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Physician puts plan to charge patients monthly fee on hold after commission review

Some patients were concerned that they would lose their family doctor if they were unable to pay the proposed $125 monthly fee.
Dr. Perpetua Nkechi Nwosu of Perpetual Health Centre at 375-3066 Shelbourne Street told patients in a letter she would no longer be enrolled with Medical Services Plan as of Nov. 1, and proposed billing them directly $125 a month for enhanced services. VIA GOOGLE STREET VIEW

A doctor in the capital region who proposed charging patients a monthly fee of $125 for enhanced services — such as longer appointments and home visits — withdrew the scheme after it came under review by the Medical Services Commission.

This month, a patient told the Times Colonist that her family physician, Dr. Perpetua Nkechi Nwosu of Perpetual Health Centre at 375-3066 Shelbourne St., said in a letter she would no longer be enrolled with Medical Services Plan as of Nov. 1.

Since private clinics cannot charge patients and also bill the Medical Services Plan, the doctor proposed billing patients directly for enhanced services — 30-minute appointments to discuss a variety of concerns — and putting the money into recruiting staff, including nurses and mental-health counsellors, as well as overhead costs.

Some patients, however, were concerned that they would lose Nwosu as a family doctor if they were unable to pay the proposed $125 monthly fee. The letter did not address the fate of patients who could not pay the fee.

Saanich family physician Dr. Jennifer Lush said until family doctors receive better compensation, more will begin thinking “outside the box” in order to continue caring for their patients.

“Dr. Nwosu is not the first doctor to charge patients for services not covered by MSP, and rather than asking ‘How dare this doctor do this?’ we should be asking ‘How dare the government, in a universal health-care system, dare to not adequately compensate family doctors to care for British Columbians?’ ” Lush said in a text.

Physicians can charge “block” fees for services not covered by MSP, such as completion of certificates and forms, tests required for ­driving a vehicle and elective cosmetic ­procedures. They can also charge for devices such as crutches or splints.

If the block fee for optional ­services is offered, according to the College of Physicians and Surgeons, the doctor cannot require the patient pay it before the patient can access another service, treat the patient preferentially because the fee is paid, or terminate the relationship if the patient chooses not to pay it.

Several months ago, B.C. Health Minister Adrian Dix asked the Medical Services Commission, which oversees MSP, to review private fee-based services offered by Telus Health MyCare to ensure there’s no queue-jumping for patients who pay the fee, which isn’t allowed under the Canada Health Act.

Telus’s LifePlus package — which includes 24/7 access to a health-care practitioner and costs about $4,500 annually — and other fee-based services have drawn criticism that they’re creating a two-tier health-care system. The commission has also been asked to look into other physicians in the province charging patients a fee for similar packages that offer fast-track physician access and diagnostic tests.

After announcing last week temporary funding of $118 million to help doctors in family practice with increasing overhead costs, Dix was asked about the public release of the Medical Services Commission findings.

Dix said the independent commission’s job is “to assess and enforce the law,” and it looks into cases and sometimes acts prior to a report being made public.

“There was a case a number of weeks ago of a clinic in the Capital Regional District that was proposing to charge a fee and they’ve withdrawn that now and the commission engaged with them,” said Dix, not referring to Nwosu by name. “In that case, it wasn’t an investigation — they engaged with them and that was the conclusion.

“In the case of Telus Health … I asked the Ministry of Health, the commission, to review it, and they’re doing that,” said Dix.

If any action is to be taken, it’s the commission that will take the lead, said Dix. “They’re an independent body and they will announce their decisions, not just their review, but their decisions, in due course and it won’t be me announcing that — it will be the commission.”

No timeline was given. Dix had said earlier in the year he’d hoped to hear from the commission — which includes three Doctors of B.C. representatives, three from government and three representing the public — in June.

In the wake of the province’s announcement last week of short-term funding for family doctors to cover overhead costs, Lush said she’s encouraged the province is headed in the right direction. “It seems to me the government is now at least ­meaningfully listening to physicians and the public,” she said, adding she’s optimistic the province will work with Doctors of B.C. on a sustainable compensation model that will both attract and retain family doctors.

Nwosu could not be reached for comment.

The Doctors of B.C. expects to provide in coming days application forms for family doctors and those in primary care clinics and walk-ins wanting to access the temporary overhead-costs funding from the province, which is about $25,000 per physician.

The province and doctors are negotiating new funding models under a new physician master agreement.

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