Priority activity

Update

1. 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.

• In January, the parties entered into interest-based negotiations as a way to move forward discussions for a provincial master agreement. Mr. Rick Wilson (a labour and management facilitator) was appointed by the parties to facilitate these discussions. Numerous joint meetings have been held in February, March, April, and dates are scheduled for May.
• A recent update on the discussions was included in the March 18, 2022, President’ Letter.
• Work on the lawsuit has continued through the months even without an agreement.
• On May 4-5, 2021, the questioning stage for the AMA lawsuit commenced with AMA interviewing the representative who was the lead negotiator for Government. On October 4, legal counsel for Government began its questioning sessions of AMA representatives. Questioning sessions were also held in December and will continue in the coming months with the AMA representatives.
• The next scheduled matter in the lawsuit is a case management meeting. Case management is a process by which the Court of Queen’s Bench appoints a judge to help ensure the lawsuit moves along in a timely manner and to settle disputes between the parties as they arise. Due to delays by the Court in appointing a case management judge and the appointed judge’s limited availability, May 26, 2022, was the soonest a substantive meeting could be set for.
• Following the case management meeting, the parties will resume the questioning process and continue to take the steps necessary to set the matter down for trial.
• The AMA board continues to receive regular updates relating to the lawsuit. Updates on the status of the claim are also provided to the membership through the Presidents’ Letters.

2. Support members in local compensation discussions and through the provincial framework development including AHS-paid stipends, Physician on-call, contractual arrangements for Laboratory, DI and Cancer Care other physician AHS-contracted services.

• The AMA has contracted several experienced ARP consultants to assist physicians with immediate clinical ARP exploration, development and implementation needs.
• Several physician groups have requested and received assistance with stipend discussions with AHS and/or cARP discussion with AH. As stipends have once again been extended, this area continues to be an area of greater focus and resource requirements for AMA Health Economic staff.
• On April 1, 2022, AMA-AH released a joint statement to halt any pending changes to physician compensation rates or programs until negotiations conclude. With respect to stipends, those with arrangements extended to March31, 2022 will now be extended to June 30, 2022, to facilitate talks.
• 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.

3. Support members in local clinical ARP discussions and through provincial framework development considering contractual, sessional, or capitation-based ARPs.

• Several physician groups have requested and received assistance with stipend discussions with AHS and/or cARP discussions with AH. As stipends have once again been extended, this area continues to be an area of greater focus and resource requirements for AMA Health Economics staff.
• A physician-led committee (AMA SAC) was also assembled to address, at a provincial level, the concerns expressed by various physician groups being impacted by changes in AHS stipend arrangements. Progress updates intended to keep membership informed have been developed and will continue as new information arises.
• On April 1, 2022, AMA-AH released a joint statement to halt any pending changes to physician compensation rates or programs until negotiations conclude. With respect to stipends, those with arrangements extended to March 31, 2022, will now be extended to June 30 to facilitate talks.
• AMA had some limited engagement in the Invictus ARP rate review project discussions with AH and Invictus, and is awaiting results from that review. AMA will continue to raise awareness on the complexities in physician payments and the current challenges.

4. Support academic physicians in the negotiation of the Academic Health Services Plan and the supporting Individual Services Agreement.

• The AMA’s AMHSP Council has focused on providing the academic medicine physician perspective and on illustrating the value of AMA engagement in representing this group to Alberta Health, the Faculties of Medicine and AHS. This has included a presentation of academic medicine physician results in the most recent AMA survey at a provincial table. The presentation included commentary regarding proposed policies in development.
• AMA continues to press for engagement in AMHSP policy work related to FTE, clinical compensation rates, included/excluded work and other areas impacting AMHSP compensation equity.
• AMHSP Council continues to provide a strong link between grassroots AMHSP physicians and the AMA. Their input into AMA consideration of issues and policy development shapes Council’s work.
• Two new members have been appointed to Council and one member re-elected to Council in the spring as part of ongoing refreshment and renewal of membership.
• Council continues to pursue the 15 declared negotiating interests in various venues including provincial multi-stakeholder committees as it reviews policies being proposed at provincial tables. A consultant has been engaged to refresh and update these interests (developed in 2020).
• A consultant has been engaged to support the AMA in provincial work to look at flexibility in payment models within AMHSPs; further information will be provided as those proceeds.
• Relationship-building with other stakeholder groups, including Faculties of Medicine and Faculty Associations continues to be a focus.

