2013 Minutes of AGM

Delta Sun Peaks
Friday, March 21, 2013

1. Call to Order – Dr Karimuddin called the meeting to order with 20 surgeons in attendance.

2. Minutes of Previous AGM – May 5, 2012 – The previously circulated minutes of the 2012 AGM were adopted as circulated.

3. President’s Report – DR AHMER KARIMUDDIN

The Year in Review – Dr Karimuddin informed the members that the Section Executive had had a busy year. He said 90% of the surgeons of BC belong to the Section.

Negotiations – Update – Dr Karimuddin reported that the 2012 negotiations reopener is about to begin. It is not expected to that the profession will make major gains. He said General Surgery has done well in that its earnings used to be in the bottom 10 Sections and now we are in the top 10. He felt a good portion of those gains were made through the introduction of the lysis of adhesions fee and the 07001 fee for patients greater than 75 years old.

MOCAP review – Dr Karimuddin reported that he sits on the redesign panel for MOCAP. The final report will be coming end of April, but he said General Surgeons will remain at Level 1 for MOCAP. He said the Interior Health Authority decision to not pay for MOCAP between 3 – 5 am was a complete surprise to the panel, and he advised members not to sign contracts within IHA until directed by BCMA.

Provincial Privileging Project – This province wide initiative is underway and Radiology has been completed. General Surgery is next and the Section has been engaged in suggesting names for large panel who will oversee a set of core and non-core procedures that will become the template of what general surgeons will be privileged to performed. It is important that the breadth of our specialty is protected and input will be needed from all members. It is strongly encouraged for all who can to be engaged. Case volumes will be part of the decisions.

Pamphlets and Posters – Dr Karimuddin asked the members to pick up copies of the newly produced pamphlet to distribute to patients in their offices. Also a poster for displaying in their office. The hope is to bring more awareness to the general public about general surgery practice and the issues facing us, mainly lack of resources.

Members were reminded that the website www.generalsurgeons.ca has all documents on it including a letter to patients about the waitlist situation. Members can access the site by using their first initial and last name and their MSP number.

4. Treasurer’s Report – Tanyss Bugis presented the financial statement for 2012 which showed a year end profit of $225. She presented a deficit budget for 2013 and explained that the assets of the Section would easily cover the deficit. The membership approved the recommendation of the Executive that the annual dues remain at $650 for 2014.

It was moved and seconded

“That the financial statement for 2012 be approved.
That the budget for 2013 be approved.
That dues for 2014 remain at $650”


5. Economics Representative Report – Dr Karimuddin gave the Economics Update. He reviewed all new fees, pending fees and changed items. The report forms part of these minutes. A summary of the fees covered in the report:

New New upper GI fees (see 2012 Billing Seminar on generalsurgeons.ca)
71630 Use of mesh for hernia repair
72794-98 Laparoscopic liver resection fees
72673 Transanal endoscopic microsurgical resection of rectal tumour
78717 Discharge planning fee (SSC)

Pending Consultation for management of malignancy $125.50
Special office visit for malignancy $47.64
Laparoscopic distal pancreatectomy +/- splenectomy

Proposed Laparoscopic internal drainage pseudocyst
Laparoscopic hepatotomy for drainage of abscess or cyst
Bill 70169 x3 ($369.90) for VAC changes
Special hospital visit for malignancy $40.56

07010 Increased to $99.21 April 1, 2012 – back to $97.77 April 1, 2013
71700 Closure of congenital or acquired anal fistula with rectal advancement flap
07005 Emergency visit – not paid within 10 days post-op

Estimated cost to fund Laparoscopic internal drainage of pancreatic pseudocyst and Laparoscopic hepatotomy for drainage of abscess or cyst (single/multiple) is $6,000

Moved and seconded “ that the Executive of the Section of General Surgery are enabled use money allocated to the Section to fund the above fees at 25% the open fee value”

Estimated cost to fund Temporary or delayed abdominal closure with VAC is $32,000
Moved and seconded “ that the Executive of the Section of General Surgery are enabled use money allocated to the Section to change the fee schedule so that fee code 70169 can be billed x3 for VAC changes under GA”



The specialist discharge planning fee is severely underutilized. This is for patients only received through the emergency room.

The hernia fee with mesh continues to be negotiated at MSP and the Section will be informed once it is clarified.

The new consultation fee for malignancy and office visit for malignancy will be effective April 1. Some members had concerned about the necessity of histologically confirmed malignancy as often there is no pathology report accompanying the patient. It was suggested that if this was the case, once the pathology was confirmed, on the next visit a new consult (limited consult) could be billed.

Dr Chung raised an issue he hoped the Section could help with. When two surgeons are working together, ie, one on the liver and one on the colon, it is felt that both should be paid for their special expertise and not have one of the fees reduced as a second procedure. He requested that the Section make a submission to MSP for this scenario.

Dr Karimuddin reported that the Section will organize a billing seminar for this fall. It will likely be held in the lower mainland. Both surgeons and MOAs should attend.

6. Representatives Report – Dr van Heest submitted a written report from the CAGS Provincial Reps meeting held in February 2013 – for information

Dr Brosseuk raised the issue from his Health Authority about the patient prioritization codes. A review is being conducted currently and while some section members have been involved, Dr Brosseuk felt it was important that ALL general surgeons complete the review. He pointed out that the time component is very important because if it is accepted as a target time, and the target times are not met, Health Authorities potentially lose funding from the Ministry of Health and this then results in cut backs in OR because of lack of funding. He felt it was important to push back to the Health Authorities about this issue and to be sure that we get all our members involved. He asked that the Section send a letter of complaint about this further penalization to the Ministry of Health and the Health Authorities with copies to the BCMA.

It was noted that the Ministry’s response to the waitlist issues is to blame the surgeons.

Dr Karimuddin reminded the members that there is a letter on our website which can be given to patients which addresses the waitlist. The patient letter, the new brochures are all part of the same awareness campaign. Our next push will be to the MLAs and the media.

7. Election of Officers – Slate for 2013 – 14

It was noted that all officers will remain in their current positions except the Resident Rep who will be replaced by Dr Dan Jenkins. Dr Karimuddin called for nominations from the floor. There being none coming forward, the slate was presented and elected as follows:

TREASURER ………………………………………….DR NAM NGUYEN


There being no business from the floor, Dr Karimuddin adjourned the meeting at 1130 am.


2012 Annual General Meeting Minutes

Westin Whistler
Saturday, May 5, 2012

  1. Call to Order – Dr Karimuddin called the meeting to order with 58 surgeons in attendance.
  2. Minutes of Previous AGM – May 7, 2011– The previously circulated minutes of the 2011 AGM were adopted as circulated.
  3. President’s Report– DR AHMER KARIMUDDINSpecialist Services Committee – SSC– Dr Karimuddin informed the members that the synoptic reporting proposal was not accepted by the SSC. The reasons for the rejection are not clear. He reported that the proposal will be sent to the Tariff Committee as a new fee item. He assured the membership that the Section will not miss opportunity to apply for funding at every level.Negotiations – Update– Dr van Heest reported that the negotiations have moved to the mediator phase but there was nothing to report at the moment.

    Worksafe BC return to work policy– Drs Jason Forbes and Nick Fry were acknowledged for their work on the Section response to a BCMJ article about returning to work after hernia surgery.. The response will be published in the MJ.

    New Rep for CAGS – Dr Ray Dykstra will be stepping down as the CAGS rep and has asked the Section of nominate his replacement. After discussion it was decided that the CAGS rep would be the immediate Past President of the Section for continuity purposes.
    Therefore, Dr van Heest is the new representative to CAGS from BC Section of General Surgery.

