2022-23 Year-End Update on KRA 1, Financial Health

Priority Activities

Year-end update

Negotiate an agreement for the provision of insured services with government that is fair to physicians and provides value for patients; and restores physicians, through the AMA as an active partner in the health system.

• The parties reached a tentative agreement in late-August after many months of discussions. Following board discussions and a special RF the tentative agreement was sent out for ratification on September 13. On September 28, the AMA membership ratified the AMA agreement with just over 70% of responding physicians voting “Yes” (voter turnout was 45.8%).
• Implementation activities have continued over the last few months. At a staff level, the Joint AH/AMA Agreement Implementation Working Group have been meeting once per week to discuss the status of the implementation activities underway related to the AMA Agreement. The AMA Board receives an update on the activities as an agenda item at each of their meetings. As well as updates on the agreement activities in the President’s Letters, the parties have agreed to joint communications as appropriate to keep either party’s stakeholders informed.
• Representatives to the Management Committee and Rates Committee under the agreement have been finalized. After a membership-wide callout process, the board selected its representatives for both committees.
  • Management Committee: Dr. Paul Boucher, Dr. Alison Clarke was chosen as the AMA physician representatives for Management Committee. As well, by virtue of position, Mr. Michael Gormley, AMA Executive Director will sit on the Management Committee. Meetings of the Management Committee were put on hold pending the provincial election. To date, Management Committee met on November 23, 2022, and March 3, 2023. The next meeting is scheduled for September 25.
  • Rates Committee: Dr. Heidi Fell, Dr. Jeff Way and Dr. Brian Wirzba were selected as the three physician representatives for the Rates Committee. Meetings of the Rates Committee were put on hold pending the provincial election. AH has indicated that the next (second) meeting of the committee will be scheduled for September 11. In the interim, staff-level discussions are occurring around year 2 allocation items which will be brought forward for approval at a Fall RC meeting.
• Government tabled legislation on December 5 to repeal Section 40.2 of the Alberta Health Care Insurance Act. This regulation enabled termination of the AMA agreement. Government committed to eliminating that provision as part of its commitments under the AMA agreement. AMA legal counsel has advised us that Bill 4 received Royal Assent meaning it is now a law in full effect. As Section 40.2 was released, the AMA filed its discontinuance of claim through the courts on January 9, 2023. This matter is now officially concluded.

Support members in local and provincial compensation discussions on rates, viability of practice, due process and working conditions, including:

• Laboratory grid agreement
• Cancer care agreement implementation
• Stipends, on-call, z-codes
• ARPs

• Lab Grid Agreement: Negotiations between AMA-ASLP and AHS-APL have come to an impasse. Mediation/arbitration is scheduled for November.
• Cancer Care: Collaborative Advisory Committee (CAC) meetings between AMA-CCA physicians and AHS have commenced. Discussion included a high-level summary of activities undertaken by the previous Joint Workforce Planning Committee, identification of challenges in workforce planning and workload management and next steps. The goal is to address retention and recruitment issues for CCA physicians and AHS. A Workload Standards Working Group was struck under the CAC to engage in this work.
• Stipends: The newly ratified AMA Agreement extends stipends to March 31, 2025. Schedule 6 provides for a Stipend Working Group to develop a process to review current stipends paid by AHS to physicians and allows for an independent chair to make a decision should the parties fail to reach consensus. A recommendation is made by the working group to the Management Committee and subsequently to the Minister. AMA is of the firm belief that:
  • The due process afforded to stipend-paid physicians must also apply to any consideration of physician stipends going forward (e.g., non-stipend groups experiencing difficulties with physician retention and recruitment)
  • There must be alignment of all AHS payments (stipends, overhead, on-call).
  • Transparent processes must be developed; AMA has created a draft and Terms of Reference to include objectives, principles, terms and conditions, roles and responsibilities for AHS, impacted physicians and AMA for presentation to Management Committee for use by the Stipend Working Group.
• AHS has asked the AMA to think about a side process, outside of Schedule 6, for physician groups already in the process of exploring a clinical ARP. The stated intent of the side process is to allow for willing physicians to transition towards new arrangements without having to wait 6-12 months for the working group process.
• An MOU between AMA and AHS outlines an AHS-AMA Engagement Framework on Physician Compensation Related Matters within AHS Facilities to address issues through a process of engagement (negotiating, renewing, extending) within the best interests of patients and the health system. The parties may, through mutual agreement, appoint mediation and/or arbitration to help resolve the issue.
• AMA staff and the Stipend Action Committee continue to exchange information with physicians that are receiving stipends, often regarding the AMA Agreement, the Engagement Framework and the due process that is available to them.
• ARPs - Clinical ARP rates and associated FTE definitions will be reviewed by the Rates Committee as per the new AMA Agreement. AMA staff and the Clinical ARP Working Group continue to review, identify and prioritize key ARP issues to raise with Alberta Health. A joint AH-AMA ARP Working Group has been struck to inform on clinical ARP policy and ARP models.

