Download 2015 Economics Report

2015 Annual General Meeting
Economics committee report
Dr Hamish Hwang, Economics Chair
Dr Mark Dickeson, President
Mrs Tanyss Bugis
@bcsurgeons
Economic report
• New fees 2014-2015
– Implemented
– Approved, awaiting implementation
– Approved, awaiting funding
• Fee changes
– Residual amount from 2013/14
– New allocation 2015/16 and 2016/17
• Outstanding and proposed motions
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and archived economics reports
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New fees 2014-2015
New fees – implemented
• 70718 Portal lymphadenectomy $750
• Can be billed as stand alone or in
combination at 50%
• “C” procedure, eligible for 07001
• Cost $17000 – New fee fund
• Effective February 28, 2014
New fees – implemented
• 72751 Laparoscopic reduction of volvulus,
intussusception, internal hernia $645.13
• 72721 Laparoscopic mobilization of
splenic flexure (extra) - $117.44
• 72650 Laparoscopic resection of bands,
enterolysis - $615.54
• “C” procedures, eligible for 07001
• Cost $6000 – New fee fund
• Effective Nov 29, 2013
New fees – implemented
• 72641 Laparoscopic cecostomy tube
(extra) $370.23
• 71651 Laparoscopic correction of
malrotation (Ladd’s procedure) $574.73
• Not “C” procedures
• Cost $1000 – New fee fund
• Effective February 28, 2014
New fees – implemented
• 72600 Temporary or delayed abdominal
closure with VAC $369
• An error put fee value at $339.30 (fixed
now)
• Can be billed in combination at 50%
• Can’t be billed with 07600 or 07601
• If billed 10+ times note record needed
New fees – implemented
• 71292 Peritonectomy, with or without
intraperitoneal chemotherapy (each hr,
up to 8hr) $650.00 per hour
• 71293 each additional 15 min or greater
portion thereof (maximum of 16 units per
patient) $50.00
• “C” and “V” procedure, eligible for 07001
• $110K from new fee fund
New fees – ?implemented
• Radical resection of malignant skin or
soft tissue tumor measuring 5-10cm be
introduced at $256.85
• Radical resection of malignant skin or
soft tissue tumor measuring 10cm or
greater be introduced at $443.84
New fees – ?implemented
• New fee for pre-operative secondary
consultation
• 80% of the consult fee
• Requires dictated history/physical and
consent
New fees – ?implemented
• Catheterization, complex - male patient
(operation only) $200
– Notes:
i. Restricted to Urologists and General
Surgeons
ii. Procedure must involve the use of Filiforms
and Followers, or introducers (stylet or
catheter guide)
iii. Not paid in addition to the critical care
fees, or diagnostic urological procedures
(e.g. voiding cystourethrogram).
New fees
• Please see handout
• Thank you to Steve Chung, David Konkin
and Yarrow McConnell for helping with
application for successful new fees
• We encourage other members to suggest
new fees (not fee increases)
• Questions about new fees?
Fee changes
Fee changes
• Concurrent colorectal or sarcoma
resections in combination with liver
metastasectomy when performed by two
surgeons can now be both billed at 100%
• Funded by 2015-16 allocation
• See handout for eligible fees
$12K
Fee changes
• Several items from the Plastics fee guide
have been deleted and replaced with new
fees on a revenue neutral basis, effective
April 1, 2014
• We initially agreed to bill from the new
Plastics fee guide
• The Section of GPs withdrew and were
allowed to bill the old codes
• We have also withdrawn and old plastics
codes will be hopefully transferred to us
Fee changes
• Underutilization from 71010 and 71017
resulted in a $237K residual amount
• In 2014 proposed to fund several low fees
• Given new money from PMA for 2015/16
and 2016/17 the residual amount was
redirected to consult and related fees
(see handout)
– Retroactive to April 1, 2013
– Amounts to a 0.95% increase
Fee changes
Code
Description
Old fee New
fee
07005
07006
07007
07008
07009
07010
07012
70070
70072
70076
70077
70078
Visit - Emergency - General Surgery
Directive care - General Surgery
Subsequent office visit - General Surgery
Subsequent hospital visit - General Surgery
Subsequent home visit- General Surgery
Consultation - General Surgery
Consultation - General Surgery - repeat or limited
Telehealth Consultation - General Surgery