  4. Presentation of New Website – Dr Nam Nguyen demonstrated the abilities of the new website and encouraged members to log in and become part of the online debate on issues. Dr Nguyen was thanked for his work on behalf of the Section in organizing the launch of the new site.
  5. Economics Representative Report – Dr Hamish Hwang gave an extensive report on the following areas:
    a. New Fees – Implemented and awaiting implementation
    b. Deleted Fees
    c. Revised GI guide
    d. Future Allocations for Section – new motion
    His report is attached to and forms part of these minutes. The new fees items approved in the past year are:2011:
    70070-70078 Telehealth fees (MSP)
    10087-10089 Trauma team leader fees $296.07 / $102 / $77.20
    72739 Laparoscopic sleeve gastrectomy $1083.78
    Laparoscopic fees increased 25%:
    71535, 71540, 71542, 72623, 72625, 72631, 72633, 72652
    New laparoscopic fees at 125% open fees:
    72725, 72726, 72727, 72728, 72729, 72730, 72731, 72732, 72733, 72735, 72737, 72743, 72775, 72736, 72720, 72770, 72770, 72734, 72755, 72762, 72763, 72760, 72769, 72767, 72741, 72789, 72765, 72740, 72745, 72715, 72788, 72703, 72704, 72705, 727232012:
    New GI fees (see primer)
    Discharge planning fee (SSC) $100
    TBA Laparoscopic liver resection fees (pending implementation)
    TBA Transanal endoscopic microsurgical resection of rectal tumourDr Hwang stated the Section is applying to Tariff for a new fee for special consult and office/hospital visit for malignancies. It was then moved and seconded

    “that the Executive of the Section of General Surgery are enabled to use a portion of the 2012 allocation to create special fees for malignancy consultation at $125.50, office visits at $47.64 and hospital visits at $40.56”


  6. Regional Representatives Report – there were no official reports from around the province.
  7. Election of Officers – Slate for 2012 – 13It was noted that all officers will remain in their current positions. The slate was presented and elected as follows:
    2012 – 2013PRESIDENT …………………………………………. DR AHMER KARIMUDDIN
  8. Treasurer’s Report– Dr Nguyen presented the financial statement for 2011 which showed total income of $114,122, total expenses of $77,261, for a profit of $36,860, leaving total assets at 156,230. In the Budget for 2012, there is a proposed profit of $24,400.It was moved and seconded“that the 2011 financial statement and the 2012 budget be approved as presented”
    CARRIEDGiven the asset base of the Section, it was recommended that the Annual Dues for 2013 be reduced by $100. There was lengthy debate about this proposal, as members felt they were getting good value for the dues. However, a small reduction was approved.It was moved and seconded

    “that the dues for 2013 be reduced from $750 to $650.


There being no business from the floor, Dr Karimuddin adjourned the meeting.

Nam Nguyen, MD
Acting Secretary

2011 Annual General Meeting Minutes



Saturday, May 7, 2011

Parksville BC

Call to Order – Dr van Heest called the meeting to order.  There were 30 members present. 

            Minutes of Previous AGM – May 2010  – The minutes of the 2010AGM were previously circulated.  It was moved by Dr   Dykstra and seconded by Dr Michelle Sutter

“that the minutes of  the AGM held May 2010  be accepted as circulated”


President’s Report – Dr Rardi van Heest

Dr van Heest has been President of the Section for three years, since 2008.   She asked the membership to continue to email us with billing issues as we can address them with MSP and it helps all of us.   Our section has approximately 150 surgeons and communication is  important.  She pointed out that there is a different attitude from government with allocation of monies.   Rather than fee increases, the government wishes physicians to engage in programming geared toward patient care and those programs will get the funding.

a)      Specialist Services Committee  – Dr van Heest pointed out that the SSC is the way future allocations will be made.  They have already put money toward telephone consults, follow ups, and perioperative visits.  In the works are multidisciplinary fees that could be billed by our members and there is hope to get fees for surgical checklists.   She pointed out that there is some unspent money that needs to be utilized and members should familiarize themselves with these.

b)     BCMA Advocacy for Surgeons – Dr Sam Bugis, general surgeon and past president of the Section, is the new Director of Professional Relations at the BCMA.  Dr van Heest has met with several senior staff to promote the Section.  A Council on Health Eeconomics and Policy has produced a paper on OR efficiency.

c)      2012 Negotiations – Specialists Subsidiary Negotiations – Dr van Heest has agreed to remain as Chair of this committee and as such sits on Negotiating Committee Group in that capacity.  She reported that the future negotiations look promising.  A strong emphasis is on preserving MOCAP.  She confirmed that specialists needs are being addressed.

Election of Officers – Slate for 2011-12

Dr van Heest introduced the new President DrAhmer Karimuddin and the following new Executive slate for 2011-12




TREASURER ………………………………………….DR NAM NGUYEN


NORTHERN HEALTH REGION                        –            DR BRIAN DUBOIS

INTERIOR HEALTH REGION                        –             DR STEPHEN HISCOCK


FRASER HEALTH REGION                                    DR DAVID KONKIN


RESIDENT MEMBER                                                 DR JASON FORBES

Special thanks was offered to Dr Ray Dykstra who has been on the Executive since 2003.    Dr Michelle Sutter was also recognized for her work as Northern Rep.   Drs Jenny Hankins, VIHA rep and Susan Macdonald, FHA rep, were also thanked for their service to the Section.

It was then moved by Dr Dykstra and seconded by Dr Sampath

“that the slate of officers for 2011-12 be accepted as circulated”

Dr Ahmer Karimudden accepted the position as President and presented Dr van Heest with a gift and thanks for her work on behalf of the Section.  She was awarded a plaque engraved with “in recognition of dedication and outstanding contribution


Dr Rardi van Heest



Economics Representative Report – Dr Hamish Hwang

Attached to and forming part of these minutes is a power point presentation prepared and presented by Dr Hwang.

Highlights of report are:

Approved New Fees  –   Dr Hwang reviewed the fees implemented through the Specialist Services Committee

Telehealth fees – see Preamble B 1b

70070 – Telehealth consult

70072 – TH repeat consult

70077 – TH subsequent office visit

70078 – TH subsequent hospital visit

70776 – TH directive care

SSC initiatives

07007 – can now be billed for all pre and post op office visits (previously not for 42d post op)

07008 – can now be billed after 14d post op (previously 42d)

10001 – Telephone physician advice – urgent

10002 – Telephone physician advice – one week

10003 – Telephone follow-up

and those initiated by the Section

70660 – Laparoscopic lysis of adhesions – first 30min…………………………………            $150

70661 – Laparoscopic lysis of adhesions – each subsequent 15min……………            $75

This fee will be paid retroactively to November 19, 2010 and members were asked to review their operative reports to see if this was applicable.  Members were also reminded that this fee is not to be billed until after 30 minutes of lysis.

Several new initiatives have received general acceptance at MSP and Tariff and await final approval at Board level.  They are as follows:

PCxxxxx– Laparoscopic or laparoscopic assisted, to (insert fee item)…………             add 25%

Pxxx00  Initial Trauma Assessment and Support…………………………….…………..            $296.07

Pxxx21Trauma Tertiary Assessment (after 24 hrs. and before 72 hrs)…………..            $102.00

Pxxx31 – Trauma Team Leader Subsequent Hospital Visit (Days 3 – 15 inclusive )             $77.20

Full details and notes to each are attached to these minutes.

Pending Approval – New applications have been forwarded to Tariff Committee for two new fees

1)              Malignancy Counselling fee – and

2)              Malignancy Major Surgery Surcharge

And one amended description for Mastectomy – skin-sparing, when performed for reconstruction

We have previously submitted and are awaiting approval for a new fee Laparoscopic Vertical Sleeve Gastrectomy.

Dr Hwang reported that there is a major overhaul of  GI fees underway, and ownership is being considered.  Dr Dykstra believes that no one section should own them.  Dr Jim Gray is representing the gastroenterologists and Dr Hwang is representing the Section of Gen Surgery and will report back to the members when completed.

Future Allocations for Section

Dr Hwang pointed out that the Section of GPs introduced a new fee last year for first assist of the day.  It was felt that our Section should buy into it with any new allocation of funds.  

Estimated cost = 4000 x $75.38 = $300,000

It was moved by Dr Dykstra and seconded by Dr Sampath.

•that the Executive of the Section of General Surgery are enabled to use a portion of the 2012 allocation to allow members of the Section of general surgery to bill fee code 13194 – First surgical assist of the day”


MSP will be approached to ensure that this fee applies to  Certified assists as well as surgical assists.

Office Anoscopy fee (Estimated cost of buy in = 9300 x $7.41 = $69,000) is another new fee introduced by the Section of GP.  It was believed that we should have the right to bill it even though it would likely not be greatly utilized.  In most cases a rigid sigmoidoscopy would more appropriate.    Dr Hwang said that membership will be given notice about all new eligible fee items.

It was moved by Dr  Karimuddin and seconded by Dr Stephen Hisock

that the Executive of the Section of General Surgery are enabled to use a portion of the 2012 allocation to allow members of the Section of general surgery to bill fee code 10710 In-Office Anoscopy”

Carried with two opposed

With any remaining money, it is recommended that fees be increased based on a comparison with the Alberta Fee Guide .  First allocation would be made to fees less than .65 – then second to all fees .80 – then remaining funds to fees that re 1.0 or less.  Any fees which are greater than the 1.0 get no new allocation.

It was moved by Dr Bao Tang  and seconded by Dr Brad Amson

that the Executive of the Section of General Surgery are enabled to use the BC/Alberta comparison as the basis for applying general fee increases in the following manner: to apply a portion of the allocation to fees valued less than 0.65 of the Alberta values, then apply a portion of the allocation if funds remain to fees valued less than 0.80 of the Alberta values, then finally apply the remainder of the allocation if funds remain to fees values less than 1.00 of the Alberta values


Regional Representatives Report  – There were no specific regional reports – but all were thanked for a great job during the year.

