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SOCIETY OF GENERAL
PRACTITIONERS
A GP FOR ME
AND
RELATED GPSC INCENTIVES
JUNE 2013
DR. CATHY CLELLAND
EXECUTIVE DIRECTOR, SGP
FACULTY/PRESENTER
DISCLOSURE
Faculty: Dr. Cathy Clelland
Relationships with commercial interests:
• None
DISCLOSURE OF
COMMERCIAL SUPPORT
This program has received no financial support from any
commercial organization.
Potential for conflict(s) of interest:
• There is no potential for conflict of interest. This presentation was
developed through membership dues funding of the Society of
General Practitioners of BC. The SGP is the Section of General
and Family Practice within the BCMA and part of its mandate is to
support the economic interests of all family physicians in BC.
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MITIGATING POTENTIAL
BIAS
There is no potential bias to mitigate as SGP policy
prohibits commercial support of its activities.
DISCLAIMER
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The Medicare Protection Act requires that every physician maintain
such records as may be necessary to establish whether he or she
has provided an insured service to a person, that it was medically
necessary, and that the service billed to MSP was the service the
physician provided.
The presenter has made every effort to ensure that the examples
presented represent “best practice “ billing.
However, all physicians must personally read their BC MSP fee
schedule preamble and be responsible for meeting all criteria for the
appropriate billing of the services they provide
When in doubt consult your MOH advisors.
All of the service and documentation criteria elaborated in the
schedule of benefits must be provided and documented for
appropriately submitting the answers to the following billing
examples.
EDUCATIONAL
MATERIALS
Society of General Practitioners of BC www.sgp.bc.ca
BC Medical Association www.bcma.org
• MSP Fee Guide and Updates
• Uninsured service guidelines
GPSC Website Attachment Initiative section:
http://gpscbc.ca/attachment-initiative
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Billing questions: info@sgp.bc.ca or
gpsc.billing@bcma.bc.ca
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A GP for Me
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(or the Attachment Initiative)
A GP FOR ME: BACKGROUND
Number of unattached patients in BC uncertain
Using Canadian Community Health Survey data, it
is estimated:
• 13.8% of British Columbians (~615,000 people) have no
regular family physician; and
• 3.96% (~176,000) are looking for a family physician, but
cannot find one.
A GP FOR ME: BACKGROUND
Hollander's BC data indicates better outcomes
at lower costs for patients attached to a FP
Care through walk-in clinics or Emergency
Departments
• fragmented & expensive
• poorer outcomes
Lack of access = health inequities
2010 Government commitment to provide a
family physician for any BC resident who wants
one, by 2015
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A GP FOR ME: GOALS
Confirm and strengthen the FP-patient
continuous relationship
Better support the needs of vulnerable patients
Enable patients that want a family doctor to find
one
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Increase the capacity of the primary health care
system
A GP FOR ME:
FEE SUPPORTS
Attachment Fees
1. Attachment Participation Code
2. Unattached Complex/High Needs Patient
Attachment fee
3. Non-Complex Unattached Patient Intake (future
incentive)
4. Complex Care Management Expansion
5. Telephone Management Expansion
6. Patient Conferencing Simplification
A GP FOR ME:
FEE SUPPORTS
Attachment Participation Code G14070:
• Once per physician per calendar year
• Submission indicates the FP will:
• provide continuous full service family practice services
• confirm their primary care relationship with their patients
• register with and work with local Division of Family Practice and/or community
to develop community-specific supports as they are able
Locum Attachment Participation Code G14071:
• Submit at start of first locum of the year in an Attachment participating
practice – covers for rest of calendar year.
• Submission indicates the Locum will:
Participation opens access to Attachment fees
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provide continuous full service family practice services when covering in an
“Attachment Participating Practice”
contacted the Divisions of Family Practice central office
(AGPforME@divisions.bc.ca) to share contact information and to indicate a
willingness to participate as a locum in the community-level Attachment
initiative as the locum is able
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A GP FOR ME:
FEE SUPPORTS
Attachment Participation Code G14070 &
Locum Attachment Participation Code G14070
Submit with “Patient” Identifiers
•
•
•
•
•
PHN#: 9753 035 697
Patient Surname: “Participation”
Patient First Name: “Attachment”
Date of Birth: January 1, 2013
ICD-9 code: 780
A GP FOR ME:
FEE SUPPORTS & LOCUMS
Needs to be a discussion between the host FP and
the locum as to the provision of any service that is
covered by any GPSC incentive regardless if the host
FP is participating in the Attachment Initiative or not.
