FEE CODE UPDATES

We have once again been awarded compensation as a (relatively) underpaid specialty.

There was approximately $2M left over from various disparity awards that we have allocated to inpatient follow-up visits based on your feedback.

While we are continuing to work on APP contracts for inpatient work (see below), we have heard time and again that inpatient (MRP) care is among the least well remunerated work we do. Hopefully, this is a step in the right direction to correct that.

Another step in the right direction is expanded criteria to bill complex follow-up codes. As of Sept 1, 2025, there will be fewer restrictions on both inpatient and outpatient complex follow-up.

For inpatient care
Complex follow-up will no longer be restricted to the first 10 days of admission

For all follow-up visits
The 6-month limit (following a complex consult) will no longer apply

You will also be able to bill a complex follow-up on a patient that did NOT initially have a complex consult.

We have been working on these changes for some time and are thrilled to finally have them in effect.

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APP NEGOTIATIONS

Webinar Debrief

On Thursday, June 26th, SGIM hosted an online event to provide members the opportunity to hear the first-hand account of the experience of one hospital’s APP contract negotiation. Their legal counsel, David McWhinnie, was available for a Q&A session.

We discussed how to get set up for success by being organized, drafting a clear proposal, and being able to make a business case to back up your requests.

We also discussed how to get the most value from your legal counsel, options for leverage, and the risks associated with this process (i.e. consequences of many forms of “job action”, risk of audit, etc.)

Most importantly, we must work together to increase our negotiating power with hospital administration and the government. While each group has specific needs, we can build on the “wins” each site achieves and work towards better contracts for everyone. A high tide raises all boats.

We would like to ask all groups to forward their current service contracts/APP agreements to SGIMBC. This information will be kept confidential and used only to inform other groups of what is possible to achieve.

Supports

If you’re navigating Alternative Payment Plan (APP) negotiations or implementation, SGIMBC is happy to share insights and experiences from recent work in this area.

Members involved in APP discussions are available to offer peer support, context, and lessons learned.

While this is not formal legal advice, we believe that shared experience can help others feel more prepared, informed, and confident heading into these conversations.

Please feel free to reach out to shannon.harrison@sgimbc.org.

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EVERYTHING cSBC 

Over the past several years, they have made substantial progress on improving the working conditions for specialists.  

They were instrumental in the development of the “Advice” codes (i.e. 10001, 10005, 10007, 78710, etc) that allow us to get paid for previously uncompensated work.  cSBC also worked with MSP to develop the Implicit Re-Referral (IRR), which allows us to bill new consults every 6 months (without the need for a new referral). 

With respect to the issue of rising waitlists, they have been ardently working on the “Specialist Waitlist Management Initiative” that would remunerate us for administrative/non-clinical time (similar to payments under the Longitudinal Family Practice (LFP) model).

Using a data-driven approach, cSBC is working to show the government that specialists are cost-effective to the system as a whole and thus deserving of more funding (especially for those providing rural/remote services).    

They also continue to advocate for increased training & workforce development, team-based care (where appropriate), and are in the process of rolling out Health & Dental benefits plans specifically designed for specialists (as well as their families and staff).  Finally, they are offering discounted consulting services to assist physicians looking to apply for SR&ED (research) tax credits.  

Perhaps most importantly, they have a seat at the table(s) that we don’t as an individual section. They are better able to liaise directly with DoBC, MSP, Government and other stakeholders on our behalf that is difficult or impossible to do on our own. 

However, they are chronically underfunded (especially compared to BC Family Doctors) and are thus hampered in how much they can help.

We encourage all our members to join the Consultant Specialists of BC as an important organization advocating on our behalf.   

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BILLING FOR PROCEDURES

Due to outdated (but never updated) payment rules, MSP considers a “visit” to be part of the fee for a procedure.

This is illogical as our follow-up visits (in isolation) are remunerated at a higher rate than any procedure. As a result, billing a procedure (i.e. thoracentesis, but also ETT) on the same day as a follow-up fee will result in the follow-up fee being rejected.

This leads to many people not billing the procedure at all or essentially doing the work for free.

These rules do NOT apply with respect to new consults (which can be billed on the same day as a procedure).

It has come to our attention that many sites at remote sites that are referred for cardiac testing (i.e. ETTs or MIBIs) to referral centres are being booked for new consults, even if they have previously been seen by another GIM for the same issue. While this is understandable from a billing perspective for the reason above, this may not be the most efficient use of patients’ time, nor a cost-effective use of our healthcare dollars.

We would encourage regional Division and Department heads to look into this matter.

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