Essential Deliverable – High priority deliverable

Enhance support and representation on compensation matters

Discussion

With no AMA agreement in place discussions on physician compensation matters are going to take place in many venues and often in somewhat different ways. This includes existing models of payment through fee for service and alternate relationship plans (clinical and academic) but also whole new models that may come out of recent legislation. It is essential that the AMA support its members in achieving fair rates and terms of compensation in all settings.

Plans for 2021

Year-end Update

• A budget provision of $1.1 million has been included, which is roughly double current spending in this area. 
• The use of these funds will be based on the assessment of physicians needs and requirements and could be used to support physician leadership, consultant resources including legal and staff.
• The additional resources will allow an enhanced commitment in all venues including cARPs where we’re hearing an interest from government as well as members.
• Representation funds will also be needed in the AHS environment to address several issue including overhead, on-call, stipends and representation of individual physician groups in contract talks. 
• We’ll also be looking at the best organizational structure of the representation area to ensure best use of AMA resources available for these activities.
• The resource provision included in the budget is based on an estimate developed by a senior staff working group; however, deployment will remain flexible so that we’re responding in the areas of greatest affect.

• AMA has contracted an experienced ARP consultant to assist physicians with immediate clinical ARP negotiations including supporting physician groups with the exploration, development and implementation needs. A consultant has also been retained to assist with Laboratory Physicians contract negotiations.
• Alberta Health’s review of AMHSP funding inflows and compensation-related policy review/input (FTE definition, workload) has concluded, and the focus of the remaining work is on Clinical ARP rates, FTE definition and workload requirements. AMHSP rates for clinical work, workload requirements and FTE definitions will require differing approaches, and relationship enhancement with other AMHSP parties.
• The AMA has provided assistance to physician groups that have been notified that their stipends will end on December 31, 2021. This support will continue to evolve as some groups are meeting with AHS and/or AH. The Stipend Action Committee (SAC) has been formed to advocate on a provincial level on behalf of all physicians impacted by stipend changes. The SAC has met with several groups of physicians and has initiated communications with AHS and AH. 
• The AMA received a consultant’s report to determine the optimal resourcing, structure and methods for providing AMA representation and support to physicians in all non-fee-for-service payment arrangements. This includes clinical ARPs, Academic Medicine and Health Services Program (AMHSP), AHS payment arrangements, new ARP models, and any new contract payment arrangements arising out of Bill 30. 
• Also see KRA 1 for more details.

Essential Deliverable – High priority deliverable

Member engagement & alignment

Discussion

Members are the AMA; owners, leaders, workforce, etc. Given the changing relationship with government, the impact of COVID 19 and the rise of new technology, there are new ways to engage with members to get input and learn. A key requirement for this period of time, is that we develop and leverage our listening capabilities and be responsive to member needs. Alignment between member interests and the Association is what member engagement is all about.

Plans for 2021

Year-end Update

• During the pandemic we have engaged directly with thousands of members through webinars including physician wellness, business viability, ARP’s and virtual care codes to name a few. We are leveraging these learnings and making more resources available to expand this capability.
• As we’re developing strategies to inform government and encourage a return to discussions on a new agreement, we needed structures that are close to membership and bring key stakeholders together. The Joint Task Force, which brings together, Primary and Specialty care leadership, EZMSAs and others, is a key vehicle for bring in input and coordinating activities across stakeholders.

• With the ongoing COVID pandemic, Zoom has been the exclusive “face to face” member engagement mechanism. We know that an association must offer the collegiality and energy that in-person contacts deliver so our go-forward strategy will contemplate best ways to do this while still harnessing the capabilities and flexibility of virtual options.
• From the ratification period, when the Tentative Agreement Package was voted down, to today, thousands of physicians, resident physicians and medical students have engaged through virtual town halls, AMA discussion boards, email and social media. They have expressed what they saw missing in the Tentative Agreement Package that was voted down – and where they think the relationship with government needs to go. We have built on that rich foundation of insight with the experience of the many physicians involved in the ongoing discussions around AHS stipends (member login required) and other negotiations, e.g., laboratory medicine and diagnostic imaging in AHS. Still more intelligence arrives daily in correspondence from members who take time to respond to President’s Letters, events in the news or other issues that are important to their practice and their wellbeing.
• Supplementing this individual input, physician leaders have been meeting with the Board on a regular basis as discussions have continued. This leader group includes: the Sections of Family Medicine and Rural Medicine; Specialty Care Alliance; Clinical Alternative Relationship Plan Working Group; Academic Medicine Health Services Program Council; Council of Zonal Leaders; Joint Task Force; AMA Compensation Committee; and Physician Compensation Advisory Committee.
• A member survey to explore individual member states and concerns was launched in August and results will be available by the fall RF
• Two discussion papers were released for member feedback: What We Heard (June 2) was a summation of member concerns during ratification with the TAP. Where We Are Going (Aug 11) explored the main issues facing the profession as government has requested that the AMA table a proposal for changes to the TAP rendering it acceptable for physicians. 
• A new kind of research project is being planned to dive more deeply into the issues facing practices and clinics with third party interview expertise in a format allowing comparability and generation of evidence of issues facing members in considering a new agreement.