Support academic physicians in the negotiation of the Academic Medicine Health Services Program and the supporting Individual Services Agreement.

• Comparison between FFS, cARP and AMHSP rates

• In late fall, following an election process, the AMHSP Council elected its North and South co-chairs. Dr. Walter Hader as the South co-chair and Dr. Steven Katz as the North co-chair were elected.
• The release of the draft AMHSP Master Agreement by Alberta Health has been delayed and the current Master Agreement will be extended for up to one year to allow for further review and consultation. We are hopeful that this will allow time for successful discussions with Alberta Health regarding AMA representation and recognition as a signatory to the Agreement.
• AHS sent a formal letter in early May 2023 acknowledging the AMA’s representation of AMHSP physicians and confirming they will honor the 2019 opt-in process.
• In December, communication was shared with the AMHSP participating physicians on the recent initiatives and activities Council has been focusing on over the past year and the status of that work.
• The AMHSP Council last met on June 21. Consideration at that meeting included expected changes and impact to AMHSP physicians related to the clinical rates funded through the Physician Services Budget, ongoing communications with participating physicians, engagement with AMHSP Participating Physicians, and a discussion for Council direction to the AMHSP Negotiating Committee as it prepares for further engagement with AH once the AMHSP Master Agreement is released.
• An expansion total of 72 FTEs to the existing AMHSP is in process. Three new programs will see a total of 12 FTEs each (anesthesia, obstetrics and gynecology and general surgery); 12 new FTEs will be added in psychiatry focusing on pediatric and adolescent care and 24 FTEs will be added in family medicine. These positions focus on increasing the number of Alberta-trained physicians, as well as supporting generalist care in rural and regional centers. Grid rates for the new expansion groups are being discussed at a provincial subcommittee, and with discussions focused on existing provincial payment rate methodologies.

Advance AMA third party contracting principles and support physicians involved in these new models.

• While supportive of physicians who wish to be involved in these types of alternate compensation models, the AMA must consider and evaluate how the physician portion of the Physician Services Budget would be managed as well as the effect of giving third parties’ control over the physicians. AMA’s role is two-fold: to ensure there is clarity on the impact to the PSB, as well as to support physicians through representation and provide guidance as requested by physicians considering alternate compensation models.

Priority Activities

Year-end update

Support activities that promote the effective management of practices, including:

• Expand peer review activities including education and schedule modernization.
• Support sections in schedule modernization/improvement efforts.
• Support improvements to virtual care that promote quality and comprehensiveness including participation in the Alberta Virtual Care Coordinating Body.
• Promote professionalism and best practice in billing and referral practices.
• Continue to develop tools like the fee navigator and billing training tools.

• Schedule Modernization: Allocation provisions under the new AMA Agreement allow for some section and AMA-driven fee modernization:
  • Allocation year 1: fee-only adjustments. Rates Committee and Management Committee approved section-submitted changes which were implemented on April 1, 2023.
  • Allocation year 2: fee adjustments and some limited SOMB amendments (new and amended codes, wording and rule changes). Activities are currently underway, with sections having submitted priorities by November 30, and the AMA Fees Advisory Committee having assessed requests by the end of February 2023. Discussions are underway with government, with Rates Committee approval scheduled for Fall 2023.
  • Allocation year 3: sections are recommending fee adjustments and more significant structural changes over summer 2023. AMA Fees Advisory Committee to assess proposals beginning in September. Discussions with government will follow sometime in the Fall period.
• Virtual Care: Under the terms of the new AMA Agreement, Alberta Health and AMA committed to a joint review of virtual care to be completed by March 31, 2023. As part of this, a review was to be undertaken of mental health virtual care codes by November 30, 2022, with a Ministerial decision by January 1, 2023. This work was delayed by the slower than anticipated formation of the Rates Committee. In early April, the Rates Committee and Management Committee recommended implementation of mental virtual care priorities put forward by the AMA during negotiations, i.e., aligning time requirements for virtual 08.19CW with the in-person 08.19G, virtual group and family psychotherapy, complex virtual therapy, prolonged pediatric visits, and consultations to support mental health services. While the changes were approved at the joint AMA/AH Rates Committee and Management Committee, Minister Copping did not have an opportunity to sign off on the changes before the election was called. As of August, the request was being considered by government. The wider, virtual care review is still outstanding, including implementation of some other virtual care improvements previously identified by the AMA and Virtual Care Working Group.
• Informal peer review/billing appropriateness efforts have occurred within various sections of the AMA and within the AMA’s billing education services. Re-establishment of a formal AMA Peer Review Committee is dependent on future government support to establish a trusted third party to distribute confidential peer review information to physicians.

