Nova Scotia

Doctors raise alarm about long delays in getting paid for medically assisted deaths

The president-elect of Doctors Nova Scotia is concerned that delays in getting paid for administering medically assisted deaths is deterring more doctors from offering the service.

Payments have been slow and amount of time that doctors can bill isn't enough, says Dr. Tim Holland

Of the 67 claims made in Nova Scotia for assessments and procedures related to medically assisted deaths, 35 have been paid and 32 are being assessed for payment. (Getty Images/Blend Images)

The president-elect of Doctors Nova Scotia is concerned that delays in getting paid for administering medically assisted deaths is deterring more doctors from offering the service.

Dr. Tim Holland said he's yet to be paid for any of the procedures he's done since Bill-C14 came into effect in June 2016.

Of the 67 claims made in the province for assessments and procedures related to medically assisted deaths, 35 have been paid and 32 are being assessed for payment, the Department of Health and Wellness said Tuesday. 

"I think a lot of physicians would find that a hindrance if they're not going to be getting paid," Holland said.

Spokesperson Tracy Barron said the reason for the slow payments is the billing codes that were introduced for the service last September.

"It's not unusual to have an adjustment period when new codes are introduced," she said.

Barron said the department is working with Doctors Nova Scotia, the Nova Scotia Health Authority and Medavie to resolve billing issues.

Time limits for billing not enough

Doctors can submit claims for assessments and the procedure itself, but Holland is concerned the time doctors can bill for isn't enough. He said the initial assessment, and the procedure itself, are both capped at two hours for billing.

"There's usually a lot more time invested into these procedures, be it the time speaking with the family, the time trying to make sure the assessment is done, collaborating with others — the family physician or palliative care physicians — to make sure the decision is right for the patient," said Holland.

He said it's important to have the right amount of compensation in place.

"It's a difficult balance because you don't want to make it profitable, you don't want people doing this for the wrong reasons, but you don't want it to be such that it's a discouragement for physicians who would be interested to actively participate," said Holland.

"It's all about ensuring appropriate patient access."

In an email, the Nova Scotia Health Authority said between June 17, 2016, and March 31, 2017, they received 67 requests for medical assistance in dying. Of those, 31 were administered.

The other 36 requests included individuals who withdrew their request, patients who died before administration or did not meet the criteria, or procedures that did not occur before the most recent numbers were reported.

'A very rewarding part of my work'

While Holland said he's concerned more doctors won't come forward to help people die because of the pay issues, he'll be continuing the work despite not yet having been paid for it.

"[It's] a very rewarding part of my work," said Holland.

"There's a lot of stress involved, any death is tragic, but the amount of gratitude you get from the family and the patient.

"It's sort of karmic dividends that can't really be captured in money."

With files from CBC's Maritime Noon

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