve seen some provinces approach a permanent payment model in different ways, and we want to ensure we have the strongest case possible for Manitoba. 

A few important considerations:

  • Pay particularly close attention to tariff requirements when submitting claims. Ensuring your claims are fully compliant with the rules will strengthen our case as we negotiate making them permanent (see above). 
  • We anticipate Manitoba Health is closely monitoring and studying the value and effectiveness of virtual visits, which is why they require extra information to be collected for virtual visits in order for physicians to claim (e.g. start and stop times). 
  • We anticipate virtual visits will be the focus of Manitoba Health audits into physician billing, to ensure they are being used appropriately. 

As part of our advocacy work, we have conducted public opinion research with Manitobans that shows strong support for making virtual visits a permanent option in Manitoba, but also an expectation that in-person care is available when needed or when desired by the patient. 

Reminder 3: Comply with the Virtual Visit Standard

In addition to the billing requirements from Manitoba Health, the College of Physicians and Surgeons of Manitoba lays out standards physicians must follow. CPSM supports virtual medicine ​“to optimize and complement in-person patient care”. Aside from certain exceptions, any physician providing virtual care must be able to provide in-person care personally to a patient, within 24 to 48 hours of a virtual visit if needed.

One exception is virtual care provided to patients in ​“distant rural, remote or institutional locations” where the patient’s location hinders access to care. There is more latitude given to specialists, where there are fewer options for care. Another exemption permitting use of virtual medicine is if the virtual platform company has an agreement with the health authority, hospital, or government and that care is integrated into the health care system. The other exception is that the timely in-person patient care can be provided by another member of your group family practice. However, the CPSM has made it clear this must be a physical clinic, with shared medical records. 

We recommend reviewing CPSM’s information to ensure your approach to virtual medicine follows their standards. 

  • The Standard of Practice for Virtual Medicine, available through this page. You will notice CPSM emphasizes that ​“each member’s practice of medicine must include timely in-person care when clinically indicated or requested by the patient. It is not an acceptable standard of care to solely practice virtual medicine. A blended model of care balancing in-person and virtual medicine is required if providing virtual medicine.” 
  • An information sheet on practicing virtual medicine across provincial or international borders. This includes Manitoba physicians looking to offer virtual visits to patients outside of the province, and out-of-province physicians 

Like any other care physicians deliver, CPSM may receive complaints and investigate concerns about the provision of virtual medicine. 

Physician of the Week

Dr. Eric Lane is our Physician of the week. He has been involved in the care of many multi-generational families. Dr. Lane has delivered more than 750 babies, some born to patients he delivered decades ago. He is proud to have been involved in establishing a community-based clinic that grew from six doctors when he first started to more than 40 physicians today. Long-time colleague and friend Dr. Don Klassen calls Dr. Lane a​‘consistent presence’ and says,​“physicians like Eric often go unrecognized but are the heart of our profession!” Dr. Klassen values Dr. Lane’s willingness to​go beyond what most situations dictate. Read more about Dr. Lane and others who have been named Physician of the Week here.

What is Physician of the Week? 

For 2023, we have established a new way to recognize dedicated and hardworking physicians. The Doctors Manitoba Physician of the Week will exemplify the best of the medical profession, including a commitment to delivering exceptional patient care, to supporting the health and wellness of their colleagues, and/​or to leadership in the medical profession.You can suggest a colleague as Physician of the Week here.

Disrupting Racism

Last week, Shared Health released its plan to disrupt racism in health care (see summary here). This week, the Assembly of Manitoba Chiefs held a Special Chiefs Assembly on Health Legislation on Treaty One Territory.

CPSM Apologizes for Racism Towards Indigenous People

At this event, CPSM delivered a Statement and Apology on Truth and Reconciliation and Indigenous-Specific Racism in Medical Practice. The apology was delivered by Registrar Dr. Anna Ziomek, President Dr. Jacobi Elliott, and Past President Dr. Ira Ripstein, with Dr. Lisa Monkman delivering opening remarks as Chair of the CPSM Truth and Reconciliation Advisory Circle. The apology noted CPSM’s failure to regulate the medical profession’s current and past racist treatment of Indigenous peoples is a tragic part of CPSM’s 150-year history, and acknowledged that Indigenous racism continues to exist in the medical profession resulting in great harm to Indigenous people. CPSM emphasized that an apology is only the beginning and that much work needs to be done to ​“work towards establishing truth and reconciliation between the regulator of the medical profession and Indigenous peoples in Manitoba.”

The statement recognizes and outlines in depth the current and past Indigenous-specific racism in the medical field. Along with the apology comes a pledge for improvement.

“Guided by Indigenous physicians, scholars, Elders, and knowledge keepers along with the legal and ethical requirements to provide respect, dignity, and equitable health care for Indigenous persons in Manitoba” CPSM pledged a long list of actions, including developing a standard of practice to prevent Indigenous racism, ensuring CPSM staff and councillors are trained in Indigenous anti-racism, unconscious bias, and where appropriate, trauma-informed care, and requiring all registrants to participate in Indigenous cultural safety and anti-racism training. 

You can read the full statement and apology here.

AMC Grand Chief Cathy Merrick appreciated the apology and statement. ​“We think of the many First Nations patients who have experienced racism and discrimination in medical practice, some of who lost their lives in the health care system and know that we have to collectively address this on many levels,” she said. ​“I walk away with cautious optimism until I hear and feel from our people the changes you promise here today.”

