Mothers, babies overlooked
Doctors Nova Scotia says they are, MSI says they aren’t, and the health department says it’s an oversight that newborn babies and mothers-to-be aren’t worth as much as an old, ill-used carcass like mine.
Pregnant women and the tiniest of babies were overlooked when the province instructed the insurer, MSI, to increase the fees doctors are paid for treating patients in their o ces.
Earlier this year, after it stumbled into a windfall of back payments on o shore gas royalties, the province carved o a little less than $40 million to try to cheer up the most egregiously o ended physicians in the province — that diminishing species known as family doctors.
e $39.5 million was mostly injected into the fee-for-service scheme, where it lifted doctors’ gross take — pre-tax, preoverhead — for an o ce visit from $32, the lowest in the country, to $36, the lowest in the country.
But the fee for prenatal care and newborn baby visits stayed at the old, lower rate, leaving the family doctors in Nova Scotia who still do the work of trying to help propagate the species to nd out why they are undervalued this time. ey took a nancial hit the last time the province and Doctors Nova Scotia struck a fee agreement.
e Health Department says it was an oversight, and it is working with MSI to get it xed. Doctors who have been told repeatedly by MSI that their work with mothers- to-be and newborn babies is worth less than re lling a Viagra prescription are frustrated and angry.
“It paints a very disorganized picture of the MSI implementation of the enhanced fees. e fact that anyone even considered it acceptable to state pregnant women and well- baby care would be excluded (from the fee increase) is astounding to me. I have to pinch myself that I even have to have these conversations,” said one such doc.
Since the $39.5 million was added, MSI has been steadfast in telling the doctors that pre-natal and newborn care fees were not increased. Doctors Nova Scotia got wind of the problem and intervened on the doctors’ behalf. e health department admitted it’s all a big mistake.
But it’s a mistake that’s inexplicably hard to x. e health department has been aware of the “oversight” for at least two weeks, yet this week MSI was still telling doctors that prenatal and newborn care fees remain at the lower level.
Errors and miscommunication happen, but what does it say about our health-care system that the various bureaucratic beasts charged with operating the thing can’t nd and x a mistake without the concerted e ort of doctors, who’d rather be practising medicine?
e billing codes doctors use to collect their pay from MSI form a labyrinthine encyclopedia of compounded confusion that, over the years, has come to overvalue some medical services, undervalue other procedures and ignore some altogether.
Doctors Nova Scotia has been working for ve years on developing a new fee structure, but the province seems to have lost interest in the project.
e various slow-moving parts of the health structure simply do not work well together. In Nova Scotia, the department, the health authority, the IWK, and it seems MSI has joined the game, have formed themselves into a circle for protection.
Except they seem to be shooting into the middle. e department and health authority are particularly adept at disparaging one another. Maybe, if they keep it up long enough, they will eventually kill each other o and Nova Scotia will have no choice but to rebuild a new “system.”
ere is a library full of reports and recommendations hidden among the cobwebs somewhere in the government’s basement that details how to improve everything from emergency care to mental health to long-term care.
Somebody ought to dig those out, dust them o and put them to good use. In the meantime, the health department might want to adopt the adage heard on other sinking ships: Women and children rst.