Health Canada wants Nova Scotia to repay $1.277 million for allowing private clinic to operate

It was business as usual Monday for two private health care clinics operating in Halifax. 

Nova Scotia’s Health Minister Michelle Thompson appears in no hurry to shut them down despite a directive to do just that from the federal health minister last week. 

In addition, the province has confirmed it must repay $1.277 million it received in health transfers from Ottawa for the year 2020-21. 

That’s because the province allowed a for-profit diagnostic imaging company called Health View Medical Imaging to continue offering faster access to MRIs, arthroscopes, and ultrasounds for patients who can pay with a credit card. Prices are not provided on the Health View Medical Imaging website.

Health View Medical Imaging’s Clayton Park operation is owned by Canadian Health Solutions, which is headquartered in Saint John, NB. A Dalhousie University Medical School graduate, Dr. David Elias, is the president and CEO. 

The clinic has operated since 2009 under various names from its location on Lacewood Drive and has been patronized by athletes with the Halifax Mooseheads, RCMP officers, and worker’s compensation clients. 

In 2018, the federal government issued a directive to all provinces giving them two years to close all private-pay clinics providing diagnostic imaging or face a clawback of some transfer money from Ottawa. 

Last week Ottawa made good on that threat and sent statements to provinces asking them to return more than $76 million for diagnostic services provided by private clinics in 2020-21.

Quebec owes $41 million; Alberta and British Columbia must return another $30 million. Khalehla Perrault, a spokesperson for the Nova Scotia health department, confirms Nova Scotia has been asked to repay $1.277 million, the same amount as New Brunswick.

The repayment reflects Health Canada’s Reimbursement Policy, which allows provinces to create “a Reimbursement Action Plan to eliminate the patient charges and the circumstances that led to them” up to two years after the original deductions were made. 

The response yesterday from the provincial Health Department indicates closing Health View Imaging is one option but not the only option the department is considering. 

Maybe the for-profit service takes pressure off the queue for publicly funded MRI and ultrasound appointments. Maybe paying a fine to allow a private clinic to keep operating is the cost of doing business if a province is unable to satisfy demand. 

Bluenose Health Primary Care Clinic

Thompson has not sent letters to Health View Imaging or Bluenose Health Primary Care Centre informing them they must close. 

But federal Health Minister Jean-Yves Duclos served notice last week that all private companies that charge patients money for “medically necessary services” must be brought to heel. 

This includes national virtual care companies such as Maple Corp, into which grocery magnate Galen Weston recently invested $75 million. Maple offers subscribing patients same-day online appointments with a doctor or nurse practitioner for $69 a visit. 

In Halifax, Bluenose Health offers appointments with a nurse practitioner for adults willing to pay a $30 monthly fee.

Seventy-four-year-old Randy Stevens started Bluenose Health after he had a heart attack last fall and became dissatisfied with what he calls the lack of access to timely, followup care. 

Like 139,000 other Nova Scotians today, Stevens wasn’t attached to a family doctor or nurse practitioner. A Chester resident, Stevens has a chronic heart condition as well as kidney issues that require ongoing bloodwork every three months. 

Stevens put up his own money to start the Bluenose clinic and he told the Examiner during a phone call on Monday he receives “about 20 calls a day from people who are scared and nervous” they don’t have access to a health care professional on a regular basis.”

The Examiner asked Stevens how he plans to stay in business given the federal directive issued to provinces last week. The nurse practitioner he employs provides the same type of services you would expect from a family doctor’s office but unlike doctors, nurse practitioners are not permitted to bill MSI directly.

“We are considering writing a letter to Health Minister Thompson asking her if MSI can reimburse our patients directly for the cost of the service they receive from our nurse practitioners,” Stevens said. 

That proposed change might get around the knotty problem of patients “paying for medically necessary services.” If the public purse is paying for the advice and the treatment, the monthly subscription fee is arguably going towards rent, advertising, overhead, and profit. Maybe that wouldn’t contravene the Canada Health Act. Or maybe it would be interpreted as an end run towards further privatization. 

As for what’s next for a private clinic offering primary care through a paid subscription, the response from Khalehla Perrault suggests that at this time, the province will continue to advocate for changes at the federal level rather than shut it down.

“The Department of Health and Wellness has not sent any letters to the Bluenose Health Clinic or HealthView Medical Imaging informing them that they must stop providing services,” said Perrault in an email.

“The Canada Health Act is a major part of the problem,” she continued. “It’s old and outdated, and it was written for a very different health care system in 1984. It has gaps that allow these private clinics to take root. We are more than happy to do our part to strengthen publicly funded health care, but we need strong federal legislation to back us up.”

Stevens said he intends to hire a second nurse practitioner by the end of April and claims he is not “stealing people from the public system.”

He said he recruited from New Brunswick and Newfoundland and neither employee has previously worked for Nova Scotia Health. 

That may be the least of his problems depending on how this latest disagreement plays out over the delivery of health care.