Dr. Marcia Anderson Honoured

This week the Assembly of Manitoba Chiefs honoured Dr. Marcia Anderson for her work to prevent the spread of COVID-19 in First Nation Communities. She worked collaboratively to develop a process to stratify and report data separately for First Nations people, which became one of the foundations for influencing how the government and health system responded to the needs of First Nations people and communities during the pandemic. Through the pandemic Dr. Anderson found herself in the national spotlight for her work supporting public health for Manitoba First Nations on the Pandemic Response Coordination Team. Her work in this area also led to her being honoured as Doctors Manitoba Physician of the Year for 2022. 

Hospitals to Collect Patient Race and Ethnicity Data

Beginning this spring, the province will ask patients to self-declare their racial or ethnic background as part of the hospital admission process under a new joint UM and Shared Health initiative. This builds on the race, ethnicity and Indigeneity data collected during COVID testing and vaccination which was foundational in directing the pandemic response. Because of the success of that initiative, it will be led by Dr. Marcia Anderson and the First Nations Pandemic Response Team. 

Manitoba appears to be the first province to roll out this data collection, which Dr. Anderson said is a key part of the plan to ​“disrupt and dismantle systemic racism in health care.”

Disclosing one’s identity will be voluntary and physicians and staff will receive training as part of the project.

Doctors Manitoba started voluntarily collecting REI data from our members in the last two years to better understand inequities in the medical profession. You can declare your identity in your Member Portal account or by contacting our office.

You can read more about the initiative in this CBC story.

February is Black History Month

Black History Month gives all Canadians the opportunity to learn about and celebrate the many accomplishments and contributions that Black Canadians have made and continue to make on our country’s history and cultural landscape, including in medicine. It is also a time to identify and work to break down the many barriers Black Canadians face. 

We’ve put together a brief story about Black History Month, including events and resources to support you. Stay tuned for feature stories later this month highlighting Black physicians. 

CMA Election

It’s Manitoba’s turn to elect the next President-Elect of the Canadian Medical Association. As the voting period approaches, we have a few key updates:

  • The CMA will be hosting a candidates forum on February 13 including a Q&A.
  • The CMA has posted information about each candidate, including their background and vision. 
  • You must be a current CMA member to participate, as of February 16. This means you can still join to vote. 
  • Voting opens on February 22 and runs until March 8. 

We set up a CMA election page with links to register for the candidates forum, information about each candidate, and instructions on how to check your CMA membership and renew if needed. You must be a CMA member to participate. Doctors Manitoba members are not automatically CMA members, so it is important to check your membership status. 

The four candidates include Dr. Cory Baillie, Dr. Anthony Battad, Dr. José François, and Dr. Joss Reimer. 

Resident Appreciation Week

Next week is Resident Appreciation Week. Resident Physicians work hard caring for Manitobans, all while learning and supporting attending physicians. Show a resident physician some appreciation by sending them an eCard from our website. Throughout the week we will have many different events planned to show our appreciation for Manitoba’s hard-working and brilliant Resident Doctors. Next week’s Physician of the Week will be a resident physician and we plan to announce the 2023 Doctors Manitoba Resident of the Year next Friday. Stay tuned!

Respiratory Virus Updates

Surveillance Update

Manitoba Public Health produces a weekly report on respiratory viruses. Below are highlights from this week’s report.

COVID Surveillance

This week’s report covers the week ending January 28 and shows similar activity for COVID compared to recent weeks. Highlights include:

  • There were 6 hospital admissions, down from 7 last week and a continued steady decline over the last five weeks. This week included 2 ICU admissions, down from 3 last week. Weekly hospital admissions last peaked at 264 in the week ending April 16.
  • There were no COVID deaths recorded over the last week. 
  • There were 62 lab-confirmed cases reported in Manitoba, up from 59 last week.
  • The test positivity rate was 10.5%, down from 11.3% last week.
  • Wastewater surveillance data from January indicates sustained activity of COVID-19 in Winnipeg and Brandon at lower levels. 

Influenza & RSV

Influenza activity continues to decrease. Highlights include:

  • Test positivity for influenza A was 0.5% this week, down from 0.8% last week. The predominant strain circulating right now is still Influenza A (H3N2), with 9 lab confirmed cases (down from 10 last week) and there has been 1 case of Influenza B reported (with a test positivity rate of 0.2%).
  • There were no hospital admissions as a result of flu/​RSV (down from 2 last week).
  • There were 1,300 respiratory related visits to EDs in the province this week, down from 1,306 last week.
  • RSV is also circulating with a 5.7% test positivity rate, down from 8.3% last week.

Health System Updates

MMR Eligibility Updated

Manitoba Public Health has updated eligibility for the Measles, Mumps and Rubella vaccine as follows: Effective immediately, children aged 6 months to under 12 months are eligible to receive one additional dose of MMR vaccine if travelling to a measles-endemic country. 

They have issued a reminder that ​“if a child receives a dose of MMR before age 12 months, that child should still receive their two routine doses of MMR at 12 months and 4 – 6 years of age.” 

See public health’s memos here and here.

Health in the News

Another busy week of health news. We’ve curated the top stories with exclusive access to subscription-only content. 

Doctors Manitoba in the News

Other Notable Health Stories

ICYMI

Here are some of our top recent posts, in case you missed them. 

Events

Upcoming events are always listed on our events calendar.

Featured Events

Webinar for New Extended Hours Premium for Primary Care — February 8, 2023 — 6:30pm
Learn about the new Extended Hours Premium for Primary Care, including the requirements to qualify, billing advice, and tips to optimize your practice for extended hours. 

Dissecting the Culture of Medicine: Addressing Systemic Inequities from Patient to Provider — February 11, 2023 — 9am-4pm
Learn from various provider and patient perspectives on how to foster anti-discrimination in practice.

Other Events

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