In British Columbia, a new physician payment model launched on 1 February 2023. Currently, more than 80% of physicians in the province are paid through fee-for-service (FFS) payments, which is one of the highest shares of FFS among primary care doctors in Canada (Canadian Institute for Health Information, 2022). The new model, referred to as the longitudinal family physician (LFP) payment model, provides an alternative to the current FFS scheme and incorporates:
- time spent with a patient;
- number of patients a doctor sees in a day;
- number of patients doctor supports in their office;
- complexity of patient issues;
- and administrative costs (Doctors of BC, 2022b).
The LFP payment model is intended to improve timely access to care in part by reducing the administrative burden on physicians (Government of British Columbia, 2023). Prior to the roll-out, physicians were not paid for additional time spent on activities such as reviewing results, paperwork, or updating patient records. The new model is also part of the broader Health Human Resources Strategy that focuses on recruiting, training, and retaining health care workers in the province (Government of British Columbia, 2023).
Through the LFP payment model, doctors will receive C$130 hourly rate and a C$25 per patient visit regardless of the time spent with a patient. For patients with medical complexities, doctors will now receive an annual one time-payment of at least C$34 per patient per year (Lavergne 2022). Time modifiers for patient complexity have been previously introduced in another province (Alberta), where physicians can bill an extra fee if a visit exceeded 15 minutes. However, the complex (time) payment modifier in Alberta received some backlash when the government proposed halving the rates for 15 minute visits from C$18 to C$9 (Government of Alberta, 2020). While the LFP payment model in BC aims to address access, there have been other concerns that the model would be unlikely to address major access to care problems such as the large number of patients who are unattached. To further address these issues, the Government of BC also announced the introduction of a digitized patient rostering system to be rolled out in Summer 2023 with the aim of identifying opportunities to attach patients to clinics and providers (Government of British Columbia, 2023).
The LFP payment model and the Physician Master Agreement between Doctors of BC and the BC Government’s Medical Services Commission received 94% acceptance from voting physicians in autumn 2022 (Doctors of BC, 2022b). The new model is consistent with recommendations made as part of member engagement with Doctors of BC, where the resulting report suggested a “blended model of salary and fee for service with time modifiers and incentives rewarding hard work” (Doctors of BC, 2022a).