Healthcare Areas

In Alberta, as well as healthcare systems around the world, we are looking at different ways to meet patients’ needs for interacting with their family doctor, other than through an office visit.

Alternate appointment types can improve access to care for patients in some situations. They can also remove barriers of time and distance that can make it difficult for patients to visit their primary care provider on short notice when needed. For example, in rural areas, patients may have to travel a long distance to see a family doctor. Using alternate ways of communicating with patients may give a family doctor more flexibility in how they meet their patients’ care needs.

Four types of appointments, other than an office visit, include:

• phone
• email
• home visits
• videoconference

In March 2020, the Alberta government added temporary physician billing codes to allow for more virtual visits during the COVID-19 pandemic. In June 2020, these billing codes were made permanent.

Use of alternate appointment types is expected to increase over the next few years as technology becomes more accessible, confidence in privacy and security improves, and comfort of both patients and doctors in interacting this way increases.

Some things that might limit family doctor’s uptake of alternate appointment types are time and how they get paid. An alternate appointment type may take the same amount of time as an in-person appointment, and the amount of time allocated for them must be balanced with all the other demands on a family doctor’s time. In the current fee-for-service system used to pay doctors in Alberta, they may be paid less for phone and email consultations than for in-person visits. This may limit the number of these types of visits that doctors will book.

This chart only includes the alternate appointment types that are billed by the family doctor. It does not include alternate appointment types with another team member such as a nurse.

During the five-year data period shown here, a family doctor was able to bill for a total of 14 phone, email or videoconference visits each week, and only once for any given patient in a week between November 2018 and March 2020. Since March 2020, the Alberta government changed the cap on the number of claims a physician can submit for a virtual visit. The virtual billing code can only be claimed once per patient, per physician, per day.

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess primary healthcare’s performance in these dimensions of quality: Acceptability, Accessibility, and Efficiency.

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