British Columbia has effectively doubled the compensation for doctors who preside over assisted deaths after an outcry from physicians who said the old fees were so low they turned some doctors away from providing the service altogether.
B.C. used to pay its doctors less than almost any other province for providing medical aid in dying (MAiD,) an end-of-life option that became legal across Canada nearly two years ago.
The new, higher fees took effect May 1 and most of the increases will be paid retroactively to June of last year.
“In the past, the fees have been a significant barrier to recruiting new physicians to do this new work,” said Stefanie Green, a Victoria doctor and the president of a national organization for doctors who provide MAiD.
“My hope is that now that we are [paid] at a more reasonable rate, we will stop the hemorrhaging of people who’ve decided to stop doing this work.”
Under the old fee structure, B.C. doctors could bill a flat rate of $200 for helping grievously ill patients end their lives.
That fee was supposed to cover prescribing the lethal drugs, picking them up from the pharmacy, spending time with patients and families explaining the procedure and obtaining final consent, administering the intravenous drugs and filing follow-up paperwork with the coroner’s office.
The rate has now been increased to $280.
A new, $125 pick-up fee has also been created for cases in which doctors collect the lethal drugs from off-site pharmacies, which is what usually happens when doctors provide assisted deaths outside hospitals.
That means that in many cases, doctors will now be able to bill $405 for providing an assisted death.
On top of that, doctors can still bill $114.29 for a home visit or up to $56.21 for a hospital visit, depending on where the assisted death takes place. That fee is essentially unchanged from the old structure.
B.C. is also allowing doctors to bill for more time spent assessing patients to determine if they meet the eligibility requirements of the federal law.
Initial assessments used to be capped at a maximum of 90 minutes, no matter how long it actually took to conduct an assessment.
The maximum is now 135 minutes for a first assessment and 105 minutes for a second assessment, with an option for doctors to apply for more funding in extraordinary cases.
The law requires that two doctors independently assess patients to see if they qualify.
Last fall, the province also began compensating doctors for their time when they travel to rural and remote communities where no other physicians are willing to hasten the deaths of qualifying patients.
Trina Larsen Soles, the president of Doctors of BC, said the initial fees were “set in a vacuum” because medical aid in dying was new to the Canadian health-care system.
“When [the old fees] were implemented, it was a shot in the dark as to what would be an appropriate amount for the work,” she said. “It didn’t take long before the providers came and said, ‘This really is inadequate.’ ”
Dr. Green said that, although her members are “very, very happy” about the fee increases, providing assisted dying in B.C. still pays less than routine office work for a family doctor.
She added that every province other than Nova Scotia and Quebec still pays more for providing assisted deaths than B.C. does, even after the fee increases.