Alberta, Canada - Private Hospitals Bankrupt

[IVlamisil]

Things getting tougher in Calgary Canada for foot surgeons (ortho and pods) as a private hospital/surgery centre goes under and requires bailout.

In another story, Alberta Health closed down all surgery centres doing cataract surgery and consolidated the cataract surgery service (public) into only 4 sites across the entire province. The timeline given to surgeons to move their surgeries from their own centres to the consolidated ones....3 days. Opthal surgeons are in an uproar over the heavy handedness by the government.

Breaking News


The Canadian Press - ONLINE EDITION
Alberta Health seeking bankruptcy protection for private hospital




CALGARY - A private Calgary hospital that has been performing hip, knee, foot and ankle injuries for the last four years is fighting for its financial life.
Alberta Health Services, which oversees all hospitals in the province, filed an application in Court of Queen's Bench on Friday to have an interim receiver appointed in the operations of the Health Resource Centre to protect the interests of patients during bankruptcy proceedings.
An ongoing legal dispute between Networc Health Inc., which owns HRC, and one of its creditors led the court to appoint PricewaterhouseCoopers Inc. as the interim receiver.
"The reason we did that was to ensure that patient care is protected and the hip and knee and foot and ankle surgeries that we're performing at that site are not disrupted," explained Deb Gordon, a senior vice-president with Alberta Health Services.
"We found out in the early part of April and we became aware because of other court documents that had been filed. At that point we felt we had to start working to protect the interests of our patients and their families."
Premier Ed Stelmach, speaking to reporters before a party policy conference in Edmonton, said he did not know of any other health provider in similar straits.
"They're really unique circumstances in this particular situation, which do revolve around financial issues of an individual business," he said.
"I can't really comment too much further because we'll see how the application goes through the court."
Alberta NDP Leader Brian Mason said the government should simply take over ownership and operation of the HRC.
“Albertans want a publicly funded and publicly delivered health-care system so that they can avoid this exact scenario,” Mason said in a news release.
“Patients waiting for hip and knee surgeries at this clinic have been victimized by this government’s move toward private health care.”
Mason said the Alberta government erred when it originally sanctioned private surgical facilities such as HRC and argued that public hospitals offer better services at less overall cost to the taxpayer.
“Albertans can’t depend on a medical system that put profits before patients."
The Health Sciences Association of Alberta, the union that represents more than 18,000 professional, technical, support and ambulance workers, calls it the latest “privatization scheme gone awry.”
“I would hope that Alberta Health Services and the Stelmach government take a lesson from this, as they continue to look to the private sector to provide vital services to Albertans,” said union president Elisabeth Ballermann.
“For so long we've been inundated with the mantra that anything the public sector does the private sector can do better and cheaper. In the end, when push comes to shove, they look to public dollars to bail them out, or simply fold the tent and close.”
The facility was originally the Salvation Army Grace Hospital, one of three Calgary hospitals closed in the mid-90s.
It has been under contract to perform 900 surgeries a year and the news of its problems came as a surprise, said Gordon.
"They are busy and they do a good amount of work," Gordon said.
"I guess you never really know what exactly is going on for people in their businesses and again that's not really our concern. Our concern is to make sure the care for the patients is uninterrupted if at all possible."
Gordon said operations at the hospital is "business as usual" at this point and a judge will hear submissions Monday on whether to appoint an interim receiver.
Alberta Health Services is readying a plan just in case things don't go well on Monday.
"Our preference is to ensure they continue as planned and that's our first choice," she said. "In the event they were not able to do that, of course, we are beginning to work with our teams and anticipate what our contingency plans would look like."
There have been critics of Alberta's decision to include privatization as part of its health strategy but Gordon said it has worked well so far.
"From our experience this has been a good relationship for us — a good partnership and the patient care has been very good at that location."

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[darazon]

I do appreciate your willingness to keep us informed with what is going on in home turf, but I fear your posts are bordering on fear-mongering.

Alberta does have a long way to go with podiatry, and it not the same as comparing the situation to the US (apples to oranges). I know of many DPMs that are very happy and are doing extremely well. There are quite a few that I have spoken with who are either currently looking for a partner or will be within the next couple of years. A good friend of mine just opened up 4 new offices across the province.

Yes, chances of doing rear-foot surgery is virtually zero, but it is still a great profession and very rewarding -both financially and personally.

