Activities
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Year-end update
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1. Negotiate the financial reopener of the AMA Agreement that expires March 2020. This is the main agreement with government where negotiations for the payment of insured services occurs.
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- After many months of negotiations and an unsuccessful attempt at mediation, government unilaterally terminated the AMA Agreement on February 20. As well, it announced its intention to implement on March 31, 2020, a number of their consultation proposals. Spontaneous grassroots advocacy by members emerged immediately and AMA moved forward with plans to launch a campaign to build support that would hopefully bring government back to the negotiating table. The campaign is still going strong.
- 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 Defence on July 10, 2020 and the legal challenge is still with the courts. The AMA has recently filed its Affidavit of Record and will await government’s filing of theirs within the new couple of months.
- Since negotiations broke down, the AMA has attempted to get a negotiated settlement with government. Informal discussions occurred between the AMA and government in March 2020, at the end of June and, most recently, on August 20 where the parties agreed that the AMA would provide a response to the government’s August 11 proposal. The AMA submitted its response on August 28. Highlights of the AMA submission included:
- AMA management of the Physician Compensation and Development Budget ($5.4B) that includes ongoing assessment of expenditures against that budget, and the assignment of responsibilities and accountabilities with annual over-or under-expenditure.
- Support on the expansion of ARPs and improvements to the Patient’s Medical Home
- Opportunities to address challenges associated with recruitment and retaining physicians
- Reinstatement of the Physician Benefit Programs
- The AMA also requested current data on expenditures for physician services to assist AMA in assessing proposals from Alberta Health and suggested that the parties implement a joint communication protocol.
- The AMA has been working to get a grant agreement in place for the physician benefit programs since the Physician Funding Framework was announced in February. Despite various discussions, budget iterations, grant schedule development and indications the grant was forthcoming, the AMA has still not received a grant. Communication was received in early August advising the AMA that government would end funding for the for the Alternate Relationship Plan Physician Support Services on August 30, and the Physician Locum Program would be transferred to AHS on the same date. After some discussion, government postponed the effective end date to September 30, 2020. Funding support for the other physician benefit programs will continue until March 31, 2021, however, the AMA is still awaiting a signed grant agreement.
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2. Negotiate renewal of the Academic Medicine Health Services Plan (AMHSP) Master Agreement and Individual Services Agreement template for AMA members who are part of the AMHSP.
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- The AMA AMHSP Council’s Negotiating Committee met with Alberta Health and Alberta Health Services May 27, 2020 and August 31, 2020. The Committee advanced a negotiating proposal that has objectives as follows:
- Strengthen AMA and participating physician engagement with respect to improvement of AMHSP contractual arrangements and governance structures
- Advance transparent policy development processes
- Advance a Just Culture by promoting physician wellness and procedural fairness
- Encourage innovation and entrepreneurship
- Meetings continue. The Faculties of Medicine are engaged in discussions with government and AHS regarding the new AMHSP Master Agreement through existing governance structures including the North and South Sector Committees and Provincial AMHSP Operations and Strategy Committees. The interests brought forth by the AMA are being discussed in these venues as well.
- It remains to be seen which issues are addressed through contractual changes in the Master Agreement, the ISA Template or through operational policies that support the two agreements. As of the date of writing, Alberta Health has expressed the view that the AMHSP Master Agreement is simply a grant agreement that covers the flow of funds from AH to AHS and the Universities. Further AMA input will therefore emphasize content within the Individual Services Agreement which is between AHS, the University and the Participating Physician.
- At this point the intent is for there to be one Master Agreement, covering North and South Sectors in place for April 2020.
- The AMHSP Council met June 25, 2020 and discussed the above as well as the results of the AMHSP Review, completed by Nichols Applied Management Inc. There were 22 recommendations grouped around the following program components:
- Legal framework
- Purpose and goals
- Strategic and funding framework
- Governance and program support
- Performance monitoring, accountability and continuous improvement
- This report serves as a further input into the development of the next AMHSP Master Agreement
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3. Negotiate new and amended Alternative Relationship Plans and other alternate funding arrangements that support and align physician and system objectives.
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- Alternative Relationship Plan Rates and Full Time Equivalent/Sectional Allocation Equivalent (SAE) Definitions:
- Given the cancellation of PCC meetings by government since January, further discussions and decisions related to ARP rates and rate methodologies have not advanced.
- With Government’s cancellation of the grant funding for the ARP PSS, the AMA is currently examining what resources will be required to support current and prospective clinical ARP physicians in the absence of the ARP PSS. Representation, advocacy and support for physicians considering or currently in an alternative arrangement continues to be a key priority for the AMA.
- In mid-February, Alberta Health announced a new expedited 6-week process for approving new ARPs. Any significant improvement to the timeframes for the approval process has yet to be seen.
- Provincial Hospitalist Program - AMA and AHS representatives have met regarding plans to create a provincial hospitalist program. AHS has indicated that the program has been delayed and expressed uncertainty around a possible implementation date.
- Blended Capitation Model - The AMA continues to be actively involved in advancing further clinic engagement in the BCM, in addition to supporting three clinics who have transitioned to the BCM. Refinements to the model in the key areas of focus: negation rules, development of a draft rural model, and development of an evaluation framework, will be guided by govt’s mandate and willingness to collaborate with AMA.
- Physician concerns with the model will continue to be brought forward by the AMA and shared with AH at an operational level.
- The AMA is prepared to provide support to physician groups interested in implementing new capitation-based models.
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4. Negotiate on behalf of member groups for the provision of insured services:
- Physicians within and considering joining the AMHSP
- AHS-paid physicians and physician groups
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AMHSP (See Activity 2 above)
AHS Physician Groups
- The Strategic Agreement (SA) expired on March 31, 2020.
- AMA has been consulted by several physician groups, currently subject to contracts with AHS to provide services in AHS facilities pursuant to stipend arrangements. Many of these contracts are in the course of re-negotiation and the applicability of the SA is still being considered through a separate hearing.
- Although these contracts were scheduled to lapse as of September 1, 2020, AHS agreed to extend all stipends until March 31, 2020 thus allowing time for the parties to continue good faith negotiations.
- Groups of affected physicians include:
- Edmonton Zone Surgical Hospitalists - AMA and AHS Agreed to use this group as a test case for the jurisdictional matter of the applicability of the SA. The decision reached in this test case could apply to the other physician groups who served notice to negotiate to AHS prior to March 31, 2020.
- Calgary Pediatric Plastic Surgery ACH
- Calgary Trauma Surgeons
- Chinook Regional Hospital (Lethbridge) General Surgeons
- Edmonton Trauma Surgeons
- Edmonton Zone HCT Physicians
- Fort Saskatchewan Hospital Care Teams
- Lab Physicians Working Group
- Lethbridge General Surgery
- Medical Officers of Health
- Northern Lights Hospital (Fort McMurray) Code Blue (Emergency) Physicians
- South Health Campus Obstetrical Anesthesia/COVID-19 Intubation Physician Group
- South Zone Palliative Care
- U of A Clinical Faculty (FFS Physicians)
- Notices were sent to AHS advancing to arbitration prior to March 31, 2020, for all of the above groups, with the exception on Pediatric Plastic Surgery ACH, and CancerControl.
- Other groups are inquiring and collecting opt-in forms for AMA representation.
- Increasing numbers of individual physicians continue to receive AMA assistance in reviewing/renewing their contracts.
WCB
- AMA representatives have completed negotiations with WCB. The new agreement was ratified by AMA membership, and is in effect April 1, 2020 to December 31, 2024.
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