Emergency medicine journal slams fee-for-service payments

Fee-for-service (FFS) payments are a “dinosaur” when used in emergency departments, the editor of the Journal of the Canadian Association of Emergency Physicians (CJEM 2000;2[4]:228) says. Not only does FFS lead to longer patient waits and physician burnout, says Dr. Grant Innes, but it encourages highly skilled workers to perform low-complexity work and refer early.

“FFS also causes emergency medicine groups to limit their size and maximize single coverage to maintain income,” says Innes, who practises at St. Paul's Hospital in Vancouver. This in turn leads to longer patient waiting times and increases physician overload, job dissatisfaction and burnout. In the editorial he argues that FFS “motivates us to work like dogs to see more patients faster and to handle more volume than we otherwise would — or perhaps should.”

After 13 years practising in an FFS environment, Innes moved to an alternate funding agreement. He says the improved physician coverage this makes available means he can spend more time with patients in the trauma room and at the same time experience less stress related to patient volume. “FFS rewards high volume and low intensity,” says Innes. “At tax time, the physicians who spent the fewest minutes per patient and treated the most stubbed toes will mail the biggest cheques to Ottawa.” —