Nurse practitioner clinic charges patients due to lack of billing agreement

Nurse practitioner Miriam Neufeld can write prescriptions, diagnose health conditions and order tests at her new Art of Caring clinic in Camrose. She can help manage chronic health conditions and refer patients to specialists. 

However, unlike physicians, she can't bill Alberta Health for her services because she owns and works in her own independent practice. The province has no mechanism for paying nurse practitioners who work for themselves even though the profession is frequently touted as a solution to the province's chronic shortage of family physicians. 

"People do have to pay to see us," Neufeld said in an interview with CBC News. 

"But I'm hopeful that will change and that we will be able to move into a public-funded system because I do believe in our public-funded healthcare system."

Neufeld's storefront clinic, close to Camrose's downtown business district, opened in the middle of July. The freshly painted space has large windows which allow the morning sun to flood the waiting and reception areas.

The clinic has two examination rooms that are fully equipped with medical equipment such as a blood pressure monitor and devices to examine the eyes and ears. The reception desk displays a list of procedures and their prices. It also has a debit machine. 

An initial visit costs $60. After that, patients can see Neufeld for a routine medical visit on an appointment or drop-in visit at a cost of $25. She said some employee benefit plans cover the costs of her services. 

Alberta Health confirms what Neufeld is doing does not violate the Canada Health Act. That's because they don't have a compensation system for reimbursing nurse practitioners who set up their own clinics.

"Nurse practitioner services are currently not defined as insured services — therefore they can private-bill for these services," said Scott Johnston, press secretary for Health Minister Adriana LaGrange. 

"The legislative framework does not prevent them from doing this  — they are like midwives and physiotherapists, for example, who are not insured and can bill privately.

"An alternative compensation/business model for NPs is complex — but we continue to make advancements to support this work," Johnston said. 

The profession's advocacy association disputes the idea that any progress has been made. 

Susan Prendergast, president of the Nurse Practitioner Association of Alberta, is frustrated with the government's response, particularly in light of the current shortage of family physicians that has left many Albertans without access to a primary care provider. 

"We aren't anywhere, unfortunately," Prendergast said in an interview with CBC News. "We've been presenting our proposal for over a year and a half and we've been unsuccessful in harnessing the government's engagement."