Essential Deliverable – High priority deliverable

Maintain advocacy activities including the current public campaign and our legal case

Discussion

Our goal continues to be achieving a negotiated agreement with government but we need to be ready for the situation where activities at the negotiations table will not be adequate to bring that about. Resources have been included in the business plan for activities that inform the public and politicians in support of that goal.

Plans for 2021

Year-end Update

• An initial provision of $2.7 million has been included to support a range of advocacy activities including:
  • $670,000 over two years to fund the legal case. 
  • $902,000 for the Joint Task Force, which is the structure established within the AMA, for getting information to and from members and encouraging actions and activities of stakeholder groups. The JTF includes Section and Zone leaders as well as other stakeholders. We’ve costed our highest level of activity over the past period and annualized it to ensure the Task Force can continue its critical work throughout the year.
  • $1.2 million for engaging with the public including an ongoing social media campaign, earned media and traditional paid media.
• The balanced budget approach being taken ensures additional funding is available for greater levels of advocacy if needed. 

• As a result of the government unilaterally terminating the AMA Agreement, the AMA filed a legal challenge against government on behalf of all physicians in Alberta. The AMA’s Statement of Claim was filed with the courts on April 9, 2020. Government filed its Statement of Defense on July 10, 2020. The AMA affirmed its Affidavit of Records on September 9 and the AMA received government’s Affidavit of Records on November 16, 2020. We are currently in the questioning stage of the process, expected to last until sometime in 2022. The parties have agreed to seek the assistance of the courts for case management in mid-September, which is designed to expedite the case. 
• JTF has been revisiting its mandate and where its support can best be applied. There has been extensive work to support the various groups of AHS physicians engaged in stipend discussion and JTF remains ready to assist should it become necessary to “go public” on these issues and potential impact on patient services
• The AMA has and will continue advocacy. The COVID care deficit will be a primary focus in fall 2021, anchored on research conducted in our albertapatients.ca community through which Albertans have reported significant negative results from the pandemic on their mental and physical health. Through Health Issues Council and at behest of RF, other issues are in play including harm reduction/supervised consumption sites, health effects of coal mining and other public health issues
• The AMA worked with the Alberta Pharmacists Association on joint messaging regarding vaccine acceptance. 
• A fall campaign concerning the care deficit and including the stability of community practices as a factor in recovery will take place, beginning with release of the full results of research on the care deficit impact and to include advertising and social media discussions.
• The Mobilizer community of 37,500 public supporters has been maintained by providing updates on developments with government but not being called to action. We are exploring how they can support putting faces to the care deficit campaign focusing on their relationship with their physicians and why that matters to them at this difficult time.

Essential Deliverable – High priority deliverable

Investment in government relations

Discussion

While there was significant effort to form a strong and effective partnership with government, it has been challenged over the last while. Efforts here relate to both better understanding governments perspective and improving the relationship with them where possible.

Plans for 2021

Year-end Update

• Provisions are included for regular public surveys and lobbying support.
• Staff resources aimed at improving relationships at the bureaucracy level.

• See Advocacy update above including surveys and public messaging.
• We retain a number of government relations experts for advice and support.
• Senior staff continue to strengthen working relationships with counterparts in AH and AHS.

Essential Deliverable – High priority deliverable

Alliances with other key stakeholders

Discussion

The AMA relies on relationships to satisfy the needs of members especially in these uncertain and challenging time. Understating the interests of other organizations and aligning activities with theirs will be important in the coming period.

Plans for 2021

Year-end Update

• CPSA – Especially in regard to HPA amendments or other issues related to self-regulation.
• CMA – Support for Alberta physicians local and nationally.
• Alberta Urban Municipalities Association and Rural Municipalities Association 
• AHS
• Other provider organization and associations

• CMA grants have been signed to support physician wellness and physician leadership projects totaling $350K/year.
• CMA is providing up to $4 million over 2 years to support action to secure an agreement.
• The AMA receives requests from government to review changes to various standards (scope of practice/ethics) for other health care professions. The AMA has provided input on the following:
  • The College and Association of Registered Nurses of Alberta (CARNA): Duty to Provide Care
  • Alberta College of Speech-Language Pathologists and Audiologists: Documentation and Information Management Standard; Clinical Supervision Standard of Practice
  • Alberta Dental Association and College (review in progress): Practice Arrangements and Provision of Professional Services Standard; Code of Ethics
  • Pharmacists and Pharmacy Technicians Profession: Proposed Amendments to Pharmacists and Pharmacy Technicians Legislation to Support Animal Health
  • Alberta College of Paramedics: Amendments to Standards of Practice
  • Optometry Scope of Practice: Amendments to Optometrists Profession Regulation, treatment procedures, laser procedures
  • College of Counselling Therapy of Alberta: Draft Standards of Practice and Code of Ethics
  • College of Physicians & Surgeons of Alberta: Amendments to Cannabis for Medical Proposes Standard
  • College of Alberta Denturists: Code of Ethics
  • Physiotherapy Alberta College and Association: Draft Standards of Practice – Restricted Activities
  • College of Registered Psychiatric Nurses of Alberta: Amended Standards of Psychiatric Nursing Practice
  • Nurses of Alberta: Social Media Standard of Practice

Essential Deliverable – High priority deliverable

Maintenance of core capabilities

Discussion

The goal is to achieve a negotiated agreement with government. Many of the essential deliverables above are aimed toward that in the best interest of physicians and the system. While we did look for efficiencies across the AMA operation, we also needed to identify what was important to maintain.