5. Support members that are affected by Bill 30 and contracting out of physician services.

• The AMA has recommended to government the following principles around third party contracting:
  • All third-party arrangements must continue to support a strong and vibrant public health care system.
  • Funding from the Physician Services Budget should flow to the physician who is then free to negotiate the local terms and conditions of a contract with the third party. Much like how this works with ARPs, the physician(s) could choose to assign their billings to the third party in exchange for administrative or other services negotiated between the parties.
  • Physicians could use established payment mechanisms (i.e., FFS, ARPs) along with the established payment rates and workload measures. In addition, groups should have the ability to advance payment/workload models that currently do not exist (e.g., case rate).
  • A contract with a group should not prevent or inhibit others from being able to practice in Alberta
  • AMA representation of physician groups
• Laboratory physicians have requested support and formal representation though the AMA. A Laboratory Physician Representation Group (LPRG) was formed to represent the interests of laboratory physicians in all matters related to the reorganization of community laboratory services. The LPRG includes some physicians currently under contract to DynaLife and those who could potentially come under contract.

Priority activities

Update

1. Support appropriate member billing practices including:

• Expand peer review activities including education and schedule modernization. 
• Support sections in schedule modernization/improvement efforts.
• Expand and improve virtual care codes and introduce a virtual care strategy that supports new (virtual) models of care.
• Continue to develop tools like the fee navigator and billing training tools.

• The work of the AMA Peer Review Committee was put on hold pending negotiation of a new AMA Agreement.
• Staff have continued to support section-driven peer review activities. Many sections have increased their level of commitment to appropriate billing practices and have increased communication regarding billing situations unique to their section.
• As a result of some of the section-based peer review work, staff have supported sections in the development of future SOMB changes that will modernize the fee schedule.
• AMA staff have continued to work with AH staff to improve virtual care codes. In early 2022, physician time spent providing patient management services related to the provision of virtual care was recognized through the introduction of some complex modifiers on visits and consult codes and through an acknowledgment of indirect care on virtual psychiatry services.
• The Fee Navigator continues to evolve hosting relevant information for physicians and their staff. In a 6-month period ending Jan 31, 2022, the Fee Navigator had nearly 750K pages views.

2. Support members participating in or considering alternate compensation models including:

• Clinical alternate relationship plans.
• AMHSP arrangements.
• Private contracting models enabled through recent legislation.

• On April 1, 2022, AMA-AH released a joint statement to halt any pending changes to physician compensation rates or programs until negotiations conclude. With respect to stipends, those with arrangements extended to March 31, 2022, will now be extended to June 30 to facilitate talks.
• AMA has proposed a partnership with AHS, towards ensuring continuance of essential medical services beyond June 30, 2022.
• AMA along with SAC appointees will continue to keep membership informed on progress through routine updates and President Letters.

3. Support physicians and sections that are impacted by unilateral fee changes and SOMB interpretation.

• AMA staff have been providing support to physicians impacted by the government’s Physician Funding Framework, including stipend changes, AHS overhead charges, SOMB interpretation or unilateral rule changes. AMA supports include representation, advocacy, analysis, education and advice. Communication channels between AMA staff and AH staff are open, however, resolution of items would be greatly facilitated by a negotiated AMA agreement re-establishing processes and joint committees to follow issues through to resolution.

Priority activities

Update

1. Enhance member insurance and wealth management offers by formalizing a regional financial services alliance with MD Financial and BNS. 

• On December 1, 2021, a Sponsorship and Referral Agreement was finalized between the four western provincial medical associations, the Northwest Territories Medical Association and The Bank of Nova Scotia and MD Financial Management Inc. The five-year agreement specifies how the parties will work together to optimize the offering of insurance and wealth/financial products for our mutual members/clients while providing unparalleled value and service.

2. Maximize AMA’s member health and dental benefit offerings under the new federal framework for Life and Health Trusts.

• On January 1, 2022, the AMA Health Benefits Trust Fund converted from a Health and Welfare Trust to an Employee Life and Health Trust, as required by federal legislation passed in 2021. The ELHT legislation reduced the amount of medical expenses an incorporated physician can claim as a business expense, while increasing the amount that a sole proprietor can claim. Incorporated physicians and sole proprietors are now aligned on the amount that they can claim as a business expense. With the successful conversion of the plan, participation remains at pre-conversion levels indicating the value members continue to see in the health and dental benefit offering.