Treasurer’s Report – Dr Sampath

Dr Sampath reported that 2010 was a good membership year with 140 fully paid members.  An expense and income statement was presented showing an excess of income over expenditures of $46,648 for total assets at year end of $119,370.

It was moved by Dr Sutter and seconded by Dr Karimuddin

to accept the 2010 financial statement as presented”   CARRIED

Dr Sampath presented the budget for 2011 showing excess of income at 26,600.

It was moved by Dr Hiscock and seconded by Dr Sutter

“that the budget for 2011 be accepted as circulated”   CARRIED

It was noted that with the $26,600  projected income plus $119,370 from year end 2010, a  total of $138,000 in funds would be realized.  Information regarding non-profit audit will be sought, ie close to $200,000 can trigger audit.

Executive Compensation – Dr Sampath reported that the Executive is working very hard on behalf of the membership and it was felt that compensation should be appropriate.  Suggestions were that Executive members attending meetings on behalf of the Section be compensated $300/hr, or minimum half-day $1200 and full day $2400.  Project work will be increased to $200 hour.

It was moved by Dr Dykstra and seconded by Dr Hiscock

“that the Executive compensation be increased as outlined”             CARRIED

Discussion of annual dues took place.  It was felt that if the $200,000 limit for Non-Profits was not an issue, that dues should remain at $750.

It was suggested by Dr Tang that an amount equivalent to 2.5 time the annual expenses would be an appropriate amount to keep in the Section account.

It was moved by Dr Sutter and seconded by Dr Dykstra

“that the dues for 2012 be set at  $750 and that next AGM consider information about assests of Non-Profit Organizations”


CAGS – Dr. Dykstra reported as the British Columbia representative on the CAGS board.  He chairs the provincial representative committee of the board.  He reported that the board has undergone a significant change to its governance and is seeking a larger advocacy role for general surgeons thru the provincial committee.

The committee is composed of a representative from each province.  The board members are chosen from these members.  British Columbia + Yukon, Alberta + Northwest Territories, Ontario, Quebec all have a voting member.  Saskatchewan and Manitoba alternate a voting member and the Maritime Provinces of New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland have one voting member.

The issues currently being dealt with by CAGS are 1-endoscopy (training and access), 2-development of a national fee guide template, and 3-a standardized referral form.

Dr. Dykstra took on the role of CAGS very informally.  CAGS now requests a formal voting process from the Section/Society.  The executive of the Society would prefer that this fall under the auspices of the Section since it deals with economic matters.  Dr. Dykstra requests that the section’s executive consider this, in the meantime he will continue as representative for one more year.

Dr. Dykstra suggested that the executive look at the possibility of combining the sections and CAGS dues and memberships into one payment collected by the Section.

Moved by Dr Sutter and seconded by Dr Tang

“that Section of General Surgery supports Dr Dykstra in role as liaison for CAGS


Rural Specialist Locum Program – Dr Dykstra asked for support to try to get increase to the Rural specialist Locum stipend currently at $1200 a day.    MOCAP is billable as well.  Granger Avery – is chair of the Rural committee and we can write to him as a section and ask for it be addressed.  Dr Dykstra will draft a letter from our Section.

Business from the floor  – Dr Konkin raised the issue of anesthesia work action on May 30 when they will support a province wide work to rule.  The Section of Anesthesia  has fired BCMA as negotiator for their Section.  Fraser Health is going to be impacted all summer by Anesthesia’s job action.

Dr van Heest  recommends we watch and see and not to react – the regional reps can gather and send info out to the membership quickly.

No further business – meeting adjourned at 3 pm


2010 Annual General Meeting Minutes

2010 Annual meeting minutes.



Saturday, May 15, 2010

Grand Okanagan Hotel, Kelowna

  1. Call to Order – Dr van Heest called the meeting to order.  There were 40 members present.


  1. Minutes of Previous AGM – Feb 2009 – The minutes of the 2009 AGM were previously circulated.  It was moved by Dr Fuller and seconded by Dr van Heest

“that the minutes of the AGM held February 2009 be accepted as circulated”



  1. Business Arising


  • Laparoscopic versus open procedures study – Dr Hamish Hwang addressed this issue as part of the Economics Committee Report.


  1. Economics Representative Report – Dr Hamish

a)       Approved New Fees –  Dr Hwang reviewed all three sets of new fees by funding, BCMA, SSC and Section funded.  They are attached to and form part of these minutes.


b)     Utilization Issues

  • Premium of $62.50 for patients 75 years + – Dr Hwang reported that our membership has under utilized this new item.  He asked that members talk to their MOA’s to be sure they bill it.   The Section is trying to get BCMA to increase the fee based on the utilization but to date this has not happened/
  • Lysis of abdominal adhesions – The utilization of this new item to date is overrun by $67,000. Dr van Heest has met with Tariff and has argued effectively as the reasons why.  We are awaiting MSPs decision.
  • pre and post op visit fees.  This fee was introduced at $19,  reduced to $10 because of over-utilization.  This demonstrates how much work was done previously without compensation.  Effective April 1, 2010, the Specialist’s Services Committee is funding this billing rule change, and the Section has had its money returned.  The Section will continue to fund fee item #71008 ($17) – Day 1-14 post op hospital visit with  $1.1 m returned to us.  After one year monitoring we hope to have that fee item increased permanently.


  • Housekeeping motion introduced by Dr van Heest, and seconded in several places,


“that all subsequent new fees introduced by the Section pay for themselves and  do not decrease any existing fees, unless passed by the membership at an annual general meeting”

Carried Unanimously


c)      Future Economic Initiatives – Dr Hwang reviewed some of the initiatives underway by the Section:

  • Comprehensive trauma care fees – parallel set to critical care fees.


  • Labour Market Adjustment  –  $10 million available.  Our section is submitting several proposals  including, cancer counselling fee, cancer operative fee, BMI surcharge, Increase 2nd procedure to 75% or 100%, specialist-specific after hours premiums, chronic disease surcharge.  Other ideas were welcomed.



  • Advanced Laparoscopic Fees – The Section plans to apply for all realistic fees that do not already have a lap fee code (ie, Lysis of Adhesions – application gone to MSP) – with increased value to 125% for new technology


  • Bariatric schedule – Dr Sampath is looking at the bariatric fees with a view to increasing them in the future


  • In 2011, a  .5% increase will be coming to the Section. The 2010 increase went to the consultation fee, which increased it by $1.30.  Dr Hwang supported the money going to the 71008 to try to increase the value of the in hospital post op visit.  Most members present favored another increase to the consult fee.


  • On behalf of our membership, the Section investigated the amount of outstanding claims from MSP.  We estimate that approximately $3 million of our members money is held at MSP.  There is no language in Master Agreement to ensure timely payment is made and it is hoped that in the 2012 Negotiations and the  Specialists Subsidiary Negotiations,  resolution to this situation can be achieved. We are asking our negotiators to add language that ensures payment within 30 days and after 30 days, interest be paid, and that there be a penalty after 90 days.



Dr Bugis described the various levels of negotiations within the BCMA – Statuatory Negotiations Committee, Specialists Subsidiary Negotiation Committee, SSPS, and then Tariff Committee.


  • Laparascopic fee set at higher value than open fees.    Dr Hwang gave the background to this discussion and offered the pros and cons.  He pointed out that the Section has introduced two advanced lap procedures with a 25% differential, splenectomy and ventral hernia.  He felt there were two issues before the members:


1)     Set new lap procedures at 25% for new lap fees

2)     Try to increase existing lap procedures.


Dr Karimuddin stated that 25% may not be enough given the extra time and work that goes into training.   However, the  precedent has been set with splenectomy and ventral hernia as well as in other provinces.


The membership felt that #1 – applying for 25% surcharge on new advanced laparoscopic fees was the right approach and should be effective immediately.


Following extensive discussion on trying to increase existing laparoscopic fee items, the following motion was carried

 “that the Executive of the Section of General Surgery are enabled to apply up to 40% of future  allocations to incrementally increase  up to a maximum of 10% per fee increase, existing advanced laparoscopic fees until a 125% differential over equivalent open procedure is achieved.  Where existing laparoscopic and open fees exist, only the laparoscopic fee should be increased by this formula.

Carried Unanimously



  1. President’s Report

Dr van Heest reported that the Economics committee has worked very hard on behalf of the membership.


a)      Specialist Services Committee  – Dr van Heest reported that in addition to the $10 million available for Labour Market Adjustments,  $45 m per year has gone into new fees, ie telephone advice, peri-operative rule changes.

b)     BCMA Advocacy for Surgeons – Dr van Heest has met with several directors at the BCMA to garner support for our Section.