Plans for 2021

Year-end Update

• The activities identified under each of the Board’s long-term goals will continue but many will be resources at a lower level in order to achieve the essential deliverables over the next two years, including expertise in physician income and business models, keeping an eye on legislation and advocating on informatics matters and physician health. 
• Physician supply - PRAC ID regulations are expected April 2021 and we will need to be ready and working with other parties in the context of a needs-based strategy.

• In November 2019, government unilaterally disbanded the Physician Resource Planning Advisory Committee. Following that decision, Bill 21: Ensuring Fiscal Sustainability Act, 2019 achieved Royal Assent on December 5, 2019, with work expected Fall 2020 to develop regulations that would be complete by April 2021 and take effect April 2022. 
• Government has since announced it will not implement its new PRACID legislation on April 1, 2022, to allow for further work with AMA, PARA and medical students, and to allow community input, including that from the Provincial PCN Committee’s Rural Sustainability Task Force.
• The AMA will be working with stakeholders including medical student associations, PARA, training institutions and communities to provide comments and suggestions to government’s consultation process on its new regulations.

Essential Deliverable – High priority deliverable

A financial strategy that balanced the use of contingency funds with efficiency savings

Discussion

The plan is built on a financial strategy that supports the achievement of the essential deliverables while maintaining a strong foundation and financial flexibility for moving forward.

Plans for 2021

Year-end Update

• Time horizon of 2 years at the end of which, board reserves will be fully funded and we will be moving to a balanced budget. 
• The plan includes significant real savings of roughly $3 million described elsewhere and the use of contingency funds. (Contingency funds are effectively AMA savings above the minimum board reserve requirements.)
• A key aspect of the financial strategy is the ability to shift resources within each of the essential deliverables to meet the needs as they arise and the ability to shift resources across essential deliverables to those of greater value.
• Balancing investment across activities to maximize marginal returns in each area (e.g. a small investment in one area may have a much greater impact than further investment in an area of great importance).

• The planned operational savings were captured, including 5% reduction in salaries, honoraria and contractor rates applied November 1.
• Membership renewal rates were strong with an overall retention rate of roughly 100%. As a result, the AMA’s full reserve was preserved, and we will enter the second year of the 2-year plan in a strong financial position.

Essential Deliverable – High priority deliverable

Physician Compensation (Including Income Equity)

Discussion

The recent past has taught us that this government advances major policy initiatives with little discussion or engagement with the profession. We need to continue educating government and the public on the complexities of physician payment and be ready to respond as new policy comes forward from government.

Plans for 2021

Year-end Update

• Complete the Income Equity Initiative studies including the overhead, hours of work and market impact studies ($632,643).
• To educate government and the public on the complexities of physician payments.
• Advancing internal equity work as directed by the RF. 
• Physician Compensation Advisory Committee – Support AMA representatives at the committee to influence government on compensation matters.

• AMA has contracted with several consultants to complete the various studies associated with the Income Equity Initiative.
• The AMA Overhead report was completed and presented to the Spring RF. This report included overhead cost estimates for all types of physician practices identified for the study. Work is continuing to assign all physicians to the appropriate practice type which will ensure appropriate office type weighting in section results. 
• The hours of work study is ready to launch. The AMACC is closely monitoring criteria and feedback received from a panel of section representatives regarding stability of practice activity that would allow for reasonable hours of work estimates. Early survey enrollment/familiarization opportunity and subsequent Q&A meeting is planned for section panel representatives.
• Phase 2 of the Market Study is proceeding with results expected by year end.
• AMA will continue to support PCAC representatives and individual sections to influence government decision-making with respect to changes to the Schedule of Medical Benefits. Some important changes to the PCAC Terms of Reference, including more formalized consultations with sections impacted by any proposed PCAC fee changes, have been adopted by the PCAC. Some elements are still problematic, such as the requirement to embargo PCAC recommendations. The AMA continues to advocate for a fair and transparent fee review process grounded in principles of natural justice and procedural fairness.
• The AMA continues to press for engagement in AMHSP policy work related to FTE, included/excluded work and other areas impacting AMHSP compensation equity.
• AMA has been engaged in the ARP rate review project discussions with AH and Invictus. AMA will continue to raise awareness on the complexities in physician payments and the current challenges.