2021 AGM

Economics Report

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This talk will be posted on

generalsurgeons.ca

All previous Econ reports are there too!

Summary

• New fees

• Fee changes

• Temporary COVID fees

• Fee increases

• Misc

• Billing seminar

General Surgeons of BC – What do we do?

• Apply for new fee codes - >100 since 2006

• Negotiate for targeted funds from PMA

• Negotiate for billing rule changes that affect our members

• Advocate for members in billing disputes with MSP

• Advocate in other political and economic issues

General Surgeons of BC – What do we do?

• Average billing $266K to $398K, 2006 - 2019

• N=258

• A 50% increase

• $34M annually

• 17600% return

on $750 dues

General Surgeons of BC – What do we do?

• Major fee innovations

– 71008 – in hospital postop visits (previously all visits up to 42 days included in surgical fee)

– 07001 – surcharge for age>75

– 07003 – surcharge for BMI>35

– 70650/70660 – time-based adhesiolysis fees

– 71010/71017 – malignancy consult/visit fees

– Time-based fees for sarcoma and peritoneal malignancy

General Surgeons of BC – What do we do?

2006 2020

07010 - Consult 94.77 116.00

07007 – Office visit 22.24 28.50

07008 – Hospital visit 18.94 29.00

71606 – inguinal hernia 318.17 364.12

71619 – umbilical hernia 222.11 343.80

72658 – lap appendectomy 280.37 480.30

72635 – anterior resection 1082.42 1515.90

71720 - Whipple 1285.90 3449.82

New fees - implemented

• P07481 Oncoplastic breast conserving surgery -Level 1 $450.00

– i) Restricted to General Surgeons with appropriate training and/or mentoring.

– ii) Includes mobilization of breast parenchyma, creation of skin flaps, and layered closure and mammoplasty

• Eligible for 07001

• $483,000 from New Fee Fund

New fees - implemented

• PC07482 Oncoplastic breast conserving surgery -Level 2 $550.00

– i) Restricted to General Surgeons with appropriate postgraduate or post-fellowship training.

– ii) includes mobilization of breast parenchyma, creation of skin flaps, rotational flap closure, and nipple areolar complex repositioning.

• Certified assist

• Eligible for 07001

New fees - pending

• Complex polypectomy fee - $175

– Billed in addition to 10731, 10761, 00716, or 33373

– Must be booked for more than 45min

– >2cm, non-pedunculated

– Complete removal after submucosal injection by piecemeal or EMR

• Budget - $400K from 2021/22 disparity allocation

• Delayed…

Fee changes

Fee Current Proposed

10750 Transnasal esophagogastroduodenoscopy 88.71 112.30

10761 Esophagogastroduodenoscopy 88.71 112.30

10763 Initial esophageal, gastric or duodenal biopsy 28.73 15.00

33324 Thermal coagulation 42.11 80.00

33325 Gastric Polypectomy 159.63 60.00

33326 Percutaneous endoscopically placed feeding tube 72.94 120.00

33327 Endoscopic repositioning of the gastric feeding tube 14.08 50.00

Fee changes

• ERCP fees transferred to GI

– 07517, 07518, 07519, 07554, 07556, 07560, 07562

– 33341, 33342, 33343, 33344, 33345, 33346, 33347

– Still can bill 71008 after “V” procedures

– Still can bill 07001 with 33346, 33347

Fee changes

• 07634 Enterotomy or colotomy (single) for exploration, biopsy, or foreign body removalFull thickness repair of iatrogenic intestinal perforation (single)

• 07635 Multiple colotomy, with operative sigmoidoscopyFull thickness repair of iatrogenic intestinal perforation (multiple)

• Effective October 29, 2020

Fee changes

• 70127 Closure or radical resection requiring a free split thickness skin graft (extra)

– Greater than 65 cm2

– Greater than 65 cm2 on trunk

– Greater than 25 cm2 on extremities or head/neck

• Effective January 28, 2021

Temporary COVID-19 fees

• 10050 COVID-19 Perioperative Complexity surcharge $60

– For yellow/red pathway patients

– Only under GA

– Billed by surgeon, anesthesiologist, or assist

– One surcharge per surgery

– Can be billed more than once a day on same patient if more than one surgery needed

Temporary COVID-19 fees

• 10000 Urgent Specialist Advice on patient with previous visit - $60.00

– Exactly the same as 10001 except exclusion of patients seen within 180 days removed

• 10009 Specialist Advice on patient with previous visit within 7 days - $40.00

– Exactly the same as 10002 except exclusion of patients seen within 180 days removed

Temporary COVID-19 fees

• 10007 Delegable Specialist Email/Text/Telephone Medical Advice Relay or ReRX Fee - $10.10

– Email/Text/Telephone Medical Advice... The task of relaying the physician advice may be delegated to any Allied Care Provider or MOA working within the physician practice.

– Chart entry

– Not for appointments

– Not payable on same day as another service

Temporary COVID-19 rule changes

• Telehealth fees can be billed after telephone calls

– 77070, 77072, 77077, 77078, 70076, 70080, 70087

– Fees the same as in person equivalents

– Eligible for Business Cost Premium

– Cannot bill partial consult 07012 after teleconsult

Temporary COVID-19 alternate payment

• Based on 1680 h per year, max 1867 h

• Only until Dec 31, 2021

• 60d termination notice

• $335K ($200/h) gen surg

• $406K ($242/h) surg onc

• Can bill MOCAP and WCB in addition

Temporary COVID-19 alternate payment

• Contract is with HA

• Must continue to bill for services with payment to HA

• Hours reported to HA

• Clinical services

• Donning/doffing/aerosol clearance

• Research and teaching

• Meetings and admin time

• Documentation and charting

• 5% of hours “service redesign”

Fee increases

Implemented

Total $3 million

$1.6 M from disparity fund

2019 2020 2021

General 431K 461K 461K

Disparity 363K 616K 616K

Fee increases2018 2019 2020

07010/70070 114.06 115.25 116.00

71015 114.06 115.25 116.00

07007/70077 25.89 26.50 28.50

71010/70080 141.56 141.56 150.00

71017/70087 60.64 60.64 65.00

07008 24.26 25.50 29.00

71008 25.29 26.00 28.00

New location codes

• As of April 1, 2021 location code A (practitioner’s office in community) being phased out

• After Oct 1, 2021 A will no longer be accepted

• New codes

– B – community health centre

– Q – specialist physician office

– V – virtual care clinic

Worksafe authorization fee

• Once approved surgery must be performed within 40 business days of approval

• The “clock starts” when 19911 is billed by default

• If there is a delay for authorization bill 19326 (zero dollar code) on the day authorization is received to reset the clock

Business Cost Premium

• You don’t get the $$$$ unless you sign up!

• Applies to office consults, visits, telehealth fees

• 5% City of Vancouver, max $60/d per doc

• 4% Greater Vancouver/Victoria, max $48/d

• 3% Other urban centre, max $36/d

Business Cost Premium

• To hit daily maximum – 11 consults

• Assuming 10 office days per month

– Vancouver - $600 per month, $7200 per year

– Gr Van/Victoria - $480/m, $5760

– Other urban - $369/m, $4320

• Payment shows up as an adjustment on remittance – “BP”

Business Cost Premium

• Step 1 – register your office

– https://my.gov.bc.ca/bcp/register-facility

– Need the facility code for Step 2

• Step 2 – attach yourself to your office

– https://my.gov.bc.ca/bcp/practitioner-registration

Business Cost Premium

• When billing you have to enter your 5 digit facility code with each bill

Questions?