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Nova Scotia Representative
Dr. Les Wasilewski
e-mail:  lesw@eastlink.ca
 
Report from the Province of Nova Scotia - April 14th, 2011
 
Dear colleagues,
 
Most of the activities of the surgical section this year can be summarized together with the most recent CAGS board meeting update below.
I have recently returned from the CAGS winter business meeting as well as the first meeting of the newly formed Provincial Affairs Committee (PAC).
Items raised at the PAC included discussion of a relative value fee code for the country to help each province in all future negotiations with government. After deliberation it was decided to adopt the model from Alberta which seemed to have the most up to date and rational schedule with regards to weighting of different procedures, appropriate duration and intensity of post-op care as well as consideration of degree of operative difficulty.
Also discussed were establishment of improved gp- surgeon referral and communication pathways. This has become an Important priority with CMA.

Several members expressed concern re the current practice of faxing/e-mailing surgical consults to the on call physician with the possibility of miscommunication resulting in significant delays in assessment of a potentially sick patient as well as prolonged hospital stay. The group has proposed a CAGS policy statement that all inpatient surgical consults be physician to physician verbal communication.
Fee code disputes and with-holding of payments were a common thread between provinces. I raised the current situation in Nova Scotia with auditing for poorly defined codes such as umbilical hernia repair with incarceration 65.49b as well as the appropriate use of the code for lysis of adhesions 66.4a. Withholding of payments for multiple fee codes within the same OR case have also become extremely frustrating. Several members have recently been audited with requests for clarification and direction from MSI either inadequately addressed or ignored completely. Letters from myself and the
QE11 leadership have similarly been ignored both by MSI AND DoctorsNS leadership. Strategies for response including legal action through CMPA were explored and may be our only and best response. In fact recent STOPPAGE of several audits involving Dartmouth General surgeons  have resulted from CMPA assistance. I would like to hear from any section members who are facing similar difficulties with MSI so that there can be a co-ordination of efforts.  I would encourage you to contact CMPA and reference the Dartmouth General group cases. Finally We have recently established a g-mail account for all general surgeons in nova scotia to communicate quickly with each other as well as to post questions to other section members details will follow soon.
Sincerely,

Les Wasilewski
   
   
   
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