Support members participating in or considering alternate compensation models including:

• Clinical alternate relationship plan
• AMHSP arrangements
• Third-party contracting models

• ARPs: The AMA continues to support and represent the interests of physicians (either those considering a clinical ARP and those already participating in clinical ARPs) in their discussions with Alberta Health and AHS. Management Committee is tasked with reviewing the application and approval process for alternative-to-FFS bases of payment of benefits for insured services, including ARPs, for opportunities to increase transparency and efficiency and reduce red tape. AMA staff and the Clinical ARP Working Group continue to exchange information with physicians participating in clinical ARPs, regarding the identification of key issues and priorities, to advocate on behalf of physicians to Alberta Health.
• Clinical ARP rates and associated FTE definitions will be reviewed by the Rates Committee as per the new AMA Agreement.
• AMACC has approved a methodology to include ARP and AMHSP physicians in the income equity model. Physicians paid through alternate compensation methods will be included in the final income equity model that will be presented at the fall 2023 RF.
• Given the new Physician Agreement with Alberta Health, in Fall 2023 the AMA will request Management Committee to consider a full review of ARP and AMHSP rates.
• AMHSPs: The AMA continues to support and represent AMHSP physicians’ interests at various provincial tables and in discussions with Alberta Health, AHS and the Faculties of Medicine. Council Co-Chairs have had a number of meetings with senior leaders in Alberta Health to emphasize the need for AMA representation of AMHSP participating physicians relating to their clinical work (e.g., environment, discipline, working conditions) and clinical compensation.
• ARP and AMHSP clinical compensation rate increases for 2022-23 and 2023-24 have been implemented, though the retroactive payment timing for 2022-23 may be somewhat different than for fee-for-service physicians. AMA has raised concern that there will not be commensurate increases in funding and payment for the other AMHSP CARE pillars and continues to raise this at provincial tables.
• Preparations are underway to confirm the AMHSP participating physicians currently working in the province and their preferred contact email. This will assist in building both the current participation list and lay the foundation for regular updates as the participating physician group changes.
• Alberta Health has been working on an updated AMHSP Master Agreement; however, it is not ready to be shared as part of the consultation process. The current AMHSP Master Agreement and individual physician services agreements have been extended for one year to allow time to complete the draft and the consultation process.

Launch a collaborative learning opportunity focused on community clinic viability, leveraging the Patient Medical Home, including:

• Business foundations (practice agreements, improvement team)
• IM/IT (EMR tips, privacy)
• Using your team (change support, QI and clinic efficiency)
• Efficiency through Panel (screening, panel management)
• Efficiency through Access
• Assessing your practice (HQCA panel reports, ASaP, Schedule B, Patient experience, EMR reports)

• The “Vital Clinics” program was launched in May 2023. The first facilitated learning session was conducted followed by a session for practice facilitators and a workshop addressing key clinic processes and efficiencies. An evaluation was conducted to understand how well the target audience for the program was reached; modifications to the program are under way prior to offering a second round of the sessions. One of the key themes identified is the desire for access improvement content. Another set of sessions is scheduled for late September and current access materials are being reviewed.

Priority Activities

Year-end update

Operationalize the new MD Financial /Bank of Nova Scotia alliance with the Alberta based MD Financial teams, to ensure members benefit from our respective offerings.

• A process was developed with MD Management’s regional management team to ensure that members receive coordinated advice on their insurance and wealth management needs regardless of the members entry point (i.e., ADIUM Insurance or MD Management).
• The Alliance Management Committee, which includes representatives from BC, AB, SK, MB, and Yukon medical associations, along with MD Management and Scotiabank representatives, is meeting regularly to review insights, trends, best practices and developing industry matters, to improve offerings to members.

Complete an analysis and market study for the AMA Disability Insurance plan to ensure coverage and premiums are competitive and the plan remains viable over the long-term.

• After completing a market study and analysis of the Disability and Professional Overhead Expense plans with Manulife, a 9% rate increase was implemented (the first in many years) effective January 1, 2023. These changes will stabilize the plan, while continuing to offer competitive products to members.