ALBERTA, CANADA: Doctors’ group changes target private clinics


By Cailynn Klingbeil, Edmonton Journal

[Edmonton, AB] Friday, September 6, 2013, physicians cannot promise or provide preferential access to insured services to patients who are already paying them fees for uninsured medical services.

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Health Minister Fred Horne said Friday he welcomed the Alberta’s College of Physicians and Surgeons taking on the issue of private clinics and the fees they charge. Photograph by: Larry Wong , Edmonton Journal

EDMONTON, ALBERTA, CANADA | SEPTEMBER 6, 2013 – Alberta’s College of Physicians and Surgeons moved Friday to clarify rules around private clinics and the fees they charge patients.

Under a new standard of practice rule adopted Friday, physicians cannot promise or provide preferential access to insured services to patients who are already paying them fees for uninsured medical services.

The change stops doctors from providing preferential access to any insured medical services based on a patient’s ability to pay.

“The area that brought this to our attention are so called boutique or concierge clinics, where patients may have to pay a fee to get a family doctor,” said Dr. Trevor Theman, registrar at The College of Physicians and Surgeons of Alberta.

“We know there are many, many patients who can’t get access to a family doctor, and so the idea of a financial barrier that would limit their access is part of what we’re trying to address here.”

patient guide dpc smallSuch clinics charge patients annual membership fees for preventive care by multidisciplinary teams. Typically, the fees cover a basket of uninsured services.

The clinics frequently promise quick access and unrushed appointments with family physicians who have a smaller patient load than most practitioners.

The change follows revelations of queue jumping at a public inquiry earlier this year. Patients who paid membership fees of up to $10,000 a year at a private Calgary clinic got expedited access to cancer screening at a public facility.

The revised standards forbid physicians from charging fees for uninsured services as a condition of receiving medical care that is covered.

Health Minister Fred Horne said Friday he welcomed the college taking on the issue.

“They’re really looking at physician behaviour and how that may or may not influence access people get to health-care services, so I think that’s really good to see them taking leadership in this,” Horne said.

“It’s an issue for Albertans any time there’s a perception someone could pay out of pocket to get better access to treatment.”

Four revised standards were approved at Friday’s meeting. Physicians and the public will be able to provide further input before the rules get final approval.

Theman expects council will discuss feedback gathered at its meeting in March 2014.

If the standard is approved, Theman said it will mean physicians in private clinics cannot charge a membership fee for access to their services. The changes would affect a small number of practices, Theman said.

marketing concierge medicine book“Concierge clinics could keep on operating and patients can still buy uninsured services,” Theman said. “What we’re saying through the draft standard is you can’t make that a barrier to accessing the necessary medical services.”

In a news release, the college said the intent of the changes is not to shut down private MRI and CT services.

Theman said it’s up to the government to put a stop to patients paying for MRI or CT scans privately.

Right now, diagnostic imaging is “a gap in the legislation, an anomaly,” Theman said. It would be up to the province to broaden the definition of insured health services under the province’s health care protection legislation to include diagnostic imaging.

Susan Azocar, executive director of Friends of Medicare, called Friday’s change to the standards of practice a “great first step.”

Concierge clinics only serve to create more of a stress in the public system, Azocar said.

“They help to promote that two tier system that goes against what we value as Canadians, which is a universal public health-care system,” Azocar said.

Azocar also urged more questioning about doctors ordering tests that are unnecessary.

“I think there has to be a lot more responsibility behind those types of diagnostic imaging testing,” she said.

concierge medicine direct primary care business booksWendy Armstrong, spokeswoman for the Consumers’ Association of Alberta, was “delighted” with the decision.

“I believe the council did the right thing by moving these standards forward, to start some discussion and debate and a better understanding of these issues.”

The Alberta Medical Association would not comment on Friday’s decision.

In a statement sent to his members last week, Alberta Medical Association president Dr. Michael Giuffre said the “college needs to more fully think through the ramifications of their proposed change.”


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