  • Dr Sam Bugis sits on Council on Health Economcis and Policy and we hope to have a policy paper about OR flow on their agenda.
  • Dr Bugis also is a member of the BCMA Statuatory Negotiating Committee.
  • Specialists Subsidiary Negotiating Cte – Dr van Heest is Chair of this committee.
  • Tariff  Committee – Jean Noel Mahy is SSPS rep on this committee
  • Cross Sectional Billing – Dr Ray Dykstra sits on this committee

c)      Regional General Surgery Working Groups – The regional reps will develop an email contact list of one surgeon in each hospital in their region.  We must be ready and engaged to respond to issues that face our members. Tanyss Bugis will help set up the contact lists and this information will be sent to full Section membership

d)     Honoraria for Executive – Dr van Heest reviewed some changes to the honoraria schedule for Executive members.  She has asked Dr Ray Dykstra and Dr Sam Bugis to act as “advisors” to the Executive – and added an honorarium for that role.  Other changes were stipend for economics projects, as well as payment to President for attending meetings.



  1. Regional Representatives Report

Dr Michelle Sutter, Northern Health Authority first thanked the Executive for maintaining good relationship with BCMA, MSP and Tariff .  She thanked Dr van Heest, Dr Hwang and Ms Tanyss Bugis for their work on behalf of the members.

Dr Sutter reported that NUBC is graduating their 3rd year of medical doctors.


Dr Jenny Hankins,  VIHA rep reported that many issues still are unresolved in her region, including endoscopy being viewed as not a core surgical entity.  Those in charge feel there are too many scopes being done, and both OR time and endoscopy time has been cut back.



Dr van Heest reported for FHA, Similar funding issues, ORs cut by 25-30 %, MOCAP issues for other specialists.  Program management has been started.

Interior – Dr Chris Baliski is stepping down as IHA rep and Dr Stephen Hiscock will become new rep.  Dr Hwang reported that the IHA Orthopedic Surgeons were organized with media relations experts and lawyers which allowed them to sound united and professional.

Vancouver Coastal Rep – not here


  1. Election of Officers – Slate for 2010-11 was presented as follows:





















ADVISORS:                              DR SAM BUGIS



It was moved by Dr Sutter, and seconded by Dr James

‘that the Slate of Officers for 2010-11 be accepted as presented”



  1. Treasurer’s Report – Dr Sampath, Treasurer, presented the income statement to April 30.  It shows a starting balance of $72,722 as at January 1, 2010.  He also presented the budget for 2010 including the new honoraria schedule.  Dr  Sampath reported that the Executive Committee decided that the 2011Annual Dues should remain at $750, as there have been times when the surplus was needed.  The membership agreed.



It was moved by Dr Dykstra and seconded by Dr Sutter

      “That the budget for 2010 be accepted as presented”




“that the treasurer’s report be accepted as presented”



  1. Special Report from Dr Sampath – Gen Surgery Image – Dr Sampath presented a thought-provoking report on  the image of the General Surgery in the general public.  Members enjoyed the presentation and concurred that General Surgeons need to work on how to value themselves.  “Re-branding” was discussed, and a name change should be considered.  It was moved and seconded

to  allow Executive Committee to continue to work on image of general surgeons”.


  1. Any other business

Dr. Dykstra raised an issue regarding the rural specialist locum program.   Dr. Aleem gave a summary of the history of this program.  Dr. Dykstra stated that he had investigated the program and determined that with regards to general surgery the program paid for itself.  He asked the section to press for an increase in the per deim rate commensurate with the increase in fee for service


Meeting Adjourned at 3:15 pm.    Mini Billing Workshop followed – a summary is attached to these minutes.


Rardi van Heest, MD






New Fees by Funding and Billing Workshop Summary (scroll down)




1)    “BCMA New Fee Fund”  – billable retroactive to July 2009

Use submission code “A” for bills older than 90 days

Resection of retroperitoneal or intra-abdominal soft tissue tumour measuring 10 cm or greater

71290 – first 60 minutes                                                             $500

71291 – each additional 15 minutes or great portion thereof             $50.

Removal of indwelling enteral tubes with or without exploration of tube insertion site:

71280 – not requiring anesthesia (operation only)                                    $30.05 – eligible for minor tray fee.

71281 – requiring local or regional anesthesia (operation only)             $61.84 – eligible for major tray fee

71282 – requiring general anesthesia (operation only)                         $104.01

71283 – replacement of tube (extra)                                                $30.05

71380             Open or laparoscopic operative tumour non-resectional ablation by any means – $700

71682             Botox injection for anal fissure                                                $114.83 – eligible for major tray fee

Neck Exploration for Trauma billed in equity with Fee Item 02470 Radical Neck Dissection





10001 – Physician to Physician Urgent Telephone Advice Fee                                    $60

10002 – Physician to Physician Patient Management Telephone Advice Fee            $40

10003 – Scheduled Telephone Patient Follow-up Fee                                                $20

Peri-Operative Billing Rule Changes (pre and post op office visits covered)





71008            Post Operative Hospital Visit – Day 1-14                         $17.00

i.     Restricted to General Surgeons whose most recent specialty is General Surgery

  1. Restricted to General Surgery fee items with a “V” prefix
  2. Do not bill this item for “operation only” procedures, bill 07008 or other appropriate fee item
  3. For visits outside 1-14 days time frame bill 07008 or other appropriate item
  4. Not billable on the day of the procedure
  5. Paid once per day per patient.


07010             General Surgery Consult                                                 $96.07

– increased by .5% from $94.77

– effective April 1, 2010.


Billing Workshop Summary


1         Pre and post op visits

Prior to April 1, 2009:

  • Most surgical fees included 30 days pre-op and 42 days post-op of visits
  • The exception were diagnostic procedures and “operation only” procedures


After April 1, 2009:

The Section of GS introduced new fees for pre and post op visits only for items owned by GS

  • 71007 – office visit
  • 71008 – hospital visit

They were initially valued at $19 but this was later reduced to $10 to prevent a budget overrun and subsequent clawback


After April 1, 2010:

  • Funding from the Specialist Services Committee changed the pre/post op billing rules for all sections
  • Now there are no longer any restrictions on pre/post op office visits
  • 14 days of post-op visits are included in surgery fee (instead of 42 days)


How does this affect our section?

  • 71007 has been deleted since 07007 can now be used for ALL office visits
  • 71008 can be billed for GS procedures (designated with a “V” on the fee schedule) for 14 days post op for hospital visits and the value has increased to $17


When not to use 71008

  • Hospital visits after 14 days – use 07008
  • “Operation only” procedures – use 07008
  • Non-GS procedures day 1-14 – included


You should now bill for patient care for all visits – the only exception is hospital visits day 1-14 for non-GS procedures


When can 07007 be billed when it was not before?

  • Pre-op office visits within 30 days
  • Post-op office visits for non-GS procedures
    • eg 06258 – carpal tunnel release
    • 33374 – colonoscopy and polypectomy


Many billing submissions are routinely held with explanatory code “BH”

  • After hour surcharges
  • Multiple concurrent procedures
  • Any bill submitted with a “note record”
  • Any disputed claims
  • Seemingly random selection


When asked MSP adjudicators stated that they were 7 months behind in processing these BH submissions

  • As a result some surgeons had over $20,000 (some up to $40,000) in held billings
  • We have asked on your behalf to try to speed the processing of the backlog so you are paid for the work already done
  • We will bring this up with the new BCMA president
  • We will push for less automatic manual adjudication for after hours surcharges and multiple procedures

3         7001 – AGE 75+ PREMIUM

We have not used our allotted budget for this item – surgical surcharge for age 75+

Please tell your MOA to check this list carefully and bill this for all eligible fees:


