A list of changes Alberta is making to doctor rules, fees

EDMONTON — The Alberta government is implementing 11 changes to physician rules and fees starting April 1:

Complex modifiers: These fees would mandate more time be spent with patients with complex needs, 25 minutes instead of 15, before an extra fee would kick in. This plan will be phased in next year. For this year, the complex modifier can still be charged at the 15-minute benchmark, but will pay $9 instead of $18. The Alberta Medical Association, or AMA, says these changes could limit services, lead to physicians focusing on non-complex patients and bankrupt some rural and family offices.

Care plans: Comprehensive annual care plans are mutual agreements between a doctor and a patient to help the patient manage their health needs. These will be ended, because they duplicate existing coverage. The AMA has offered to tighten rules on these plans and say they still have value.

Seniors' driving exams: Patients older than 74 1/2 years will now pay out of pocket for medical exams needed to get a driver's licence. The change aligns with coverage in other provinces and makes it consistent with other Albertans who have to pay. The AMA has said it expects complaints from seniors and has urged further consultation.

Diagnostic imaging referrals: There will be no more payments for diagnostic imaging referrals by uninsured practitioners, including chiropractors and physical therapists. Only those providing publicly funded services will be paid for referrals. The AMA has urged further consultation on this, as it could lead to longer wait times for tests.

Diagnostic imaging: Fee rules and codes will be streamlined to prevent duplicate billing and over billing. The AMA says billing changes could create barriers to care.

Patient visits: The province will pay to maximum of 65 patients a day, to ensure physicians are not fatigued and patient care is not compromised. The cap applies to office visits, not hospital visits, and rural offices are exempt. The AMA has said this kind of cookie-cutter approach won't work, given that visits vary based on geography and speciality.

Overhead: Physicians will not allowed to bill for overhead costs such as equipment, supplies, leases and technical staff for work delivered in an Alberta Health Services facility, since these costs are already provided by the province. The AMA criticizes this proposal as an ineffective, one-size-fits all approach. It says doctors working in AHS facilities already have a range of counter-balancing agreements in place.

Clinical stipends: These salary top-ups will be ended. Former regional health authorities used them as incentives to compete for physicians, but are no longer necessary under one integrated provincewide health system. The AMA says this could make it harder for Alberta to recruit physicians and thereby reduce access to doctors in some areas.

Submission of claims: Physicians now have 90 days, instead of 180, to submit payment claims to improve provincial budget forecasting, policy and planning. The government originally wanted a 60-day deadline, but the AMA said that was unnecessarily restrictive and could lead to physicians not being reimbursed if there were billing problems.

Non-invasive diagnostic tests: Fees in AHS facilities for these tests, such as electrocardiograms, will be standardized for consistent compensation. The AMA says it may make it hard to find physicians willing to provide the service, increasing wait times.

Good-faith claims: No more claims will be accepted for services for patients who can't provide proof of Alberta residency or Alberta health coverage, in order to reduce unpaid billing claims. The AMA says this could impact inner-city people, many of whom don't carry health cards.

This report by The Canadian Press was first published Feb. 20, 2020.

The Canadian Press