Government

Quick access to information based on government's structure

Ministry of Health

Rural Emergency Enhancement Fund

Purpose

This program is intended to encourage the provision of reliable public access to emergency services in health authority designated emergency departments in rural British Columbia served by fee-for-service physicians.

The program is intended to recognize and support the breadth and comprehensive nature of general practice in rural British Columbia communities where physicians typically provide hospital services in conjunction with providing full scope, family practice services in their community office practices.

Program Objectives

  1. To strengthen stability of public access to hospital Emergency Department (ED) services in rural communities.
  2. To increase ED capacity, if required, by increasing the number of health care service providers supporting the hospital ED when possible.
  3. Where feasible, to encourage physician groups to develop hospital ED stabilization plans that encompass other communities as well as their own.  Plans incorporating a larger pool of resources should facilitate greater stability.
  4. To stabilize public access to hospital ED services by effectively and efficiently integrating ED services with the health authority’s health care service delivery plans for the community and the region.
  5. To contain clear accountability provisions for the year-long provision of 24/7 ED public access.
  6. To ensure that the hospital ED plan recognizes the comprehensive range of health care services required from physicians in rural communities and does not destabilize other services important to the community, e.g. primary care.
  7. To develop new models of 24/7 ED management appropriate to individual community circumstances.

Program Description

  1. An ED coverage plan (Plan) will be developed by the group of community physicians who are prepared to commit to provide 24/7/365 public access to hospital emergency services in their communities, in partnership with their health authority (HA) and other health care service providers in the community (possibly including physicians who will not participate in the Plan).  The community physicians will decide upon the appropriate collaborative group for their community.  Examples:  LMAC, a GP Division, or a representative ad hoc physician group.
  2. The Plan is to be developed collaboratively with the HA. The VP of Medicine (or designate) will acknowledge this collaboration and the provision of the appropriate human and technical resources that the HA will provide by signing with the ED physician complement. This acknowledgement of collaboration and partnership will be necessary before the JSC will provide final approval of each plan.
  3. Examples of the ways in which funding could be distributed include, but are not limited to:
    • Hiring additional full or part time ED physicians
    • Physicians providing ED services
    • Incenting weekends, holidays, and/or nightshifts
    • Hiring locums (Note: Daily rate guaranteed must not exceed the guaranteed daily rate payable under the Rural GP Locum Program, i.e. maximums for A communities = $950/day, for B communities = $900/day, C communities = $850/day. D communities = $800/day.)
    • Purchasing equipment where this fits with the HA standards and plans.
  4. The proposed plan will ensure 24/7 ED coverage and may increase capacity by increasing the number of health care professionals engaged in providing services within the community and/or in conjunction with other communities.
  5. The proposed plan must demonstrably consider the likely impact on the full range of health care services required in the community and must integrate well with other services required in the community.
  6. Potential impacts on other communities must be considered in collaboration with the HA, both positive and negative.  The JSC will not approve plans that destabilize other communities or other health care programs.
  7. The proposed plan should provide a sustainable community solution and contribute to recruitment and retention of health care professionals to meet the full range of services needed in the community.

Eligibility Requirements

  1. This program applies to fee-for-service physicians supporting EDs in a Rural Subsidiary Agreement (RSA) community.
  2. EDs and hours of public access must be formally recognized and supported by their health authority.
  3. To participate in the decision making for the distribution of funds, eligible physicians must be part of the ER on-call rota.
  4. To be eligible for funding, physicians must maintain staff privileges in their rural community hospital or health authority designated facility.
  5. Physicians willing to participate in providing ED services will need to sign a contract annually with the health authority outlining the terms of the planned commitment.

Funding - General

  1. Funding of up to $200,000 will be provided for each fiscal year where the health authority has designated a site for 24 hour per day public access to hospital emergency services and where groups of community physicians commit to collaboratively provide this service.  For less than a 24 hour per day service, as agreed to by the HA, the annual funding amount will be reduced pro rata to correspond with HA designated hours of public access.
  2. The maximum any one physician may receive under the Plan is $65,000 per annum.
  3. If the Plan requires any advance funding (e.g. for the purchase of locum time), the requests and the estimated timing will be identified in the Plan.
  4. The physician group must elect an “Appointee” to receive the quarterly funding and distribute to the other physicians as appropriate (or as outlined in the “Plan”).

Payment Process

  1. The JSC approves the Plan.
  2. At the end of each quarter, the HA will submit a “HA REEF Quarterly Invoice” form to the MoH, confirming whether or not the ED was kept open 24/7 (or the amount of time approved in the Plan), as well as whether or not the Plan was followed. The Quarterly Report will contain a record of all physicians receiving REEF funding for that quarter.
  3. Once reviewed by MoH, funding will be released to the HA (normally $50,000 per quarter).
  4. The HA will release the quarterly funding to the “Appointee” for distribution as appropriate.

Exceptions

Exceptions to program requirements may be considered by the JSC on a case-by-case basis.

Dispute Process

All individual disputes will be reviewed by the group identified in the Program Description (1) above with recommendations made in consultation with the VP of Medicine of the health authority.  If a dispute is unable to be resolved through this process, further guidance may be sought through the JSC.

Oversight

  1. The JSC will oversee the operation and application of this new, provincial, rural community initiative.
  2. The program will be funded by the government and administered through the group identified in Program Description (1) above and health authorities.

Rural Emergency Enhancement Fund (REEF) Program Process Document (PDF  79K)