07027, 07061, 07072, 07075, 07076, 07082, 07108, 07109, 07110, 07111, 07112, 07143, 07360, 07363, 07366, 07402, 07403, 07404, 07405, 07406, 07407, 07408, 07409, 07410, 07411, 07412, 07413, 07431, 07432, 07433, 07434, 07435, 07436, 07437, 07438, 07440, 07441, 07442, 07443, 07444, 07445, 07446, 07447, 07448, 07449, 07452, 07455, 07460, 07470, 07471, 07472, 07473, 07474, 07475, 07479, 07497, 07498, 07516, 07522, 07528, 07536, 07560, 07561, 07562, 07563, 07565, 07567, 07569, 07570, 07574, 07578, 07580, 07588, 07589, 07597, 07600, 07601, 07603, 07610, 07623, 07624, 07626, 07627, 07628, 07630, 07632, 07634, 07635, 07636, 07640, 07641, 07643, 07645, 07646, 07647, 07648, 07649, 07650, 07651, 07652, 07654, 07658, 07660, 07662, 07663, 07665, 07666, 07672, 07675, 07676, 07677, 07678, 07679, 07683, 07685, 07687, 07689, 07698, 07699, 07703, 07705, 07706, 07707, 07711, 07714, 07725, 07732, 07733, 07740, 07741, 07743, 07744, 07745, 07749, 07756, 07758, 07768, 07769, 07771, 07776, 07782, 07789, 07790, 07796, 70084, 70155, 70158, 70159, 70162, 70163, 70165, 70166, 70168, 70169, 70470, 70471, 70473, 70477, 70478, 70479, 70500, 70530, 70531, 70532, 70533, 70534, 70535, 70536, 70538, 70539, 70540, 70541, 70542, 70544, 70545, 70547, 70549, 70551, 70552, 70553, 70554, 70555, 70601, 70602, 70603, 70605, 70606, 70607, 70620, 70621, 70622, 70625, 70626, 70627, 70628, 70629, 70630, 70631, 70632, 70633, 70635, 70637, 70638, 70641, 70642, 70643, 70644, 70645, 70646, 70648, 70649, 70665, 70666, 70668, 70671, 70672, 70674, 70676, 70680, 70683, 70694, 70695, 70698, 70700, 70701, 70702, 70703, 70704, 70705, 70712, 70713, 70714, 70715, 70716, 70720, 70721, 70722, 70725, 70726, 70727, 70728, 70731, 70740, 70742, 70743, 70745, 70747, 70748, 71530, 71535, 71536, 71537, 71538, 71539, 71540, 71541, 71542, 71543, 71546, 71548, 71549, 71551, 71606, 71607, 71608, 71609, 71610, 71611, 71612, 71613, 71614, 71615, 71616, 71617, 71618, 71619, 71620, 71621, 71622, 71650, 71681, 71684, 71686, 71700, 71703, 71704, 71705, 71706, 71708, 71709, 71710, 71712, 71713, 71714, 71716, 71717, 71718, 71719, 71720, 71721, 71722, 71746, 72620, 72622, 72623, 72624, 72625, 72626, 72631, 72632, 72633, 72634, 72635, 72636, 72640, 72641, 72644, 72647, 72648, 72651, 72652, 72653, 72656, 72657, 72658, 72659, 72660, 72665, 72666, 72669, 72670, 72671, 72672


Some are endoscopy fees


This is sometimes rejected if it is not billed as the first sub-procedure


07707 – lap chole

07001 – 75+ surchage

07764 – intraop cholangiogram


07707 – lap chole

07764 – intraop cholangiogram

07001 – 75+ surcharge

4         CALLBACKS


Don’t forget to bill 01200, 01201, 01202 for each separate visit to the hospital – even if it is the same patient. If you have already billed a 01200 and you want to bill another 01200 on the same or different patient you must change the “submission code” to “D” (duplicate) or it will be rejected. From the Explanatory notes:


“The call-out charge applies only to the first patient examined or treated on any one special visit. A call-out charge is applicable to each special call-out whether or not a previous call-out charge has been billed for the same patient on the same day. For example, a physician may provide a consultation during out-of-office hours for which a call-out charge is applicable. The physician may then perform an operation on the same patient at a different time during out-of-office hours. If the physician was specially called, on separate occasions, to render both services and was required to travel from one location to another for both services, it would be appropriate to bill a call-out charge for the consultation and a call-out charge for the operation in addition to the regular fees for the services and any applicable continuing care operative and non-operative surcharges.”


5         RE-REFERRALS


If you are re-referred a patient for a different problem within six months and you bill 07010 it will be automatically reduced to 07012 unless

  • You change the diagnostic code for the second consult AND
  • You ask the GP to submit a 03333 (no charge re-referral)
  • Eg you see a patient for a colonoscopy and bill 07010 with diagnostic code 787 (symptoms involving GI tract)
  • 3 months later the GP sends the same patient to you with a skin cancer

–      Bill 07010 with diagnostic code 173 (other malignant neoplasm of skin)

–      Ask the GP to submit a 03333/173

–      You will be paid for a 2nd full consult


If you are re-referred a patient for a different problem after six months and you bill 07010 it will sometimes be reduced to 07012 unless

  • You change the diagnostic code for the second consult


If you are re-referred a patient for the same problem after six months and you bill 07010 it will be automatically reduced to 07012 unless

  • You ask the GP to submit a 03333 (no charge re-referral)


You should bill 07012 if you see the same patient for the same problem within six months



1)    What to bill for EGD with esophageal and gastric biopsy?

  • Option 1
    • 00706 – 100%   $105.56
    • 00711 – 100%   $26.58
    • Option 2
      • 00707 – 100%   $86.92
      • 00711 – 100%    $26.58
      • Option 3
        • 00708 – 100%   $90.49
        • 00711 – 100%    $26.58


2)    What to bill for colonoscopy and polypectomy plus gastroscopy?

  • Option 1
    • 33374 – 100%
    • 00707 – 100%
    • 00711 – 100% if applicable
    • Option 2
      • 33374 – 100%
      • 00708 – 100%
      • 00711 – 100% if applicable


Why not 50% for EGD? – Clarification from MSP

Unless specified elsewhere or agreed to at the tariff committee etc, the general interpretation of Preamble B. 11. b is when a diagnostic procedure is performed with a surgical procedure the diagnostic procedure is paid at 100%. If more than one diagnostic procedure is performed with a surgery the 2nd diagnostic procedure is paid at 50%.”


What about 2 diagnostic procedures?

Preamble B. 11c. “For multiple diagnostic procedures performed at the same sitting, the procedure having the largest fee may be claimed in full and the remaining procedure(s) at 50 percent of the listed fee(s), unless otherwise specifically indicated in the Payment Schedule.”


What about 2 surgical procedures?

Preamble 9. e. Multiple Surgery ii “When two or more different procedures are performed through separate incisions under the same anesthetic, and repositioning or redraping of the patient or more than one separately draped surgical operating field is medically/surgically required.., the procedure with the greater listed fee may be claimed in full and the fees for the additional such procedures are reduced to 75 percent, unless otherwise indicated by the Payment Schedule.” Otherwise it is 50 percent.


A note record is required stating “separate prep and drape” in order to bill 75%.


3)    Which endoscopy fees are considered “surgical” fees?

  • 07460 – flex sig decompression of volvulus
  • 70547 – EGD and varix banding
  • 70549 – EGD and stent placement
  • 70551 – balloon dilation of esophagus
  • 70552 – savory dilation of esophagus
  • 70554 – balloon dilation for achalasia
  • 07563 – thermal coagulation of stomach
  • 07574 – gastric polypectomy
  • 70638 – endoscopic feeding tube reposition

(07001 can be billed with these codes too!)


  • 33374 – colonoscopy and polypectomy
  • 33393 – PEG tube

(07001 cannot be billed with these codes)


4)    Why are complex procedures (Whipple’s etc) underpaid?

  • Complex procedures requiring a long hospital stay are now paid more because of increases to post-op care at $17 per day (71008)
  • A 10 day stay in hospital = $170 in addition to the operative fee


5)    When should the new phone management fees be used?

  • Please refer to MSP website via the link below



  • What we think is reasonable is if you give any advice that changes the management of a patient over the phone you should bill 10001 or 10002. So merely telling the other physician you will come see the patient or book an office visit you should not
  • Eg.

–      ER doc calls about a patient with possible SBO – you look at xray from home and tell them to put an NG tube and you will see them the next day – Bill 10001

–      ER doc calls about a patient with a possible SBO – you say you will see them the next day – Do not bill 10001






2009 Annual General Meeting Minutes



Saturday, February 14, 2009

Rim Rock Hotel, Banff

1. CALL TO ORDER – Dr van Heest, President, called the meeting to order.  There were 18 members present


The minutes of the meeting held in Kamloops, March 12, 2008  were approved as circulated”


3a            Approved New Fees

Dr van Heest reviewed the new fees.

  • Premium of $62.50 for patients  75 years and older – This new premium is effective Dec 2008.  It will be monitored to ensure with remain within the allotted budget.  The membership asked that MSP clarify where to bill the premium within the list of codes that could be billed, particularly after hours.  They will be asked to put the clarification in the bulletin.
  • Lysis of abdominal adhesions – Utilization to date was reviewed and for six months, $51,000 of the $90,000 budget has been used.  The members asked if the Section could please keep them apprised of the utilization during the probation period.
  • Abdominal Wall Reconstruction  -Introduced at $850 last August
  • Pre and Post Operative Visit Fee – $19 – effective April 1, 2009. The fee value is expected to be reduced because of the total dollars available for it.  Dr Dykstra felt that the value could be a bargaining tool for future.  The visit fee applies only to General Surgery owned fee items.

3b            Tariff Committee Issues

  • 13 New Fee Applications were presented to the members. This list was derived from the over 50 items submitted from the membership.   It was pointed that these items are currently work that is unpaid.  Dr van Heest will be meeting with Tariff to discuss these items soon.