Although too bad for the HRC, there are no DPM's employed there. 98% of DPMs in Alberta are in private practice. Having a private hospital in Alberta is just waiting for bankruptcy. Most people will wait the extra time and get the surgery for free.

Unless I am reading your post from another thread incorrectly, you are not a podiatrist? A chiropodist then? I don't mean to offend, but a podiatrist is a DPM, not a chiropodist. And if you are a chiropodist, that could explain why you are trying to discourage DPMs from coming back to Canada.

 

[IVlamisil]

hi darazon,

1. i am a dpm, not a chiropodist

2. nope not fear mongering, just trying to resolve some myths about podiatry in canada.

you see i never really used to speak up about podiatry in canada. I just figured that anyone who came back after studying in the US would just figure it out. they would learn our ways in Canada and survive.

then something interesting happened. the labour mobility act in canada started to take shape and chiropodists and podiatrists were supposed to be included in it. would this mean that provinces such as BC and AB which were DPM only would now have to open their doors to chiropodists? would this also mean that Ontario which was chiropody only would open its doors to DPMs? Believe it or not, after much research on the topic, and asking many people in higher up positions, I still dont fully understand how this act will be implemented. And the act is to be implemented for sure.

After doing my research, I walked away with the feeling that there was a higher chance of DPMs still not being allowed back into ON, and a high chance of chiropodists being allowed into BC and AB. Do you know how many south african and australian and british chiropodists are trying to come to BC....? A lot. this will affect the way we all practice as not only will there be more competition, but government health plans will also be placed under pressure as more providers obtain access to government funding, resulting in dropping of services by government.

another interesting thing also occurred that made me delve further into Canadian podiatry. Rumours of a school for podiatry in Canada (not meaing the quebec school).

Some posters stated that there will be a school of podiatry in AB pretty soon. Guess what? It may happen, but it definitely won't happen anytime soon. But because it got posted here, people think its going to happen for sure. IT IS NOT FOR SURE. The school in AB is tied to provincial funding, and unfortunately there is currently no funding for the school. In addition, there are no residencies in place for the graduates of the program. Would you pay for a 4 year podiatry program to come out and become a chiropodist? We already have a chiropody program in Toronto that takes half the amount of time.

If you know that there aren't any podiatric surgical residencies, and you know that there are no surgical privileges in the hospitals in the city in which the school is to be built, then why would the posters insist a school is being built? That is totally misdirecting potential students.

And the final straw that broke my back was when just prior to the recent match, I was approached by 2-3 students who were Canadian and thought that they might not match. They were asking if they could come back to Canada and work with me or any DPMs I know.

Why were they scrambling to come back? Because their visas would expire if they did not get a residency. Why did they think that they would be in the scramble? Because the majority of podiatric residencies (VA + some private) do not accept non-US citizens.

Did you ever realize that after paying so much for DPM school, and studying so hard for 4 years, that you could not come back to AB to work as a DPM. Because in AB, you need a 2 year residency to work as a DPM. So these students had to try for BC and these are the questions I was asked.

So tell me Darazon, now you are in my shoes, you are an attending and you have students calling you misinformed or nervous and anxious, what do you do? You deal with those students one on one and then realize that you now have to disseminate info on podiatry to the vast pool of potential students, current students and residents who are canadian and who have no clue about such intricate details.

Out of the 3 students who wanted to come back to AB, none (zero) had known before the scramble that they needed a 2 year residency to come back. Only when the time came to scramble did they realize. Can you imagine the pressure, the stress. This is what I am trying to avoid.

You may call it fear mongering, but i do not think so because nothing i am saying is made up or a mis-truth. In fact, those DPMs who are quoting to students that when you start up you will make massive amounts of money, and you will be doing massive surgery and Canada is the big secret to podiatry millions that no one knows about, are probably doing a greater dis-service by not stating the bad with the good.

I would also like to add that not only am I not saying anything wrong or untrue, I do not want to discourage anyone to come to Canada. I have stated to all that have PM'd me and have stated in my posts on this board that you are all welcome to come back, and I wish everyone good luck, but you need to make an informed decision that takes into account all aspects of the situation. After all, I will one day need an associate or someone to sell my practice to, it would be in my best interest to have more people come back. So let me be clear, please come back, patients here need your services. Case in point, your friend who opened 4 new offices...fantastic!!

