Author: Rob Carruthers

Dear John — I appreciate your initiative to communicate more directly with neurologists. We are all busy so I don’t know how much there will be uptake but I have learned the perils of being silent in the last few years.

I am strongly opposed to spending any more money on basic consultation codes. In my opinion, these fee codes encourage seeing high numbers of patients quickly and not providing adequate follow-up. They also discourage seeing complex patients who take longer to be seen than patients with more simple complaints.

In days of yore (not all to long ago), therapeutic options were limited for neurologists and imaging was a scarcity. The primary “job” of the neurologist was to make a diagnosis and therefore the act of medical consultation was the most important one for a neurologist. This is now arguably different. Consultation and making an initial diagnosis are the first points of contact, but many patients require counselling and management of complex therapeutics, and these aspects of neurological practice are not well captured by consultation codes. Simply put, “diagnose and adios” no longer is sufficient. We need money to encourage neurologists to spend more time counselling patients and following up on the effects of medication. If I had $300k to spend, this is where I put the money. Perhaps we can add security to the precarious complex care codes? Or the phone / email follow-up codes which are very useful for counselling patients and following up on medication prescriptions? Or perhaps we can use it to hire people to look at alternative fee structures in a comprehensive way to better prepare for the future of neurological practice?

As you may recall, an Immunosuppressant Review fee code was first proposed at the AGM in March 2016. After discussions with my Rheumatology, Neuromuscular, and General Neurology colleagues, a letter was drafted and presented at the meeting. Continue reading “MD, FRCPC”

Now is the time to establish a neuromuscular immunosuppressant fee code that could be billed once yearly for managment of patients on immunosuppressants. The precedent has already been estabilished with a rheumatology fee code for the same ie G31055 ($40.40) Continue reading “Neuromuscular physician”

Regarding the surplus, a fee code for the management of immunosuppressive therapy for conditions affecting the PNS, consistent with the existing Rheumatology Fee code for management of immunosuppressive therapy ($40.60 per year) would recognize the time it takes to provide this service . Continue reading “Fee code: immunosuppresant therapy”