It was moved and seconded

that the Section of General Surgery “approves the list of 13 items and directs Dr van Heest to meet             with  Tariff to apply for these new items”                           CARRIED

It was suggested that tray fee eligibility be added to the Chemical Sphincterotomy.

  • Advanced Laparoscopic versus open fees – differential – for discussion

The Executive brought forward a truncated list of new laparaoscopic fees which have an existing open equivalent already in the guide.  It was felt that these fees should be  introduce at the value of 25% higher than the open ones.  Dr van Heest stated that all fees are undervalued and that if  new fees are created, they should be appropriately values.  It was her contention that the others could be increased up to the same value when new allocation dollars are available to the Section.

It was pointed out that Ontario has 25% surcharge on all lap colorectal fees.

It was also pointed out that government doesn’t always follow precedent.

The Executive felt that the facts were needed, ie, what are the numbers of the average open vs lap – a measure of time.  Some members felt we should ask for 50% above open.   It was then moved and seconded that

“the membership enables the Executive to study the true time difference and complexity between open and lap and apply for new $ with a differential on lap fees based on this data”


Dr van Heest suggested that we send a survey and then vote via email involving  the full membership.   Then we could move ahead on the motion.

Drs Todd Swason and Sharadh Sampath agreed to do this study.  Dr Sampath suggested that complexity should be considered and not only time as a factor.

Ray Dykstra pointed out that MSP does not reward slow surgery.

In the joint business meeting with AAGS, Dr Sample shared an approach taken in Alberta                         was to calculate the mean operating time for a certain procedure and proposed that time                                     taken over the expected mean operating time be paid for by unit of time over and above the                         base fee. This is currently under consideration but not in effect.

Dr Bugis questioned in ten years from now when lap fees are 25% higher and new money comes to Section , will people be happy not to increase lap fees.  Dr van Heest said the gap should be closed, although there may always be a differential.

  • Obesity surcharge  BMI <35 –Dr van Heest gave the background to this issue.  The section could not reach agreement with Tariff on the BMI.  They would not go below BMI ,40.  The section has surveyed other groups and support has been received from Anesthesiology, OBG, Plastics, Orthopedics, and Urology.  BCMA Negotiations may be including this in proposal, after which the Section will revisit the issue.  Discussion about whether a BMI modifier should apply to bariatric fees.  There was no consensus reached.
  • Section of Gastroenterology Fee Request  – Two years a request was received from the BCMA Section of Gastroenterology to move all endoscopy fees to their Section.  Some fees have been transferred.  We hope to not allow them to move without our permission in the future.  Dr van Heest will write a letter to BCMA/Tariff stating this.   Utilization is a factor that BCMA uses to determine ownership.   Panton questioned the  long term effect of such a transfer of ownership – envisioning that  one day general surgeons will not be able to bill them.

The report that Dr Scudamore presented last year was not supported by GI Section.

3c            SSPS InitiativesSpecialists Negotiating Committee – Dr van Heest thanked Dr Sam Bugis who sits on the SNIC.  The Section has brought forward two items for negotiations, out of hours surcharge and a comprehensive/expedited cancer care fee.  The SNIC final report included nine items altogether.

The Section will go directly to the Negotiating Forum to be held this spring.  A survey on ideas that should be addressed will be forthcoming.  Comprehensive cohesive argument of why GS needs more money is what Dr van Heest is looking for.

4            TEASURER’S REPORT – Dr Aleem  -Dr  van Heest thanked Dr Aleem  for his many years of service and presented him with a gift.

4.1      Annual Dues – 2010

Dr Aleem presented the statement of income and expenses for 2008.  He suggested that with the budgeted expenses for 2009, dues for 2010 remain at $750.

4.2            Executive Stipend – Dr reported that the stipend for President is $15,000 and for Economics Committee is $12,000.

Dr Dykstra asked that Dr Aleem’s secretary receive an honorarium for her work on behalf of the Section.

It was then moved and seconded

“that dues for 2010 remain at $750

 “to continue to pay Exec stipend as it currently exists”

“to pay honorarium to Dr Aleem’s  secretary”

“to accept Treasurer’s Report”                                                CARRIED

4.3            The signing officers for the Section were then changed as follows:

“that  Drs Rardi Van Heest, Sharadh Sampath, Ray Dykstra and Ms Tanyss Bugis have  signing authority for the Section of General Surgery”


4.4            Bylaw Amendment – Dr Dykstra reported that he would like to bring forward a motion to change bylaws of SSPS to state that  if a section does not have 50% of their specialty as paid members to their Section, and  and 50% of their members as paid members of the SSPS, that they do not have a right to vote at Council.

This received support from the members.

5           ELECTION OF OFFICERS – Slate for 2009-10   The Slate of officers was presented.  Three new members were welcomed.

Dr Sharadh Sampath – New Treasurer

Dr Todd Swanson  – New Resident

Dr Jenni Smith – Regional Rep – for Vancouver Coastal –– replacing Dr Scudamore

There being no further nominations from the floor, the slate was accepted as follows:






NORTHERN HEALTH REGION                        –            DR MICHELLE SUTTER

INTERIOR HEALTH REGION                        –             DR CHRIS BALISKI


FRASER HEALTH REGION                                    DR SUSAN MCDONALD


RESIDENT MEMBER                                                 DR TODD SWANSON

ECONOMICS COMMITTEE                                    DR STEPHEN HISCOCK (Chair)



EXECUTIVE DIRECTOR                                                MS TANYSS BUGIS

It was moved and seconded

                        “that the Slate of Officers for 2009-10 be approved”


6             OTHER BUSINESS

  • SSPS Surgical Specialist Group – SSPS – This group plus Anesthesia, has been meeting by conference call to discuss issues of mutual interest. Despite getting surgical heads together, no one has stepped forward to be SSPS Member at Large for surgery.   Dr Jenny Hankins was suggested.  It was felt that within the SSPS, even an acute care specialty group, would not have success overcoming the low paid non-procedural group.  Leadership in this section should be mobilizing like-minded surgical proceduralists.

General discussion ensued regarding the future of  SSPS.  Sections want to have a rep at the BCMA             level and there is no other way currently.   Some are frustrated with lack of leadership and that the             SSPS meetings turn into microallocation.

BCMA Governance model had more sectional representation to the Board, but this was defeated at             the AGM.

The Alberta Surgeons had success with a generalist approach, involved general surgery, general             internal medicine, general pediatrics, general psychiatry and general practice (the Big 5).

  • MOCAP – Some Health Authorities have  reduced MOCAP payments arbitrarily.  This has not happened to general surgery but vigilance is recommended.  Some HA have stated they will not pay the  $250 call back fee – when you are not on call.
  • SAFETY equipment – Health authorities are trying to substitute various equipment  for each hospital.  First it was mesh and now with safety scalpels.  They have introduced scalpels with sheeths on them and the surgeons in Vernon feel they are unsafe.   It was agreed that the Section should write a letter to the Health Minister and Worksafe with copies to the CEO of each region.

It was moved and seconded

“That the BCMA Section of GS opposed the substitution  of  instruments and devices unless the             affected  surgeons are first consulted and deem such substitutions clinically appropriate”


7      Adjournment – the meeting adjourned at 3:45 pm





2008 Annual General Meeting Minutes

Annual General Meeting

Section of General Surgery, BCMA

Friday, March 21, 2008 – 10:30 am

Delta Hotel, Sun Peaks Resort

Dr Dykstra, President, welcomed 40 surgeons and called the meeting to order.


“that the Minutes of the Annual General Meeting held May 12, 2007 at the Grand Pacific Hotel in Victoria be accepted as circulated”


Dr Dykstra reported that Tariff Committee issues are still very time-consuming and frustrating to deal with. He was pleased that Dr Jean-Noel Mahy, a general surgeon, now sits on Tariff as it helps the committee to develop a broader understanding of surgery issues.

Dr Stephen Hiscock, Economics Representative reported on the following items:

Premium for Age 75 and over – This item has been accepted by the Tariff Committee as a complication to surgery and will pay a $62.50 premium. The Section is in the process of developing the list of fees to which the premium should apply.

Laparascopic Ventral Incisional Hernia repair – This new fee item has been accepted and funded by new money. An initial hernia will be paid at $550, and a recurrent hernia at $700. Despite trying to explain to the Tariff Committee that an “incisional” hernia by its very nature is a repeat, they insisited on the “initial and recurrent” terminology. The Section has insured the minutes of the Tariff Committee state that interpretation of this item will be that if an incision exist through which the hernia repair is done, this will be considered a recurrent procedure.

