BC Patient Medical Home/Primary Care Network

[BCelectrophile]

I’m curious to hear people’s thoughts on the new PMH/PCN system being introduced in BC. Basically it works similarly to FHOs in Ontario. 

Can be paid up to 330k for a panel of 1250 patients (number is prorated based on complexity of patients) with a minimum 1680 hours/year (37.5 hours/week with 8 weeks vacation). Can still do maternity, emerg, ltc, etc, and get paid for it outside of clinic.

the PCN is also supposed to set you up with social workers, physio, other allied health but I’m not super clear on how this works.

seems like a pretty good deal to spend more time with patients, get paid more regularly, and still make a decent income especially for the hours worked.

 

[bearded frog]

In terms of Ontario FHO it seemed like a good deal that helped optimize your time and incorporate allied health effectively, if you were able to get in, with the trade off of having increased responsibility for your roster (overnight phone-call, same day urgent appointments, etc) which was ok it seemed if you had a large shared practice which made these infrequent for individual practitioners (and typically residents would be first call it seems).

I know some old school FDs like FFS and think that rosters incentivize people to be less efficient. I personally don’t like the time pressures of FFS but if you had a really efficient system and were fast you might be able to come out ahead that way.

[JohnGrisham]

On 6/9/2021 at 10:08 AM, BCelectrophile said:

I’m curious to hear people’s thoughts on the new PMH/PCN system being introduced in BC. Basically it works similarly to FHOs in Ontario. 

Can be paid up to 330k for a panel of 1250 patients (number is prorated based on complexity of patients) with a minimum 1680 hours/year (37.5 hours/week with 8 weeks vacation). Can still do maternity, emerg, ltc, etc, and get paid for it outside of clinic.

the PCN is also supposed to set you up with social workers, physio, other allied health but I’m not super clear on how this works.

seems like a pretty good deal to spend more time with patients, get paid more regularly, and still make a decent income especially for the hours worked.

 

You might want to look back at the numbers - my colleague who works in central BC considered it but the pay was much lower than 330k, and then you had overhead taken off of it as well. Not to mention apparently NPs were offered a similar contract but with smaller patient panel requirements, and getting paid more per patient panel. 

As well, the allied health piece is a complete miss and depends on your jurisdiction.  

Overall it seemed like a watered down and crappier version of Ontario FHO. But i havent looked into it recently, so maybe they went back to the drawing board and revised it!

[Wachaa]

I work in BC. Just wanted to say a few things:

-You don't need to be under this payment system in order to access the social workers/ physio/ etc. You can continue to be fee for service and still refer to these services.

-As @JohnGrisham mentioned, the gross billing is likely going to be less for many people. Payment under this model includes certain requirements for panel size, hours worked, and completion of multiple Quality Improvement projects.

-These payments come under a contract that is not easy to break. You need to give a certain number of months of notice.

-You could work maternity care, emerg, etc in addition to this, but it is probably not easy to do. You have to provide care for your panel even while you're away. If patients start seeing other doctors because you're away (eg. walk in), I think that would count against you by reducing your effective panel size. If I was going to work hard 50+ hours a week I would probably see no reason to go under this payment model and just go for straight FFS.

-Some doctors are suspicious that this is a way for the government to lock doctors into a certain payment model, and then add more work onto their existing workload in the future, without increasing their pay.

 

So, who might consider this?

-New doctors looking to grow their practice with a steady income. They break away from this payment model when they think they can bill more as fee-for-service.

-Physicians working with complex patients who require more time

-Physicians in a group practice and several members want to use this payment model

-People who do not have any other focused interests other than being in clinic (a generalization, due to the time requirement of caring for your panel)

[jb24]

The BCNDP are likely to give increasing responsibility to NP's for primary care given strong union relationships.  I believe not long ago they authorized nurse prescribing for opioid replacement therapy. Hopefully doesn't end up becoming like the US.
 

[bearded frog]

13 hours ago, Wachaa said:

-You don't need to be under this payment system in order to access the social workers/ physio/ etc. You can continue to be fee for service and still refer to these services.

In Ontarios FHT at least, the point is that allied health is part of your practice, ie NPs doing well baby/woman checks, vaccines, etc. Psycologists/SW seeing patients for follow-up mental health visits. It's under your "supervision" and you sign off on it.

[JohnGrisham]

8 hours ago, bearded frog said:

In Ontarios FHT at least, the point is that allied health is part of your practice, ie NPs doing well baby/woman checks, vaccines, etc. Psycologists/SW seeing patients for follow-up mental health visits. It's under your "supervision" and you sign off on it.

This is correct, but is not the case in BC - most settings don't have ready access to allied health on a publicly funded model.

[Wachaa]

15 hours ago, bearded frog said:

In Ontarios FHT at least, the point is that allied health is part of your practice, ie NPs doing well baby/woman checks, vaccines, etc. Psycologists/SW seeing patients for follow-up mental health visits. It's under your "supervision" and you sign off on it.

Ah, I see. In BC we refer to these services off site.