Many of the GPSC incentives are for services or care
that goes beyond the individual visit and this needs to
be considered in the discussion and agreement.
Once 14071 has been submitted, GPSC Attachment
fee supports may be billed for the services provided by
locum as agreed to between locum and host FP.
FAMILY PHYSICIAN-PATIENT
‘COMPACT’
As your family doctor I, along with my practice team, agree to:
Provide you with the best care that I can
Coordinate any specialty care you may need
Offer you timely access to care, to the best of my ability
Maintain an ongoing record of your health
Keep you updated on any changes to services offered at my clinic
Communicate with you honestly and openly so we can best address your health care
needs
As my patient I ask that you:
Seek your health care from me and my team whenever possible and, in my absence,
through my colleague(s), xxxxxx
Name me as your family doctor if you have to visit an emergency facility or another
provider
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Communicate with me honestly and openly so we can best address your health care needs
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A GP FOR ME:
FEE SUPPORTS
Physician-Patient ‘Compact’:
NO need to call in each patient
Can be done face-to-face, by letter or other
communication, or by posting this standardized ‘Compact’
in office and examination rooms
Supportive materials (posters, brochures) are available
from the GPSC website (www.gpscbc.ca)
A GP FOR ME:
FEE SUPPORTS
Attachment Fees
1. G14076 GP Attachment Telephone Management fee
2. G14075 GP Attachment Complex Care Management fee
3. G14077 GP Attachment Patient Conference fee
4. G14074 GP Unattached Complex/High Needs Patient Attachment fee
5. Non-Complex Unattached Patient Intake (future incentive)
G14074 UNATTACHED
COMPLEX/HIGH NEEDS PATIENT
ATTACHMENT FEE
$200 in addition to visit
• Compensation for time consuming intensive process of integrating a new patient
with higher needs into a practice
• Commit to provide ongoing, longitudinal FSFP care
• Target Populations
•
Complex/high needs populations
•
•
•
•
•
•
Frail in community and in residential care
High needs chronic conditions
Cancer patients
Severe disability
Mental health and substance use
Mother/Baby dyad is counted as one
•
May be accepted into longitudinal practice at any time during pregnancy up to child
aged 18 months
• G14077 GP Attachment Conference fee payable on same day for same
patient if all criteria met.
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• Patient must be referred.
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G14074 UNATTACHED
COMPLEX/HIGH NEEDS PATIENT
ATTACHMENT FEE
Unattached Complex/High Needs Patient Referral
Sources
Acute Care: ER and Admitted
Mental Health/Substance Abuse Workers/Clinics
Home and Community Care
BC Cancer Agency or regional centres
Public Health
Colleagues
Local Division
Patients cannot self-identify
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•
•
•
•
•
•
•
•
NON-COMPLEX UNATTACHED
PATIENT ATTACHMENT FEE
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• Future incentive
• Lower priority
• Placeholder for future consideration as funding is
identified
COMPLEX CARE EXPANSION
Complex Care Incentive developed to compensate in advance
for the extra time required to provide planned care to more
complex patients that are living in their home or in assisted
living.
The Complex Care Planning Visit can be provided and billed
once at any time in the calendar year. The development of the
care plan is done jointly with the patient &/or the patient
representative as appropriate. The patient & or their
representative/family should leave the planning process
knowing there is a plan for their care and what that plan is.
Payable only to the General Practitioner who accepts the role
of being Most Responsible for the longitudinal, coordinated
care of that patient over the following year.
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COMPLEX CARE EXPANSION
FPs participating in Attachment Initiative have access to both Attachment
Complex Care fee (G14075) and original Complex Care fee (G14033) for eligible
patients.
Both have 30 minute time requirement
CDM Fees and Conferencing Fees payable in addition to complex care on same
day when indicated, but conferencing time does not count toward 30 min
complex care time requirement
Complex Care fees billed in addition to office visit or CPX (as clinically indicated)
for that initial process on the day of the planning visit
Care provided face to face over rest of calendar year billed under MSP visit fees
Both will allow access to G14079 – GP Telephone/e-mail Follow-up Management
Maximum 5 Complex Care fees billable of any combination per calendar day
Unlike the CDM fees which are for overall guideline informed management of
chronic diseases for the previous year, it is NOT required that Complex Care Fees
be billed on the anniversary date of the first billing for the complex care planning
visit.