Lysis of Adhesions – This fee item has now been accepted paid at 100% with own or other sections surgeries. It will be monitored for one year and the members will be informed when this process begins. The fee is not billable for the first half hour but then will pay $150 for second half hour and then $75 for every 15 minutes after that. Fee item 07043 (repeat surgery) was deleted and savings from that item will help to pay for the Lysis of Adhesions.

BMI >35 – Tariff Committee agreed to 25% surcharge (funded by Section) but only on BMI >40. The decision is to try to return to this issue with the help of other sections, ie, OBG and Anesthesia.

Preamble Change to increase “operation only” value from $125 to $200 – Tariff Committee has agreed to increase to $160 (estimated value of $125 in today’s dollars).

Abdominal Wall Reconstruction – negotiations are still underway for this item. Section of Plastic Surgery supports Section of General Surgery using their new item plus 50% of hernia guide. If negotiations are not successful, we will go back to our original submission.

Gastroenterology Fee Request – for transfer of endoscopy fees – Dr Scudamore reported that he has reviewed the endoscopy fee schedule and believes that it should be restructured to make it simpler and more economical. Far too many fees exist and he felt that the number of routine biopsies (that are generally normal) could be reduced and the money redistributed. There would be no reduction to the sequential, staging biopsies. He has had discussions with various gastroenterologists and was to bring forward a proposal to our Section. It is felt that cooperation between the two sections is essential.

Polypectomies would not be affected.

SSPS ARBITRATION/MICROALLOCATION – Dr Dykstra described the failed negotiations last fall (after 36 hours) at which point the Section of Anesthesiology trigger arbitration. Arbitration deadlines for submissions are every two weeks. He complimented the Executive who are working together effectively and used the Section’s submission as an example. The process will take two more months, and could potentially be resolved by end May. There is a chance that the arbitration award could be appealed. The costs for the arbitration are high, including $600/hr for the arbitrator and $320/hr for our lawyer.

Once the arbitration and the microallocation of new monies is complete, the Section will have new money to allocate. Dr Dykstra presented a detailed proposal in his 2008 President’s Report (which forms part of and is attached to these minutes). The membership supported the proposal as outlined in his report.

It was moved by Dr Dykstra and seconded by Dr Hanks

that the Executive be authorized to use as a guideline the microallocation proposal as outlined in the 2008 President’s Report.”


TREASURER’S REPORT – Dr Dykstra thanked Dianne in Dr Aleem’s office, for continuing to deal with and report the finances for the Section of General Surgery. An honorarium will be forwarded to her. A financial statement to March 11, 2008 was presented showing a bank balance of $36,671.05. Outstanding annual dues represent about $50,000 and it is hoped that all members will pay.

After providing background information, Dr Dykstra brought forward the following motions:

  1. “that the Treasurer’s Report be accepted”
  1. “that the Economic Rep honorarium be increased to $12,000 (from $10,000) and be divided equally among the three members of the committee”.
  1. “that for one-time only, the President-elect receive an honorarium of $15,000”
  1. “that the President’s stipend be set at $200/hr going forward”


It was suggested that in lieu of payment, a President could choose to be sponsored at a leadership course.

Annual dues were discussed. Last year the members passed an enabling motion which gave the executive the right to increase dues up to $1,500 if necessary. The dues were increased to $750.00. It was then moved and seconded

“that the Executive be authorized to increase the 2009 annual dues up to $1,500 if deemed necessary to meet the financial obligations of the Section of General Surgery”


The members asked if there was a way to avoid the situation with arbitration in the future. Dr Dykstra pointed out he plans to bring forward a motion to the AGM of the SSPS to change the bylaws. His motions, if passed by ¾ of members present, would remove the need for a unanimous decision on microallocation and instead a 75% majority would be required. Further he has brought forward a motion that sections must have at least 50% of their membership as members of the SSPS in order to have voting privileges. In his opinion if these motions are not accepted by SSPS, it is likely that the Society will not survive.


Dr Dykstra pointed out that a resident member has been added to the Executive. He then presented the slate and called for nominations from the floor. No nominations came forward and the new slate was approved as follows:

President – Dr Rardi Van Heest

Economics Rep/Vice-President – Dr Stephen Hiscock

Past President – Dr Ray Dykstra

Treasurer – Dr Abdul Aleem

Members at Large:

Regional Reps – Northern Health Region – Dr Michelle Sutter

Interior Health Region – Dr Chris Baliski

Capital Health Region – Dr Jenny Hankins

Fraser Health Region – Dr Susan Mcdonald

Vancouver Coastal Health – Dr Buz Scudamore

Resident Member – Dr Sharadh Sampath

Economics Committee: Dr Stephen Hiscock

Dr Norm Causton

Dr Hamish Hwang

Exec Director: Tanyss Bugis

Dr Dykstra stated that he felt the executive was in better shape than ever before and knew that the incoming President would be a great asset to the Section. He then passed the chair to Dr Van Heest who thanked Dr Dykstra for his four years of dedicated services as President and over a decade of service to the Section in other capacities.

Dr Van Heest reported on the new governance model proposal by the BCMA, which will include fewer Board members, regional reps, and section reps to a representative forum. Additionally advisory groups via section or regional health authority will be possible. This structure does not include the negotiations and other money matters, just governance. Dr Van Heest did not make a recommendation to the membership on how to vote, but instructed them to read the material coming from BCMA. She said there had only been time to concentrate on microallocation. She reported that the next round of negotiations will begin in 18 months and hoped that the profession would move ahead as a collective group.

There being no further business, the meeting adjourned.


2007 Annual General Meeting Minutes


Section of General Surgery, BCMA

Annual General Meeting

May 12, 2007 – 12:00 noon

Grand Pacific Hotel, Victoria


Dr Dykstra, President, welcomed the 31 members present and introduced Dr Mike Stanger, Chair,Council of Specialists. Dr Stanger spoke to members about the Surgical Patient Registry, the benefits of data, the compensation to surgeons, and the principles of data use.

Macroallocation – SSPS felt that the arbitrator had made an error in his award and has appealed the decision. This would amount to $50 m if successful. In the Microallocation between $100 – $150 m will be distributed to the 31 sections of the Society of Specialists. Dr Stanger said consideration will be the given to money already distributed via Retention & Recruitment ($10m) and Disparity ($20m) and will include the new overhead study figures.

Dr Stanger reminded those present that the Annual Meeting of the SSPS will be held June 23.

MINUTES OF AGM – It was moved, seconded and carried

“that the Minutes of the General Meeting held March 18 and 19, 2006 at Sun Peaks Resort in Kamloops be approved”

The Treasurer’s Report was deferred to the end of the meeting.


Approved Tariff Issues:

Surgical Start Time – this has been changed from the anesthetic time to actual cutting time. It was felt that this would allow surgeons to bill the out of hours surcharge for cases that come to the OR at 1730 but the surgeon does not begin until after 1800 hours.

Certified Surgical Assist – The Section of General Surgery was successful in having a C prefix affixed to advanced laparoscopic fee items. It was confirmed that this item could be billed along with a GP assist, if necessary. The new fees are retroactive to December 15, 2006.

Laparascopic Splenectomy – A new fee item has been established for Lap Spleen at a 25% higher fee than the open. The membership of Section of General Surgery has stated it would not accept prorationing of existing fee items to fund a differential fee for laprascopic fees. This new fee item was funded with new monies and therefore we applied and were granted a 25% differential fee.

Complicated Surgery Surcharge – Dr Dykstra gave the background to this fee proposal. Originally the Section asked for a surcharge for complicated surgery including BMI greater than 35, age over 75, ASA greater than 2, and previous radiotherapy. MSP does not support the last two factors, however, has agreed to a flat amount for age (funded by Section’s new money). The obesity factor has also been agreed to as a percentage of the fee. However, they will not agreed to a lower than BMI of 40 of the trunk. Dr Dykstra pointed out that this BMI would apply to very few patients and if we accept this it would be an increase only to bariatric surgery. Members asked if we accept BMI of 40 now, could it be negotiated downward in the future. The section should not accept a BMI of greater than 35%.

Further MSP originally wanted the surcharge to apply only to open procedures but have recently agreed to include lap procedures. The members felt the surcharge should be applied across the board, equally to open and laparoscopic fees.

The volume of bariatric surgery is increasing and it was suggested that all surgeons will be doing this type of surgery in the future.

Dr Turner pointed out the disparity among the gastric fees. He said that a gastrectomy is paid less than the first case of bariatric surgery. It was felt that the fees need to be reviewed before a decision about obesity surcharge could be made. Dr Amson pointed out that five years ago when there was new money, only Bariatric fees were exempt, all other fees went up.

The costing of this item is currently underway at the BCMA. It was decided that after a review of the gastric/bariatric fees, this issue could be brought back to the membership for a vote by email.

It was decided to proceed with the surcharge for patients greater than age 75. The surcharge would not apply to consultation, only on surgical procedures.

