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TOP 10 PRIORITIES
REQUESTED BY NEUROLOGISTS IN ONTARIO 1. Increase Consultation fee from the current $147.00 to $175.00 The purpose of this would be to: a. Recognize the increasing complexity of the neurological encounter b. Provide economic catch up for the shortfall of the previous agreement c. Achieve parity with other provinces (e.g. Alberta) d. Retain and attract more manpower to the Province
2.- Expand the Chronic Disease Premium ( E078) to include the following Neurological Disorders Motor Neuron Disorders(including ALS) Complex Peripheral polyneuropathy e..g CIDP, hereditary neuropathies (Charcot Marie Tooth) Myasthenia Gravis and LEMS Chronic myopathies (acquired and hereditary) e.g. myotonic dystrophy Chronic Movement Disorders Traumatic Brain Injury Chronic Daily Headache(CDH) Stroke Care Cerebral Tumors Congenital Malformations of the nervous system
3- Implement all outstanding CTC recommendations
The OMA has approved fair and relevant fees for the funding of professional and technical fees for EEG (electroencephalography) and EMG (electromyography). The survival of many laboratories providing these vital services to patients throughout the Province will depend on this
4. -Add Complex Modifier of 25 % of the consultation fee to consultations exceeding 45 minutes: This is meant to recognize the additional complexity of examination of patients with cognitive and/or language impairments as well as contentious or arcane diagnoses.
5- Detention fee of 25 % of the consultation fee, billed at 15 minute increments, for purely administrative duties: a. Seeking transfers and services for patients particularly in emergency situations (This has become particularly relevant to our specialty as we arrange urgent neurosurgical services in and out of country.) b. Reviewing complex investigative results on behalf of a patient (e.g MRI ,CT Films,EMG and other results) c. Giving telephone advice on behalf of not seen patients to fellow medical practitioners
6. Increase funding in hospitals (with suitably qualified neurologists on staff ) for Electrophysiology Laboratories across the Province: The OMA Negotiating
Committee must convince Government to provide increased funding to
hospitals for fully staffed and equipped EMG and EEG laboratories as
essential components to good neurological care, equivalent to MRI and CT
scanning. This will have the additional benefit of attracting neurologists
to work in these settings (community-based and academic). At the moment
hospitals will not fund these facilities adequately as they do not
generate a profit. This must change. The purpose of this request is to remove confusion regarding how to bill follow up of patients with neurological diseases. This is based on the following: a. The majority of neurological cases require either extensive examination and/or extensive discussion with the patient and relatives. Most neurological disorders requiring follow-up (ie Parkinson’s disease, dementia etc.) become increasingly complex over time, and this is not reflected in the present schedule of decreasing compensation per follow-up. b. Following the MRC Debacle, neurologists have been under billing for follow ups. c. This fee would provide an incentive for neurologists to provide follow up for complex cases, thus removing some of the burden from others.
8- CME stipend of $2,600.00 per annum for neurologists
The negotiating committee should convince the
government to provide a
CME stipend similar to that available to FHN/FHO groups of $2600.00 per
annum per neurologist. 9. Increase funding for chronic neurological diseases clinics:
Clinics for Epilepsy, Multiple Sclerosis, Stroke Prevention, ALS, Parkinson’s disease and other disabling neurological conditions are urgently needed in community and academic settings. Disabled patients have long wait times and have to travel long distances to get support services. This should be addressed.Clinic staffing should include Physician Assistants to provide interim care more effectively. The Ontario Government must be encouraged to fund these clinics which will operate under the supervision of neurologists in a multidisciplinary setting.
10: Provide financial support/incentives for EHR (hardware and software) implementation in Neurologists Offices
Respectfully submitted:
___________________________ Dr Ranjit Singh MD FRCP President of the Association of Ontario Neurologists
___________________________ Dr Edwin Klimek Chair of the Section of Neurology Ontario Medical Association
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