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COMPLEX CARE EXPANSION
G14075 GP Attachment Complex Care Management fee
• Access requires submission of Attachment Participation Code
• Initial expansion for diagnosis of 'Frailty' for patients who do not
otherwise qualify for original Complex Care Fee G14033
• Canadian Study of Health and Aging Scale; Level 6 & 7
• Moderately Frail: Help is needed with both instrumental and
non-instrumental activities of daily living
• Severely Frail: Completely dependent on others for the
activities of daily living, or terminally ill
• FPs participating in the Attachment initiative still have access to the
original Complex Care incentive (G14033) for qualifying patients.
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FPs choosing not to participate will only have access current FP complex
care dual-diagnosis fee item G14033
COMPLEX CARE EXPANSION
G14033 Annual Complex Care Management Fee
The original complex care fee (G14033) eligibility requires two of the
following chronic condition/categories:
• Diabetes mellitus (type 1 and 2) (DM)
• Chronic kidney disease (includes polycystic kidney and chronic
glomerulonephritis with eGFR > 60 in addition to stage 3, 4 & 5 CKD)
• Congestive heart failure (CHF)
• Cerebrovascular disease (CVD)
• Ischemic heart disease (IHD), excluding the acute phase of myocardial
infarct
• Chronic Respiratory Condition (asthma, emphysema, chronic bronchitis,
bronchiectasis, Pulmonary Fibrosis, Fibrosing Alveolitis, Cystic Fibrosis etc.)
• Chronic Neurodegenerative Diseases (CND) (Multiple Sclerosis,
Amyotrophic Lateral Sclerosis, Parkinson’s disease, Alzheimer’s disease,
stroke or other brain injury with a permanent neurological deficit, paraplegia or
quadriplegia etc.)
• Chronic Liver Disease (CLD) with evidence of hepatic dysfunction.
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ORIGINAL COMPLEX CARE FEE
DUAL DIAGNOSES CODES
Dx Code Dual Diagnoses
Dx Code Dual Diagnoses
N519
CND + Respiratory
I250
IHD + DM
N414
CND + IHD
I430
IHD + CVD
N428
CND + CHF
I585
IHD + CKD
N250
CND + DM
I573
IHD + CLD
N430
CND + CVD
H250
CHF + DM
N585
CND + CKD
H430
CHF + CVD
N573
CND + CLD
H585
CHF + CKD
R414
Respiratory + IHD
H491
CHF + Respiratory
R428
Respiratory + CHF
D430
DM + CVD
R250
Respiratory + DM
D585
DM + CKD
R430
Respiratory + IHD
D573
DM + CLD
Respiratory + CKD
C585
CVD + CKD
Respiratory + CLD
C573
CVD + CLD
I428
IHD + CHF
K573
CKD + CLD
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R585
R573
TELEPHONE MANAGEMENT
EXPANSION
G14076 GP Attachment Telephone Management Fee
• Requires submission of Attachment participation code by FP
• $15 per 'visit'
• All patients for whom that FP is community MRP
• 500 per physician per calendar year (Locums also have own 500 per year)
• Intent is to use to avert need for a visit; in practice, WIC, ER
• Requires clinical discussion. NOT for:
• notification of appointments, referrals
• prescription renewals
• May be delegated to another College-certified healthcare professional
(MOA not included)
• Patients who are eligible for the GP Patient Telephone/e-mail Follow-up
Management fee (G14079) are also eligible for the GP Attachment
Telephone Management fee (G14076) but not on same day for same
patient – see separate slide
FPs choosing not to participate will only have access current G14079
TELEPHONE MANAGEMENT
EXPANSION
G14079 GP Telephone/E-mail Follow-up Management fee
If sharing care with another FP (eg. shared practice, locum or on-call) – for
both telephone call fees (G14076 & G14079) submit with e-note
“locum/covering for Dr. X billing number YYYYY”
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• Must have at least one of G14033, G14043, G14053, G14063 or G14075
successfully billed in previous 18 months.
• May bill up to 5 phone/e-mail follow up fees (requires 2 way
communication) per patient per calendar year.