It was moved, seconded and carried

“to fund the surcharge for surgical patients over the age of 75 from the Section of General Surgery’s microallocation money.”

Lap Ventral Hernia – New item and other than fee, it has been approved. We are fighting for 125% of open, again with the differential to be funded from new money for new fees. Dr Dykstra pointed out that one of the scientific presentations gave reference data which he will use.

Outstanding Tariff Issues

Lysis of Adhesions – A new fee item has been approved, contingent on deleting repeat surgery 07043. Time based at $150 for ½ hour and $75 for every 15 minutes after billable at 100% if called in for another surgeon. If billed in association your own procedure, payable only at 50%. Dr Dykstra felt this was still a big improvement over the 25% surcharge on repeat surgery. He will continue to negotiate to be able to bill at 100%. Funding should be from money saved from repeat surgery. As bowel obstruction already has a lysis of adhesions fee, this new item will not apply to that surgery.

It was moved, seconded and carried

“to Delete 07043 and replaced with new lysis of adhesions time based fee”

Dr Dykstra reported that the Incisional hernia fee guide needs to be reviewed and updated by the Section.

Abdominal Wall Reconstruction – An application, authored by Dr Laurence Turner is before Tariff Committee.

Broviac and Portacath Fee items – Section of Vascular Surgery has requested that these items be transferred to their Section, as they wish to increase the items. As they bill more than General Surgery does Tariff will probably transfer the items to them. If Vascular Surgery increases the items, then General Surgery will have to fund the increase billed by General Surgeons.

A motion “that all Vascular fee items be transferred to Section of Vascular Surgery” was tabled to next year. It was suggested that we wait and see what Vascular Surgery does with these two items and how it impacts the Section of General Surgery.

Section of Gastroenterology Fee Request – A request for transfer of all colonoscopy fees has been received. Dr Dykstra was successful in negotiating a one year moratorium on the transfer. In the meantime, Dr Scudamore and Dr Jim Gray will work together and come back to the Sections involved with information and recommendations.

SSPS Initiatives

Retention & Recruitment Fund – $10 m – Drs Norm Causton, Sam Bugis and Ray Dykstra put together a proposal outlining the Section’s manpower issues. The committee asked for more focused report and it was decided to ask for money to apply to colorectal fees as a way to attract more colorectal surgeons to the province. As of May 4, 2007 – 93 colorectal items have gone up 24%. The overall increase to the General surgery budget of $50 m is 2.3%. The only item not included was the flexible sigmoid as it had a Y designation (billable with office visit) and was deemed adequately funded. However, Endoscopic sigmoid volvulous had its fee tripled.

This fee increase is retroactive to April 1, 2006.


There is $100 m on the table. The Executive has decided to argue for the majority of it to go to out of hours surcharges, and the #1 priority. #2 priority across the board raise based on per capita rather than percentage. Priorities for cost of living increase and disparity correction would follow.

The issue for General Surgery is that it received a 2.3% increase from the Retention and Recruitment Fund. The Section needs to argue successfully that this was a separate process for a separate issue, and should not be included in the calculations. This approach will result in some sections getting much higher increases, as from the Disparity allocation, some section have already received 23% increases.

Dr Rudston-Brown stated that negotiations among specialists is a completely asocial process and have nothing to do with right and wrong.

Dr Dykstra said that Service Contracts could be reviewed and set as benchmarks for negotiations for general surgeons. Some discussion of current contract was held.

Overhead Study – Dr Will Orrom outlined the process involved for the Section’s participation in the recent overhead study. The Executive Summary was distributed and the numbers reviewed. It was noted that General Surgery has been given a 33% overhead, while ENT was 50%. What are the capital costs for ENT? Others mentioned were OBG 41%, Anesthesia 22% and Orthopedics 37%.

Dr Orrom said he was suspicious of the numbers, however has not looked at the details. He assumes there must a 10% fudge factor (shifts of money to spouses, etc). The feeling of the group was that there was not point in complaining or asking questions, as the consensus was there was no way to change the outcomes.

Committee RepresentativesDykstra reported that Dr Eric Paetkau has been appointed to the Disparity Allocation Committee. He outlined the process for appointment to and the composition of the BCMA Tariff Committee. Dr Jean Mahy has been appointed as the SSPS representative on the Tariff Committee. Both Tariff and SSPS are very pleased with the appointment.

Dr Carol Dingee sits on the Microallocation Working Committee.

Regional Representatives ReportThe membership thanked Dr Dan Brosseuk, who has been representing the Northern region for several years. Dr Michelle Sutter will replace Dr Brosseuk.


MembershipMs Bugis reported that 123 general surgeons have paid their Section of General Surgery dues and that 50 were outstanding. She will be following up with the unpaid members.

Database for the Section of General Surgery was circulated and members were asked to review it for their area and let the Executive Director know of any errors.

It was moved and seconded

That Pediatric General Surgery be officially removed from our the general surgery database.” It was decided to hold this decision until Dr Al Hayashi had a chance to discuss it with the Victoria Pediatric Surgeons.

It was moved, seconded and carried

“That the members of the Section of Chest Surgery, full time thoracic surgeons be officially removed from the General Surgery data base.”

Bylaws – It was moved, seconded and carried

“That the bylaws of the Section be changed to include an Economics Representative and that this person will be the Vice-President”

From the floor a motion was moved, seconded and carried

“That residents be invited to join the Section of General Surgery, BCMA without charge”


Dr Aleem presented the financial statement to date. He reported that the rebate of $1,000 previously agreed to, had been distributed to the 67 members.

He presented a statement of income and expenses since the AGM of 2006.

It was moved, seconded and carried

“that the Treasurer’s Report be Approved

Dr Will Orrom reported that as Economics Representative he would forego his stipend and asked that it be given to Dr Ray Dykstra for all the extra work he accomplished through the past year.

It was moved, seconded and carried

“That the $10,000 economics representatives stipend be payable to the President, Dr Dykstra”.


Dr Dykstra reported that Dr Rardi Van Heest was willing to take on the Presidency however she was uneasy about the unknown territory.

Dr Stephen Hiscock, Salmon Arm will become the Economics Rep. He has practiced in Alberta, Ontario and BC.

The workload for the future should be divided between these two positions. Economics Rep is responsible for new/revised items going to Tariff. The President will deal with SSPS and the Microallocation. The Microallocation could be straight forward however, if it goes to arbitration, it will be a huge undertaking for the Section.

Ideally there should be a progression of surgeons through the Section Executive, however, because no one was able to help in the past year, there are new people at the forefront.

The membership felt that Dr Dykstra needs to be at the table for microallocation and needs to be properly compensated for his work. There are millions of dollars on the table.

The Microallocation meetings are June 16 and 17, Dr Dykstra can only attend first meeting day. He will work with the new President to keep any major decisions from being made the second day

General discussion took place regarding sessional/hourly compensation for Executive members. It was moved, seconded and carried

“That an hourly/sessional rate be investigated for executive members and the discussion brought back to the Annual Meeting in 2008”

Dr Dykstra was then asked if he would consider accepting the Presidency for one more year, given the fact that microallocation with take place.

It was then moved by Dr Dan Brosseuk, seconded by Dr Damien Byrne and approved

“That Dr Ray Dykstra be President for a further one year, and compensated for his time on sessional basis of $1,500/day plus expenses in lieu of the current honorarium of up to $15,000”

It was moved, seconded and carried

“That the Executive Committee be given the authority to apply special levy to the membership of up to $1000 if deemed necessary to meet the financial obligations of the Section of General Surgery”

It was moved, seconded and carried

“That the Executive Committee be given the authority to raise the annual dues in 2008 to a maximum of $1,500 if deemed necessary to meet the financial obligations of the Section of General Surgery”

Dr Dykstra agreed to take on the Presidency as he did not want to see the gains made through the past three years, be lost. He asked for a commitment from the membership to never let the Section of General Surgery get into this situation again.

The revised Slate of Officers was then presented.

Dr Ray Dykstra – President

Dr Rardi Van Heest – Vice-President.

Dr Stephen Hiscock – Economics Representative

Dr Abdul Aleem – Treasurer

Regional Reps:

Northern – Dr Michelle Sutter

Interior – Dr Chris Baliski

Capital Health – Dr Rachel Barton

Fraser Health – Dr Susan McDonald

It was moved, seconded and carried

“That the new Slate of Officers be approved”

It was moved, seconded and carried

“That a $1,000 honorarium be approved for the Treasurer”.

It was noted that Dr Aleem gives the honorarium to his secretary, Dianne, who does all the financial work on behalf of the Section.

Next Meeting – Timing of the Section’s annual meeting is difficult as it has to not interfere with the BC Surgical Society meeting. It will be considered whether an evening

meeting would be appropriate for next year.

The meeting adjourned at 3:00 pm