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Nurse practitioner makes house calls

By: Jordan Ross

Posted: 04/15/2017 8:30 AM

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Diane Gudmundson, a nurse practitioner who lives near Richer, recently began offering fee-for-service house calls to patients in several Southeast communities. Gudmundson is one of four nurse practitioners associated with the new Timely Care Clinic in Winnipeg. The clinic has attracted controversy for its payment model, which critics say may be a form of privatized health care. Gudmundson said the clinic does not violate the Canada Health Act, and offers increased flexibility for nurse practitioners, resulting in additional options for patients.

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Diane Gudmundson, a nurse practitioner who lives near Richer, recently began offering fee-for-service house calls to patients in several Southeast communities. Gudmundson is one of four nurse practitioners associated with the new Timely Care Clinic in Winnipeg. The clinic has attracted controversy for its payment model, which critics say may be a form of privatized health care. Gudmundson said the clinic does not violate the Canada Health Act, and offers increased flexibility for nurse practitioners, resulting in additional options for patients.

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A nurse practitioner from Richer has revived a practice from a bygone era of medicine—house calls—with the added option of virtual visits outside of her coverage area.

Diane Gudmundson, a registered nurse practitioner with Timely Care Clinic in Winnipeg, said she began offering the fee-for-service house calls in early March. She travels to communities in the RMs of Ste Anne and Tache, as well as Steinbach, Winnipeg, and Stonewall. Gudmundson carries with her a laptop computer, allowing her to offer virtual visits to those who live further afield, or to regular patients who occasionally prefer to check in online.

Gudmundson, who has been a nurse practitioner for 15 years, said she moved to the Richer area five years ago, and has prior experience with public health care clinics in the region.

"I actually was part of the QuickCare Clinic in Steinbach when it first opened," she said.

Currently, she carries out house calls on an as-needed basis. Demand has been on an upward trajectory, she estimated.

"When we first started, it was one or two calls a week. Now, it’s almost like we can’t keep up," she said.

So far, most of her house calls have been in Winnipeg, but last Friday found her en route to a patient in Lorette.

"We do anything, whether it’s prescription refills, chronic issues, acute illness, wounds that need stitches, the flu and pneumonia." She has treated children with ear infections, a young man with traveller’s diarrhea, and a middle-aged individual with allergies, and performed full physicals.

"We also can accept patients, and we can become a primary care provider if a person wants to do that," she said. "We do the full gamut of primary and urgent care."

Gudmundson described feedback she has received from Southeast patients as "very positive." Many are happy to avoid "sitting in the ER for six hours," she said.

For Gudmundson, her new job allows her to provide the flexible health care she longed to see become a reality during her years working for Manitoba Health.

"Working in the public system is very restrictive," she said. "There’s no flexibility. If you have creative ideas…they get squashed. You can’t really use your creativity to make things better."

Timely Care—a virtual clinic with a brick and mortar hub—provides her with the flexibility she desired.

"It’s all secure, cloud-based services," she explained. "You can get out and you can provide the kind of care that you want to provide as a provider, without limitations."

Gudmundson and her three colleagues are not employees of Timely Care. She explained that the clinic employs the same fee-for-service model that many physicians use at clinics in places like Steinbach, except that Timely Care bills the patient, rather than Manitoba Health.

"The doctors [in clinics] are independent businesses," she said. "They would pay a percent of their billings to the brick and mortar building to provide a secretary, computers, and security. It’s the same idea here. We pay Timely Care a percent to manage all that for us."

It’s a model— accepting payment from patients in exchange for the provision of medical services—that has attracted scrutiny from some of the more staunch defenders of traditional public health care. Some believe the clinic’s model is, at best, exploiting the grey areas of the Canada Health Act (CHA), and at worst, smuggling in privatized health care one clinic at a time.

MLA Matt Wiebe, the provincial NDP’s health critic, expressed concern about Timely Care Clinic in light of the recent closure of a QuickCare Clinic in St Boniface.

The Manitoba Nurses Union accused private clinics of poaching nurse practioners from an already thinly stretched public system.

However, Gudmundson was adamant that her clinic’s model does not violate the CHA. "If I was offering a [private] service that’s already [publicly] offered, then I’m violating it," she explained. "But I’m offering a service because there is no other option."

A physician who performs a house call can bill Manitoba Health—not so for nurse practitioners, she said. She likened her services to those provided by massage therapists and physiotherapists, who also have no option to bill Manitoba Health on a fee-for-service basis.

"Manitoba Health has chosen to keep the nurse practitioner fee structure stuck in one model," Gudmundson said. "We’re not charging private rates when we could be billing publicly. We have no option. That’s the difference."

For the time being, Timely Care Clinic has the apparent support of the provincial government. A spokesperson for Minister of Health Kelvin Goertzen issued a statement that said the clinic’s model "is not a contravention of Manitoba’s current legislation."

"Under the Canada Health Act, the range of insured services generally encompasses medically required services rendered by licensed medical practitioners…Services rendered by other health care practitioners, except those required to provide necessary hospital services, are not subject to the Canada Health Act’s criteria," the statement said.

Gudmundson, who affirmed her general support for public health care, said amending the HCA to allow more flexible funding models for independent providers "would make sense."

"All of these years, I was boxed into an eight to four, Monday to Friday [job]," she recalled. "People need something outside of these hours."

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