As for the private hospital going under and being bailed out by the government, well, I have a few things to say about that. One, yes they did foot surgery there. The surgeries were all done by ortho. So to those who think that private surgery is only done by pods in Canada, that is incorrect. Most of the surgeries were WCB related. More private surgery is done in BC by ortho than anywhere else. And Quebec even has a private ortho hospital, albeit small. So right off the bat, I want to make it clear that ortho is right on our tail in terms of offering private surgery.

Next, do you honestly think that private surgery in your clinic is going to exist in the next 5-10 years in Canada? It will be done in approved surgery centres. The centre needs to pass certain protocols by the college. Private rooms in the offices of doctors are being phased out. Currently AB and BC are reviewing their sterilization protocols and revamping them. The costs are so high in AB that some of our colleagues are reporting that some MDs are no longer even bothering to do small procedures in office and just sending stuff to the ER. Other docs are finding the sterilization policy restrictive and switching to disposable instruments. Podiatry, which is procedure based, will survive, but it will cost us.

I agree with you that podiatry in Canada is definitely not the same as in the US.

I also agree with you that you can be well rewarded in Canada doing podiatry both financially and personally.

The most interesting comment you made is regarding private hospitals and patients paying for surgery or waiting it out and doing via the public free health system. "most people will wait the extra time and get the surgery for free."

^^^^^^^^ BINGO!!!!!!!!!

In Calgary, you have pods that work in the hospital and can do surgery for free (see my other posts) and you have orthos that do surgery free. There are also pods that do surgery privately. How you will fit in Calgary is very interesting because as one of my good friends who was DPM was asked numerous times by the MD who has the office next door, why should I refer the patient to you and have them pay when I can refer them to the free system and have them wait one year. If you can answer this in your mind and are comfortable that you can pump out private surgeries in this weird environment in Calgary, then go for it.

Now take the same scenario, and substitute Vancouver with Calgary. Here ortho does private foot surgery like mad, and there are pods in the hospital and private pods and a whole mix of things.

The key here is not how many patients you will see, but how many surgeries you will do and what will be your cost and profit margin on each. This you need to calculate.

As for your last comment about podiatrist not being a chiropodist....hehehehehe...have you been to Ontario recently? If you are a DPM then you are a chiropodist, nothing more. And if the mobility act goes thru and chiropodists come to BC, then you are going to be inundated with chiropodists and it doesnt matter how many calcaneal fractures you did in training or how many bones you framed, these guys are going to blow open the market on orthotics and nail debridement...and these two things are your bread and butter.

I appreciate your comments and find you to be well informed and a great poster, thanks for your comments.

 

[IVlamisil]

I would like to post a little more about the private hospital going bankrupt in Alberta.

Granted there were no DPMs working there (atleast none that I know of), the repercussions of the bankruptcy are immense.

If you read the following article in today's Calgary Herald newspaper, you will come across an interesting sections regarding what Alberta Health is planning:

According to a health services affidavit, it can order 3,500 surgeries a year from the clinic. There is no minimum, though, and health services can cancel for a variety of reasons.That sounds like a good contract from the public's point of view. Very prudent. But it might have driven the clinic to the edge.
According to a senior clinic official, anticipated business did not materialize.
"Our future contracts with them (Alberta Health Services) were less than we'd hoped they would be," Dr. Stephen Miller, medical director for surgery clinic, told the Herald last week.
The health services affidavit gives more clues about the joys of dealing with the public system.
More public surgery suites are being built "such that there would be no further need or demand for the services presently performed by (Networc)," the document says.
"AHS has made excellent progress . . . and will be able to do all the surgical services presently performed by NHI (Networc) by February 2011, or possibly earlier."
That capacity doesn't exist now, though, so the system needs the clinic; hence the rush to court, and the willingness to pay receivership fees to keep it running.
But soon enough, the private facility will be redundant for these surgeries.

Read more: http://www.calgaryherald.com/health...ealth+clinic/2983014/story.html#ixzz0mzyPnVsb
​

From my understanding of the situation, Alberta Health is on track to decreasing private surgery and expanding public surgery so that there will not be a need for private surgery or perhaps a reduced need for private. Granted this clinic did majority hip and knee, there is no reason why this would not apply to foot surgery. In fact it probably does, but the public is more concerned about hip and knee and that is what the article pertains to.