Telehealth repeat or limited consultation - General Surgery
Telehealth directive care in emergent surgical conditions
Telehealth subsequent office visit - General Surgery
Telehealth subsequent hospital visit - General Surgery
$94.77
$27.76
$23.82
$20.28
$47.44
$97.77
$51.74
$97.77
$51.74
$27.76
$23.82
$20.28
$95.67
$28.02
$24.05
$20.47
$47.89
$98.70
$52.23
$98.70
$52.23
$28.02
$24.05
$20.47
Fee changes
• From the 2015-16 allocation = $275K
• From the 2016-17 allocation = $252K
• Attempted to bring most fees under 60%
of Alberta value up to around 60%
• See handout
Fee changes
• 07055 Ganglia fee increased to match
plastics fee
• 07063 decompression volvulus increased
to match other decompression volvulus
fee
• 07610 epigastric hernia fee increased to
match umbilical hernia fee
Fee changes
• Minimum fee under GA
• If anesthetic time <30min - $150
• If anesthetic time >30min - $200
• We had 15 fee codes where the surgical
fee was less than the surgical assist fee of
$131.64
New money summary
•
•
•
•
Portal lymphadenectomy
Misc laparoscopic fees
Peritonectomy
2015-16 allocation
– Non-owned items
• 2016-17 allocation
– Non-owned items
• Total to Section
= $17K
= $7K
= $110K
= $275
= $75K
= $252K
= $98K
= $850K
Summary 2006-2015
• 2006 Allocation
• 2012 Allocation
• 2015 Allocation
=
=
=
=
$5.77M
$679K
$527K
$6.8M
• 2006-2015 efforts of Section GS = $2.8M
– 90 new fee codes since 2006
– Equivalent to $18,000 per FTE per year
– This is a 2700% return on your $650 annual dues
2007/08
2010/11
2013/14
RADIOLOGY
OPHTHALMOLOGY
OPHTHALMOLOGY
OPHTHALMOLOGY
RADIOLOGY
RADIOLOGY
CARDIOLOGY
CARDIOLOGY
CARDIOLOGY
GASTROENTEROLOGY
GASTROENTEROLOGY
GASTROENTEROLOGY
NEUROSURGERY
NEUROSURGERY
CARDIAC SURGERY
UROLOGY
UROLOGY
UROLOGY
CARDIAC SURGERY
VASCULAR SURGERY
OTOLARYNGOLOGY
ALLERGY & IMMUNOLOGY
OTOLARYNGOLOGY
GENERAL SURGERY
NEPHROLOGY
NEPHROLOGY
NEUROSURGERY
OTOLARYNGOLOGY
GENERAL SURGERY
NEPHROLOGY
VASCULAR SURGERY
RESPIROLOGY
RESPIROLOGY
RESPIROLOGY
ALLERGY & IMMUNOLOGY
VASCULAR SURGERY
GENERAL SURGERY
CARDIAC SURGERY
ALLERGY & IMMUNOLOGY
DERMATOLOGY
DERMATOLOGY
DERMATOLOGY
OBSTETRICS & GYN.
CRITICAL CARE
CRITICAL CARE
ORTHOPAEDIC SURG.
OBSTETRICS & GYN.
ORTHOPAEDIC SURG.
CHEST SURGERY
ORTHOPAEDIC SURG.
OBSTETRICS & GYN.
INTERNAL MEDICINE
CHEST SURGERY
ENDOCRINOLOGY
RHEUMATOLOGY
ANESTHESIOLOGY
RHEUMATOLOGY
NEUROLOGY
ENDOCRINOLOGY
CHEST SURGERY
ANESTHESIOLOGY
INTERNAL MEDICINE
ANESTHESIOLOGY
PLASTIC SURGERY
PLASTIC SURGERY
PLASTIC SURGERY
ENDOCRINOLOGY
RHEUMATOLOGY
INTERNAL MEDICINE
GENERAL PRACTICE
NEUROLOGY
NEUROLOGY
PEDIATRICS
HEMATOLOGY/ONCOLOGY
PEDIATRICS
HEMATOLOGY/ONCOLOGY
GENERAL PRACTICE
HEMATOLOGY/ONCOLOGY
PSYCHIATRY
PEDIATRICS
GENERAL PRACTICE
INFECTIOUS DISEASES
PHYSICAL MEDICINE
INFECTIOUS DISEASES
PHYSICAL MEDICINE
PSYCHIATRY
PSYCHIATRY
GERIATRIC MEDICINE
INFECTIOUS DISEASES
PHYSICAL MEDICINE
EMERGENCY MEDICINE
GERIATRIC MEDICINE
GERIATRIC MEDICINE
CRITICAL CARE
EMERGENCY MEDICINE
EMERGENCY MEDICINE
Outstanding passed motions
• Outstanding passed motions:
– Per 2010 AGM: Increasing existing
laparoscopic fees to max 10% differential
• Estimated cost $520,000 (assuming $1.3M)
– Per 2011 AGM: Access to 1st assist of the day
and Office Anoscopy fee
• Estimated cost $369,000
Outstanding passed motions
• Outstanding passed motions:
– Per 2011 AGM: Increase remaining fees based
on comparison with Alberta fee values
• Increase fees <0.65 Alberta’s fee value first
• Increase fees <0.80 next
• Increase fees <1.00 last
• No increase to fees greater than or equal to
Alberta’s equivalent fees
Outstanding passed motions
• Outstanding passed motions:
– Per 2012 AGM: Special hospital visit for
malignancy $40.56
• Can be billed 2 times per 6 months
• Cost $407K
– Laparoscopic pseudocyst
• Cost $6K
Proposed motion
• In case of a threat of forced fee
reductions
• MOTION: that the Executive of the Section of
General Surgery are enabled to reduce fees
with a value exceeding the Alberta fee
equivalent and reallocate the funds as needed
to avoid a forced fee reduction
Economics Rep
• Good at math?
• Have lots of ideas?
• Looking for a replacement in 2 years
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download this presentation
http://generalsurgeons.ca