Physician compensation is a key component of any health system. In Canada, various reimbursement models which exist for physicians include fee-for-service (FFS), capitation and salaries [1, 2]. There are concerns nationally that the implementation of alternative payment plans (APP) may be affecting certain processes, such as changes in billing claims submissions (i.e. decreases), potentially leading to incomplete billing data and underestimates of disease burdens and outcomes [3, 4]. Thus, four studies were conducted to examine billing patterns between traditional FFS and APP specialists and to assess existing APP policies aimed at governing issues related to physician billing.
In the first study, a survey was conducted to gain consent to access medical and surgical specialist claims data in Calgary, Alberta. With a 35.0% (317/904) response rate, 317 physicians consented to data access (47.7% (71/149) of physicians on APP plans versus 38.9% (46/119) on FFS plans). The second study validated billing claims submitted by surveyed APP and FFS physicians. The proportion of submitted claims for APP and FFS physicians was over 90%. The third study looked at physician claims data to examine the impact of physician reimbursement programs on estimates of hypertension prevalence, cardiovascular disease hospitalization rate and mortality. These estimates (APP claims; 0.6%, n=3677, FFS claims; 99.4%, n=610,167) were minimally impacted if APP physicians did not submit claims. The final study surveyed and interviewed faculty of medicine department heads nationally about APP programs and government stakeholders to determine current policies regarding specialist shadow billing. Disincentive programs appear to be an efficient tool to promote APP physician billing submission. Similar studies should now be conducted in other Canadian regions to confirm the findings, to objectively explore the extent of the variability between billing submission processes nationally and to determine the impact of APP programs on disease estimates.