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A Saanich doctor is not backing down; charging patients $1,500 annual fee

Doctor plans to "de-enroll" from the Medical Services Plan and charge patients
Leslie Belcher at her home in Colwood. Belcher says she won't pay a $1,500 annual retainer fee to her doctor, so she will be without a family doctor as of November. ADRIAN LAM, TIMES COLONIST

A Saanich doctor is forging ahead with a plan to charge patients an annual fee of $1,500 despite having recently withdrawn the proposal while her case was under review by the Medical Services Commission.

The most recent correspondence to patients from Dr. Perpetua Nkechi Nwosu of Perpetual Health Centre at 375-3066 Shelbourne St. reiterates her plan to de-enroll from the Medical Services Plan and charge patients $125 per month. Children age 10 and under of registered parents don’t have to pay.

“Payment must be received by 1st of October 2022 to be on our clients list,” reads correspondence from the doctor. “Receipts will be issued which you can use for tax purposes.”

Patients such as Leslie Belcher who refuse on principle or can’t afford the annual fee have been told they will no longer be a patient of the clinic as of November.

“Unfortunately, Dr. Nwosu will not be able to see clients who are not registered with her from the 1st of November 2022, following confirmation from MSP that she can be de-enrolled from MSP billing,” reads a response to Belcher’s inquiries. “This is legal. You can however, continue to use Dr. Nwosu’s services as normal till 31st of October.”

Belcher, who is turning 65, worries that seniors who can’t afford the annual fee and other vulnerable people will be put at risk.

“People who really cannot pay five more cents are going to pay it because they have nowhere else to go,” said Belcher. Seniors can’t wait hours in clinic waiting rooms, she said.

Nwosu in her correspondence said 70 per cent of her practice is made up of people who are elderly and have multiple health concerns requiring multiple appointments within a month.

Belcher said she’s in the provincial screening system for mammograms and colonoscopies. She said she knows there are risks associated with not having a family doctor. It’s estimated that about one million people in B.C. don’t have one.

A physician, speaking off the record, called the practice of dropping patients who can’t pay “unethical” and likely to face reprisals from the College of Physicians and Surgeons.

The Doctors of B.C. said there are two options for doctors who want to work outside of Medical Services Plan: opt out or de-enroll.

If a physician opts out of MSP, the doctor can only charge the patient the MSP amount and the patient can be reimbursed by the plan. If the physician de-enrolls from MSP, they are no longer part of the plan and “they are free to charge the patient any amount they choose, and the patient cannot seek reimbursement from the plan.”

The number of family doctors who choose to de-enroll is incredibly low, less than 0.1 per cent, according to the Health Ministry, “and as such has not posed a risk to the integrity of the public health-care system in the past.”

Because the services provided by doctors who are not enrolled in MSP are not insured and cannot be reimbursed by MSP, there are implications for both physicians and patients regarding other services, such as ordering laboratory tests.

Last week, Health Minister Adrian Dix cited the case of Nwosu in a press conference, saying a capital region doctor had withdrawn a proposal to charge a fee after the Medical Services Commission engaged with her clinic. Patients thought the matter was resolved.

On Tuesday, the Health Ministry said it is “aware that Dr. Nwosu has communicated with her patients that she intends to de-enroll from MSP effective November 1, 2022 and is renewing her ask to patients for a retainer fee in order to be attached to the clinic.” It added: “We deeply feel for the patients who fear losing access to the quality health-care they deserve.”

The Health Ministry said it, along with the Medical Services Commission, is “reviewing several options to ensure the integrity of the public health-care system is maintained.”

Nwosu’s office, meanwhile, has told patients that if they don’t pay the fee, they can register with a MSP-billing family practice, or go to a government funded Urgent and Primary Care Centre or a walk-in clinic after Oct. 31.

Some of Nwosu’s patients say they are watching and waiting to see what happens before making their decision.

Those with chronic conditions say they are worried they may have little choice but to pay the fee or risk not getting medications and treatment in a timely way. Those who are healthy say they fear they’ll miss prevention measures and timely access that comes with having a family doctor. A letter to patients from Nwosu said “pay per consultation” is not the practice’s preferred model as the clinic would like to build relationships with our clients “instead of offering episodic care.

“The reason we have de-enrolled is to provide holistic care which episodic care does not encourage.”

Nwosu has not responded to requests for an interview.

Most doctors are paid via a fee-for-service model with a base fee of about $32 per patient visit. That amount increases based on some complexities, and annual amounts — between $50 and $315 — are paid to doctors for patients requiring complex care.

Some doctors like the fee-for-service model but want higher rates of compensation to reflect the extra time they need with some patients, paperwork, and overhead that includes staff. Others want a salary and contracts, while some want the government to take over office leases and running of the business.

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