Nova Scotia

Nova Scotia rolls out new payment program for family doctors

The Nova Scotia government is rolling out a pilot program to test a new way to pay family doctors, but opposition politicians are worried it doesn’t go far enough fast enough.

Blended capitation, which is used in some other provinces, is being introduced at 3 clinics as a trial

Nova Scotia Health Minister Michelle Thompson says the use of blended capitation is another step in the process to improve patient access to care and get people paired with a primary care provider. (CBC)

The Nova Scotia government is rolling out a pilot program to test a new way to pay family doctors, but opposition politicians are worried it doesn't go far enough fast enough.

The government will use the blended capitation model until at least March 2023 to pay 19 doctors who work at three primary care clinics in Chéticamp, New Minas and Upper Tantallon. Three other clinics, which include an additional 30 doctors, could be added to the pilot.

"We hope that this new model will encourage a more team-based approach and make it easier for patients to get the care they need when and where they need it," Health Minister Michelle Thompson told reporters during a news conference in Halifax on Thursday.

Blended capitation is a model that sees doctors paid through a formula that considers how many patients are on their roster, the number of services they provide and can include a bonus if access to care can be demonstrated to improve.

WATCH | Amy Smith's interview with Dr. Leisha Hawker, president of Doctors Nova Scotia:

President of Doctors Nova Scotia on new payment program for family doctors

4 months ago
Duration 4:30
Dr. Leisha Hawker says most new family doctors want to work in collaborative settings.

Currently, doctors in Nova Scotia are paid either by contract or fee for service. But Dr. Leisha Hawker, president of Doctors Nova Scotia, said the majority of new family doctors are looking for models that promote collaborative medicine.

"They really want to do team-based health care," she told reporters.

Hawker and Thompson said blended capitation should lead to more same- and next-day appointments for patients, and services on evenings and weekends because if one doctor is not available, another doctor or allied professional at the clinic could step in.

Hawker said the payment model also addresses the fact that many patients are sicker and require more time with a doctor than current billing codes cover.

"The way patient care is delivered has changed, and volume is no longer a good measure of good care," she said.

The pilot was agreed to as part of the master agreement Doctors Nova Scotia signed with the province in 2019, but Thompson said the rollout was delayed due to the COVID-19 pandemic. There is $7.3 million set aside to fund it and the minister said a third-party evaluation will determine what works and what needs improvement.

'We have to do a massive shift,' says NDP health critic

Opposition MLAs welcomed anything that might improve patient access to services, but said it doesn't go far enough.

Although blended capitation is only being tried here now, it's been in place in other provinces, such as New Brunswick, for years.

NDP health critic Susan Leblanc said she's pleased the program promotes more collaborative care, but said there's no reason for so few clinics to be included as part of the initial rollout.

"We already know it works in other places and so let's just implement it," she told reporters.

"We don't have any time to sit around and try things in little bits and pieces. We have to do a massive shift."

Liberal MLA Kelly Regan said the Tories promised during the election that they had a plan to fix health care and Thursday's announcement doesn't go far enough to live up to that promise. She said a variety of health-care metrics have become worse since the Tories came to power last summer.

Doctor wait-list up to 95,000

Premier Tim Houston said during the election campaign that his plan to fix health care would take time and money and things would probably get worse before they got better.

Although the intention is to expand the use of blended capitation following the pilot program, Thompson said doctors who prefer the fee-for-service model would still be able to use it.

There are currently about 95,000 people registered on the province's list to get a primary care provider.

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ABOUT THE AUTHOR

Michael Gorman is a reporter in Nova Scotia whose coverage areas include Province House, rural communities, and health care. Contact him with story ideas at michael.gorman@cbc.ca

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