• Telephone/E-mail (2 way) service may be provided by GP or staff (including
MOA). Not for simple appointment reminders or prescription renewals.
• Patients who are eligible for the GP Patient Telephone/e-mail Follow-up
Management fee (G14079) are also eligible for the GP Attachment
Telephone Management fee (G14076) but not on same day for same
patient.
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GP CONFERENCING FEES
Developed to compensate the GP when
conferencing with other health care professionals
for the creation of a coordinated clinical action plan
for the care of patients with more complex needs
Payable in units of $40.00 per 15 minutes or greater
portion.
Billable in addition to any visit as long as not done
simultaneously
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Billable by Community GP who accepts the role of
being Most Responsible for the longitudinal,
coordinated care of that patient.
PATIENT CONFERENCING
SIMPLIFICATION
G14077 GP Attachment Patient Conference fee
• Access requires submission of Attachment Participation Code
• Less restrictive; replaces G14015, G14016 & G14017
• Removes requirement for onsite attendance for conferencing on
patients in a facility
• Removes need to conference with 2+ other healthcare professionals
• Initiation by facility not required; either side can trigger
• Any patient for whom FP is community MRP – no diagnostic
restrictions
• Any time either side feels is clinically warranted
• $40 per 15 minutes or greater portion thereof
• Max 2/calendar day, up to max 18/calendar year per patient
Non-participants still have access to current fees (see next slide)
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GP CONFERENCING FEES
ORIGINAL CODES
14015 – Facility Patient Conferencing Fee
14016 – Community Patient Conferencing Fee
14017 – Acute Care Discharge Planning
Conferencing Fee
Same eligible patient population, only location different:
• Frail elderly (ICD-9 code V15)
• Palliative care (ICD-9 code V58)
• End of life (ICD-9 code V58)
• Mental illness
• Patients of any age with multiple medical needs or
complex co-morbidity
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CONFERENCING WITH
SPECIALISTS
G14018 GP Urgent (< 2 hours) Telephone Conference
with a Specialist or GP with Specialty Training Fee
……….. $40
Payable to the GP who initiates a two-way telephone
communication with a specialist or GP with specialty training
regarding recommendations for urgent assessment and
management of a patient but without the responding physician
seeing the patient.
Severity of patient’s condition must justify urgent conference
for development of a clinical action plan to keep the patient
safely in their location.
No specific age, diagnostic or location requirements.
Conference fee (14016) for less urgent community patients in the specified
categories.
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* May use Attachment Patient Conference fee (14077) or Community Patient
OTHER GPSC INCENTIVES UNCHANGED
BY ATTACHMENT INITIATIVE
Chronic Disease Management
o
o
o
o
14050 – Diabetes Mellitus (ICD-9 code 250) - $125.00
14051 – Congestive Heart Failure (ICD-9 code 428) - $125.00
14052 – Hypertension (ICD-9 code 401) - $50.00
14053 – COPD (ICD-9 codes 491, 492, 494 or 496) - $125.00
Prevention Initiative
o 14066 Personal Health Risk Assessment Fee - $50.00
Mental Health Initiative
o
o
o
o
o
o
G14043 – GP Mental Health Planning Fee $100.00
G14044 – GP Mental Health Management Fee age 2–49
G14045 – GP Mental Health Management Fee age 50–59
G14046 – GP Mental Health Management Fee age 60–69
G14047 – GP Mental Health Management Fee age 70–79
G14048 – GP Mental Health Management Fee age 80 and over
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Palliative Care Planning Fee (G14063) - $100.00
A GP FOR ME:
DIVISIONAL SUPPORTS
32 Divisions, including new provincial Rural and Remote Division
Over 95% of FPs have a Division available
$40M one-time funding to support the Attachment work of Divisions
$24M Discretionary MoH support for non-physician expenditures;
$16M GPSC allocation for physician-related costs
In areas where there is no Division an alternate mechanism will be made
available
Allows:
Engagement with and expansion of membership;
Assessment of community makeup, local primary care system;
Collaboration with local HA through the CSC to identify problems, develop
local solutions and provide community-specific supports for Attachment;
and
Implementation of agreed-upon plan.
Not to be used for:
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Long term (ongoing) Leases
Long term (ongoing) Contracts with Allied Health Professionals or Physicians
Solutions will vary – community-specific
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