2020/21 Essential Deliverables

With many challenges at play, the Board identified several essential deliverables for the AMA over the next two years. Many of the essential deliverables also appear as activities under the Key Result Areas (Part B) but were identified by the Board as the most critical deliverables since the termination of the Agreement.

Essential Deliverables – high priority deliverables 

Discussion 

Plans for 2021 

Mid-Year Update 

Enhance support and representation on compensation matters

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. 

  • 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 several experienced ARP consultants to assist physicians with immediate clinical ARP exploration, development and implementation needs.
  • Changing requirements and approaches in AMHSP, including review of AMHSP funding inflows and compensation related policy review/input (FTE definition, workload) may require differing approaches, and relationship enhancement with other AMHSP parties.
  • Several physician groups have requested assistance with stipend discussions with AHS and/or cARP discussions with AH. As stipends are set to end as of March 31, 2021, this area has quickly become an area of greater focus and resource requirements.
  • The AMA has also hired a consultant 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. 
  • The consultant’s report was provided to the AMA on January 31, 2021 and will be reviewed by SMT to determine next steps.
  • By Jan 30th, AMA will determine its best use of the $1.1M resource allocation in a way that optimizes membership value.
  • Also see KRA 1 for more details.

Member engagement & alignment

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. 

  • 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. 
  • Webinars continue to attract large numbers of members and are increasingly attractive as a method for two-way exchange with members.
  • These negotiations have triggered a wave of member activism, powered by JTF. 
  • Increasing resources are going to digital, social and rich media, including training, support and resources.
  • Virtual meetings will continue to be a key tool for engagement for meetings, town halls, governance sessions, etc. 
  • Member Engagement Innovation Team is leading the membership marketing drive as well as considering new ways to engage members according to four dimensions of engagement.

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

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.  

  • 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.  
  • Offline advertising campaign ran successfully July to September. Metrics show results well above industry averages and provided learnings useful for a future campaign.
  • Patients First® (aka Mobilizer) has continued to grow. Over 37,000 activists enrolled; 38,000 letters sent to MLAs, 340,000 mobilized impressions. 
  • JTF is actively supporting physicians in their advocacy efforts. Mechanisms under way or in development include community outreach, section town halls, MLA meeting support, advocacy training, videos, podcasts, and posters and handouts. While doing all we can toward productive negotiations, the JTF strategic plan runway for 2021 is the core of planning for government relations and increased public advocacy and advertising should negotiations break down.
  • 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 9th, 2020. Government filed its Statement of Defense on July 10, 2020. The AMA affirmed its Affidavit of Records on September 9th and the AMA received government’s Affidavit of Records on November 16, 2020. The legal challenge continues and is following its normal process. As of February 2021, given the increased likelihood of the parties reaching an agreement, the parties agreed to delay questioning of witnesses until the end of April. Should the parties come to an agreement the AMA’s has agreed to drop its lawsuit upon ratification and with other conditions being fulfilled. Updates on the status of the claim will be provided regularly. 

Investment in government relations

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.

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

 

Alliances with other key stakeholders

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.

  • 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 
  • Separate CMA grants have been signed for physician wellness and physicians leadership totaling $350K/year.
  • CMA providing up to $4 million over 2 years to support action to secure an agreement.

Maintenance of core capabilities

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.  

  • 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. 
  • The government is expected to begin consultation on its regulations for their new PRAC ID legislation over the coming months that will define the specific “rules” on how a physician can enter Alberta as of April 2022.
  • The AMA will be working with stakeholders including medical student associations, PARA, training institutions and communities on responding to government’s consultation process on its new regulations. 

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

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.

  • 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). 
  • 5% reduction in salaries, honoraria and contractor rates applied November 1.
  • Membership renewal results for February 16 indicate:
    • 100% of where we were at the same time last year across all member categories
    • 94% of last years total has been reached.

Physician Compensation (Including Income Equity)

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.

  • 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 4 consultants to complete the various studies associated with the Income Equity Initiative.
  • AMA will complete the Overhead Study by March 2021. 
  • The Hours of Work study is pending, based upon instability of physician practice due to the COVID19 pandemic. 
  • The Market Study is also pending, based upon availability of data from Alberta Health.
  • AMA will continue to support PCAC representatives to influence government decision-making with respect to changes to the Schedule of Medical Benefits. An AMA proposal to improve virtual care codes is scheduled for presentation at the February 2021 PCAC Meeting.
  • Continue to press for engagement in AMHSP policy work related to FTE, included/excluded work and other areas impacting AMHSP compensation equity.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.