Has anyone else heard about any public surgery expansion? Is this the true plan of Alberta Health? Does anyone know if such a plan exists in BC?

 

[darazon]

Thanks for your response.

Can you explain how some pods can do surgery for free in the hospitals in Calgary? I was under the impression that podiatry is funded by AHC up to around $300/year. So if you get the privilege of working out of the hospital, does that not apply?

 

[IVlamisil]

hi Darazon,

I will try to answer your question as best as I can, perhaps others with more info can add more.

In Alberta, unlike BC or ON (or any other province) there are 4 methods by which one can undergo foot surgery.

1. podiatry private. This is the method whereby a DPM can perform foot surgery in their office or a surgery centre. The patient must pay for the surgery meaning that it is not fully covered by the public health system. Therefore all the preop, post op and intraop dressings, time, equipment, injectables, staff time, surgeon time, utilities, etc must be paid for by the patient.

2. podiatry public. This method applies to DPMs that are part of the hospital group meaning that they have privileges in the hospital to perform surgery on patients and they do not charge the patient direct but rather charge the health system. This is also called free surgery as the patient does not pay anything. Everything is covered under the healthcare system. The downside to this system is that wait lists develop and the number of DPMs that can offer "free surgery" is limited.

3. ortho surgery public. This method has the patient seen by orthopedic surgeons who perform foot surgery and have the procedure done in the hospital, similar to item #2. Again, the patient does not pay anything and the surgeon bills the health system.

4. ortho surgery wcb/private. This method is not totally private as in the patient does not have to pay but rather a third party pays. The third party can be an insurance company but in most cases it is WCB (workers compensation board). There is no contract for foot surgery between wcb and podiatry. There is a contract between wcb and ortho surgery. A patient will use this route when they have been injured at work or when a third party is ready to pay for surgery.

As you correctly stated, the health system in Alberta is ready to pay up to $250.00 for a patient. This cannot be collected all at the same time unless a procedure equals that amount. So lets do an example...

Lets say a preop visit costs $10 to the patient. You can charge that $10 to the health system and get it. So the patient did not have to pay the $10, but rather the government did. You cannot charge the entire $250 straight away on the first visit. Each visit is only worth for example $10. So if the patient did not do surgery, you could see them 25 times at $10 per visit paid to you by the government. Now lets say that the patient wants surgery. You want to do a bunion correction. The government says a bunion correction is worth $200. And you see the patient at $10 per visit 3 times before surgery and 5 times after surgery. How will the billing occur?
3x$10 = $30
$250-$30=$220 remains.
Then the surgery is $200.
220-200=20
$20 remains.
Then the post op visits
5x$10 = $50
$20-$50 = negative $30.
as you can see, the government only pays out everytime you see the patient or do something, but you cannot access the entire 250 all at once.
Also in the above example we ended up with a negative number but really you would charge a co-pay for the surgery because $250 will never cover your expenses.

Now this is what really sucks...
A few years ago there was talk of removing podiatry from government coverage. This means that $250 would no longer be available to you. Granted that the amount is quite small and you can charge a co-pay, removing is serious because it takes DPMs out of the health system. And once out it is very difficult to be accepted and to re-enter in the future. If you think that I am joking or making it up, lets look at a similar group, the chiropractors.
The chiropractors in Ontario had access to provincial government billing and would charge patients a small co-pay but also get money back from the government for seeing the patients. This was stopped about 3 years ago. Depending on how the practice was set-up it was either good or bad. More established practice, good, new practitioner, bad.
The same happened to chiropractors in AB this year 2010. They are very upset and most chiros that I have talked to in BC state that it hurts business but also the medical community does not take you seriously when you are not covered under the same rules.
That makes it harder to join a multi-specialty group. Referrals are no longer free and covered under the health system.

This government billing or the lack of billing affects me the following way because BC is similar but not exact. If the $250 limit is reached in AB (and trust me you can reach it easily), the patient has to pay more or is not covered and does not want to be seen anymore. This is ok if it is a one time issue, but those patients that require long term podiatry care are at a disadvantage.
Who are those long term patients?
1. Diabetic foot ulcers
2. seniors for nail debridement
3. ?
Unless the diabetic foot ulcer patient is ready to pay for their visit, it makes the time, effort, dressing cost prohibitive. Most diabetics dont have the insurance plan or the cash to handle such an endeavor.

Hope my info helps and take care.
How is California?