Primary care changes won’t reduce costs, says rural doctor

By Kalinowski, Tim on March 11, 2020.

Tim Kalinowski

Lethbridge Herald -raymond

A family doctor in rural Alberta says recent changes made to the way primary care is funded in the province will cost Albertans more, deliver less in patient care and create poorer medical outcomes.

Dr. Gregory L. Smith of the Raymond Medical Clinic says unilateral changes brought in by the Alberta government to the way primary-care clinics can bill will not do what the government hopes, and reduce costs or improve wait times.

Smith recently posted on his Facebook page a complete breakdown on costs per patient at his clinic to refute the government’s numbers. The standard rate is $38 for 10 minutes with a physician, and until the Kenney government tore up its contract with the Alberta Medical Association, there was an $18 top-up added if the visit lasts more than 10 minutes. This would mean about four patients could move through in an hour, and ensure they had all their needs taken care of medically, Smith says, at a cost of about $224 per hour before expenses such as clinic equipment needs and staff salaries are paid. Under the changes recently brought in, the government has axed the 10-minute $18 top-up meaning physicians won’t do anything more than they can in that 10 minutes as they have no incentive to do so, states Smith; or they will have to choose to work for free. This means physicians will likely move through six patients in an hour for about $228 per hour.

That might look good on an accountant’s sheet, but the problem, says Smith, is no patient ever comes to him with only one quick problem to solve. And if they are new patient, a physician can barely even get through a full patient history in that 10 minutes. That means the patients will have to re-book another appointment later on for any additional concern, costing the taxpayer far more money in the end because of the need for additional visits.

“So you might say you are seeing more people so that moves more people through the system,” Smith confirms. “Yes, but you’ve got to remember those four people that were being seen under the previous model all can’t get done in the 10 minutes. So those four people are going to end up taking eight visits. Instead of dealing with four people’s problems in an hour, now it’s going to take an hour and 20 minutes to deal with those four people, and it’s going to cost you way more. If you are looking to save money this is the dumbest possible way to go about it.”

The government has argued the new system will reduce wait times and bring costs down.

There are two reasons that won’t happen, says Smith. First, what has been stated before about the need for multiple patient visits will actually increase the number of visits needed per patient and increase health-care costs. And second, people with medical problems aren’t just going to go away if they don’t have their needs met in a family clinic on a particular day.

“What people need to understand, I think, is there is no better deal in health care than primary care,” he says. “My office is the cheapest place to give health care, bar none. So if you reduce my ability to do that, and the ability of people like community pediatricians and internists to do that, what government doesn’t seem to understand is those patients just don’t go away. It’s not like a standard economic model where you say, ‘Well, I can’t get that, so I guess I will get something else.’ No, they are sick, they need care, and so they will get it somewhere. And usually the place they will end up getting it is in the emergency room, which is probably one of the most expensive, least (cost) efficient, ways to provide health care.”

The cost for emergency room treatment is about $1,000 per visit. It’s about $8,000 per week to put someone into the hospital. And, Smith predicts, far more patients will be seeking their care there under the new system – all because the provincial government wants to save $74 per hour by not providing top-ups for family physicians to spend a bit more time with each patient to ensure all their medical needs are met.

“Everybody’s aware of the (province’s) financial situation,” he says. “We doctors are aware there will probably need to be cuts. I don’t think anybody is fighting that. It’s just the way those cuts have been done and the places they have been done … One of the insulting things about this is Minister Shandro has said he’s convinced that the doctors just don’t understand this (new billing system), and just don’t understand the implications. I think that’s quite offensive to say we don’t understand our own bottom line and we don’t understand what the delivery of health care is all about.”

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