Fee changes devalue babies, moms

Babies and new mothers aren’t worth what they used to be.

Yes, that is a horrible thing to say, and no, that was not the intent of changes that came out of the latest agreement between the province and Doctors Nova Scotia (DNS).

It is, however, the effect. Family doctors who deliver babies took a pay cut for bringing them into the world, effective Nov. 1, and the financial incentive to visit new moms and their babies in the hospital also shrunk. There’s more, but first some context.

The government wanted to end an anomalous set of payments called the Comprehensive Care Incentive Program (CCIP), inserted in the doctors’ master agreement in 2008, at a current cost – or value, depending on which side of the ledger you stand – of around $6 million a year.

The province was motivated, in part, by an examination of the program by accountants and consultants, who found the incentives weren’t delivering the desired outcomes.

Likely lost in the mists of time is the identity of the person who labelled CCIP, but he or she should be recognized for the rare feat of accurately capturing the function of a public program in its title. The program paid incentives to promote comprehensive care.

Four of the seven (some say eight) former CCIP payments were exclusively for the care of babies/toddlers and women.

In the new agreement the CCIP is gone, but some of its elements were transitioned into the world of doctors’ fee-for-service.

In addition to the incentive for family docs to deliver babies, other incentives that did not survive were payments for performing Pap smears for women aged 45 through 75, and office visits for babies and toddlers up to two years of age.

Best practice says that babies/ toddlers, even if well, should see the doctor about 10 times between birth and their second birthday. That doesn’t happen regularly in Nova Scotia.

Most family practitioners will try to see their youngest patients every two to three months during the first two years, without an added financial incentive. Nevertheless, an inducement for doctors to force the issue is gone, and so is reimbursement for the extra time and effort to make it happen.

If you have a family doctor, you may be aware that when your appointment follows a mother and new baby you will have time to read the entire article in whatever old magazine is on offer. So, at an hourly rate, the payment made some sense, too.

Former CCIP incentive payments that were transitioned to the fee structure include visits to nursing homes; house calls; hospital visits to sick patients and those recuperating from surgery (but not new babies or their moms); preparation of hospital discharge plans; and the first office visit after discharge from hospital.

The first trip to the doctor by mothers and babies (after the new-baby check — toe count, etc.) is also recognized by a new fee that can only be claimed by the doctor who will be providing ongoing care, i.e., the mom’s and baby’s regular family doctor.

Not all family doctors deliver babies. In the Halifax region there are a group of family physicians who take on other doctors’ patients in the final weeks of pregnancy, and stay with those patients until mother and child have a clean bill of health, following that first postpartum office visit.

Those doctors — overwhelmingly women — will not receive the fee that accompanies that service, because the patients (mother and child) return to their family physicians after that visit.

These doctors feel betrayed and undervalued by these changes. It is a loss of income, in some cases significant, in the $20,000 per year range. That’s the injury. The insult – that the old CCIP payments that were not transitioned into fee-for-service are all about babies and women – is worse.

What message did the government and DNS think Nova Scotians would take away, if and when they learned that the care of newborn babies, toddlers and their mothers had been, in effect, devalued?

A spokesperson for DNS said her organization and the province’s negotiators knew it could be a problem. DNS worried about it, and found it distasteful.

The province says the end of CCIP was a mutual decision with DNS. There is no change in the amount of funding and changes were reached in consensus with DNS.

“IWK physicians and others who are providing obstetrical services are still being paid. In some cases, a decrease in the annual incentive-based payment will be offset by increases in other areas,” the health department said in a statement, adding the new fees result in real-time payment (versus a lump sum at the end of the year as with CCIP) and make billing easier.

“If any physicians believe the services they offer are being undervalued, we encourage them to apply for new fees or adjustments through the fee committee,” concluded the provincial statement.

Jim Vibert grew up in truro and is a nova Scotian journalist, writer and former political and communications consultant to

governments of all stripes.