The South Saskatchewan Heart Clinic has become the first medical care provider to opt out of the publicly funded healthcare system in Saskatchewan since first introduced in the province.
In response to what the cardiology clinic claims are uncompetitive and unfair reimbursement rates, Dr. Jeffrey Wilkinson said there are three options in the face of rising costs: close the clinic and move to an area that pays higher rates, increase the number of patients and potentially decrease the quality of their care, or privatize.
Dr. Wilkinson said reimbursement rates in Saskatchewan are significantly lower than in other regions of the country. This has been cited as a leading factor in the trend of specialists leaving rural areas and many leaving the province entirely.
"Over the last five years, being a specialist clinic in Moose Jaw has been operationally and financially difficult," wrote Dr. Wilkinson.
Rates paid to medical care providers are fixed and renegotiated every five years. The next five years, according to Dr. Wilkinson, are set to provide no increase and do not reflect inflationary changes in the cost of doing business. It’s also increasingly difficult to hire specialized staff as better incentives are offered elsewhere.
The current healthcare system was established in 1962 with the passing of the Saskatchewan Medical Care Insurance Act.
When the Act was about to be passed in 1962, the 23-day Saskatchewan doctor’s strike fought to include an escape provision citing the concern that the government could pay unfair reimbursement rates.
This escape clause can be found in Section 24-3 (a, b) of the Act. Private firms must be all in or all out, however, and you cannot have some patients pay out of pocket while others are covered by the system. If a clinic later wishes to re-join the medical system, they have the right to do so.
One benefit of a private health practice is a significantly reduced wait time – but you have to pay out of pocket for this.
According to Dr. Wilkinson, wait times to see a specialist can be reduced from several months to as little as one week.
Patients who visit a private clinic must be informed that the visit will be paid out of pocket, and that free alternatives funded by the healthcare system are still in place, as per legislation.
If you cannot afford treatment or private healthcare plans won’t cover the bill, Dr. Wilkinson will gladly recommend you to another specialist within the healthcare system. Dr. Wilkinson said the aim of the clinic is to provide patients the best possible care and to ensure heart specialists remain in Moose Jaw.
The South Saskatchewan Heart Clinic has issued the following written statement:
"Since 2018 the South Saskatchewan Heart Clinic has provided Cardiology care to the people of Moose Jaw and Southern Saskatchewan. We have strived to provide the best level of care that the people of this province expect and deserve. Until recently, we participated in Medicare as a “fee-for-service” clinic. For every visit or procedure, we submitted a bill to the government and received payment directly from the Ministry of Health. This process is the cornerstone of Medicare.
"Over the last five years, being a specialist clinic in Moose Jaw has been operationally and financially difficult. In early January 2023, these mounting difficulties became a crisis. We had a number of resignations due to the inability to pay competitive salaries and provide benefits. We also found it difficult to pay overhead expenses given that we operate in a smaller city and have to compete for qualified staff.
"Despite this situation we felt it was important to first contact our elected officials and work through an orderly political process. Our office reached out to both local MLAs – Tim McLeod and Greg Lawrence. We were also open and honest with all of our patients that we faced a dire situation and encouraged them to advocate to their elected officials. Dr. Wilkinson also reached out to the Saskatchewan Medical Association (SMA) and met with the president and CEO in early 2023. Finally on April 3, 2023, Dr. Wilkinson met directly with Premier Moe and Minister Merriman (the former Health Minister) where he detailed his concerns about the current challenges in healthcare and operating as a fee-for-service clinic outside of a large urban centre.
"Presently, the rates the Saskatchewan Ministry of Health pays for common cardiac procedures are 20-45 per cent lower than both Alberta or Manitoba – which essentially explains why so few specialists call Saskatchewan home. For example, an electrocardiogram (ECG) is paid at $34.33 per test in Alberta. In Saskatchewan an ECG is paid at $18.90 per test. A heart ultrasound (echocardiogram) in Alberta and Manitoba is paid 22 per cent and 23 per cent higher, respectively, than in Saskatchewan. Other important cardiac tests are also paid less than the Western Canadian average.
"Despite extensive advocacy over the last 10 months and our earnestness to resolve the situation through appropriate channels, we have received no response from the government or the SMA about potential changes or improvement to fee-for-service rates. In fact, we have heard informally through sources close to the SMA that the current negotiations for fee-for-service medicine for Cardiology have no rate increases planned.
"Given the situation, our clinic saw only three possible paths forward: close the clinic and leave Saskatchewan, see more patients faster and provide inferior care, or opt-out of the provincial Medicare system and charge private rates which would allow us to compete and provide high-quality and compassionate care. Opting out of the provincial Medicare Insurance program has always been an option to doctors since the introduction of Medicare in 1962. It is an option in every province in Canada. It has been most widely used in Quebec where 3-5 per cent of the physician population operates privately – and has been doing so for about 15 years.
"As of October 2, 2023, our clinic is now private. We charge patients directly for their healthcare. Our consultation rate is $350. Some patients have third-party health insurance which helps reduce or eliminate the cost paid out-of-pocket. Many patients have chosen to continue seeing us at the clinic. If a patient is unable to pay, we offer a referral to another cardiologist or follow-up with their primary care provider if they choose.
"Finally, our clinic has and always will support public Medicare. If the rates of reimbursement were reasonable and competitive, we would return to the public system."
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