Initial thoughts on Blue Ribbon Panel report

September 4, 2019

Dear Members:

Yesterday you will have heard about the release of the Report and Recommendations of the Blue Ribbon Panel on Alberta’s Finances. The report details government’s concerns over the growth and level of health expenditures, i.e., the issue of affordability. It conveys many of the same messages contained in the government’s election platform, although the focus there was more on value for patients and included creating a medical home for each Albertan, as well as issues related to seniors’ care, mental health and addiction.

As I noted in a recent President’s Letter, these issues of affordability and value must be considered together. The problem of managing the health budget – affordability – is intertwined with maximizing value from the system. Historically, approaches to managing budget alone have simply driven costs to new places and have had unintended consequences for Albertans. Likewise, dealing only with value ignores the real budget issues and fails to create the economic imperative to maximize benefit to Albertans. The AMA is prepared to discuss any options to help strike that balance.

Meeting the health care needs of Albertans must remain the primary focus. The AMA, government and other providers need to listen to the issues that mean the most to patients. This means finding meaningful ways to understand their concerns and allow them to have real input into the system. For example, through albertapatients.ca – an online community of 9,500 members strong and growing – we have heard loud and clear that they do have issues. They have concerns about the health care system being there for them when they need it, particularly in their senior years. They worry about being able to afford the care they need or having sufficient support to be caregivers for their loved ones. Patients must be included in planning for the future of our health care system.

In many ways, the content of the report is not too surprising. It is consistent with an earlier report written by the chair of the Blue Ribbon Panel, Janice MacKinnon. Boiling it down to the minimal bottom line, the panel finds that Alberta’s finances are in an unsustainable state and decisive action is needed sooner rather than later. Health care costs, particularly physician expenditures, are highlighted in the report (other than union labor costs, the report does not deal with Alberta Health Services expenditures in light of an AHS review currently underway by Ernst & Young).

At the bottom of this email, I have included four recommendations from the Report and Recommendations of the Blue Ribbon Panel on Alberta’s Finances that relate directly to physicians.

There is a lot of content in the report, but here are my comments on some of the aspects that are most significant to physicians:

Expenditures: There are always different ways in which physician payment data can be presented. We will look carefully at how the report’s statistical arguments are laid out and offer countering perspective appropriately. I won’t dwell on this element today, but I wanted you to know it won’t be forgotten as we move into negotiations this fall. We will also make sure that the financial contributions physicians have made in recent years receive due consideration.

AMA Agreement and negotiations: Government recently sent the necessary notice to initiate negotiations. We will be consulting our physician leaders at the upcoming Representative Forum on our approach and will likely be at the table with government in early-to-mid October. The Blue Ribbon Panel states that the parties should do everything possible to reach a negotiated agreement. They also go on to state that should a negotiated deal prove unreachable, then government should consider “legislative options”. The AMA Agreement itself is characterized as a barrier to government’s ability to manage costs. While there is always room for improvement, I do not agree with this view.

Negotiated AMA agreements have been some of the most flexible mechanisms in the health care system that have delivered real value for patients and taxpayers. Primary care networks and the pervasive use of electronic medical records are two excellent examples, as are physician-led savings initiatives that reduced the growth rate of physician expenditures.

The panel report indicates that a negotiated agreement is the preferred option. I fully agree. The AMA has never failed to reach an agreement with any government over many decades. I am confident that one can be achieved now too, and in a timely fashion. We understand government’s urgency. We have been preparing for negotiations over the past year and will be ready and able to commence following a discufssion with the Representative Forum later this month. In my conversations with the Minister, I have been offering collaboration and a chance to establish some shared interests before formally sitting down at the table. We need to get these discussions off to a running start.

Legislation: As for legislative options, government has always had that great power. It should not be used lightly and I do not think the panel is suggesting it should be. In all environments, collaboration is the best option. The Board believes that in building on the strengths of our current agreement, there is significant opportunity for increased value for patients and an affordable and financially sustainable health care system.

Alberta physicians have a strong track record of innovation and accountability. We have what the panel report calls a “reform culture”. While I fully expect very tough negotiations, I also have confidence in the capability and willingness of physicians to be partners in delivering value and affordability. Common ground can be found in what’s best for patients and I think there are plenty of examples of such things in this Blue Ribbon Panel report. We can keep people in the community and out of hospital as much as possible. We can set measurable targets for improving outcomes and work toward them. We are more than open to (and are already working toward) new ways to fund services and create incentives for doing things differently. Accessible, high-quality health care for all Albertans in a patient-centric system is achievable by working together.

Your comments are welcome in the usual three ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
• Share your perspectives with colleagues on our member-only Discussion Board (member login required).
• Comment publicly on this President’s Letter below.

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP
President

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ON HEALTH: THE BLUE RIBBON PANEL RECOMMENDS THAT THE GOVERNMENT SHOULD:

Recommendation 1:

Empower strong, strategic leadership to transform the current health system, using other provinces as models, and engaging nurses, doctors, other health professionals, stakeholders and the public where appropriate. The goal is to establish a health system that achieves better outcomes, provides more appropriate care for Albertans, and approximates the average per capita spending of British Columbia, Ontario and Quebec.

Recommendation 2:

Establish the following set of outcomes to measure Alberta’s progress in transforming its health system to reflect the needs of 21st century patients and reduce costs. An external organization, independent of government, should review and report annually on Alberta’s progress in closing the gap with comparator provinces on these outcomes (see page 32, table 12).

Recommendation 3:

Make greater use of alternative service delivery for day procedures and other services that do not have to be delivered in hospitals and could be delivered in private or not-for-profit facilities. The use of alternative service delivery should be applied to other areas beyond health.

Recommendation 4:

Limit the increasing cost of physician services by providing incentives for physicians to move to Alternative Payment Plans and by renegotiating the agreement with the Alberta Medical Association. Every effort should be made to achieve a negotiated agreement, but the government should also consider its legislative options.