The Derived Day Approach (DDA) was jointly developed by the Alberta Medical Association (AMA) and Primary and Preventative Health Services (PPHS). It represents a shift in thinking, with a goal to increase fairness across physician compensation models and better align cARP rates with fee-for-service (FFS).
- More transparent and accurate, reflecting current day-to-day clinical practice
- Based on the most recent fiscal year FFS claims data (April to March), with updates every three years, at minimum
- Annualized cARP rates will see an overall increase compared to the historical Provincial Base Payment Rates (PBPR) methodology, with significant increases for some specialties and more modest increases for others
- Family medicine rate for hospitalist programs was effective January 1, 2025 and for programs on April 1, 2025. New rates for remaining specialties are awaiting ministerial approval.
For each specialty or specialty group, the DDA provides an estimate of income earned by a physician on a typical clinical workday, using the 40th-60th percentile of daily FFS billings. This benchmark is known as a Derived Day and acts as a yardstick by which all other days are weighted.
Watch our 3-minute DDA explainer video
DDA Methodology
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Specialty Section Assignments
FFS claims data and SKILL modifier codes from the most recent fiscal year are used to assign physicians to specialty sections, which are then organized into groups. In some cases, specialties are combined to create more stable and reliable datasets, helping to reduce payment disparities over time.
Group 1: Family Medicine
Group 2: Emergency Medicine
Group 3: Dermatology, Endocrinology & Metabolism, Infectious Diseases, Internal Medicine, Nephrology, Neurology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, Respiratory Medicine, Rheumatology
Group 4: Obstetrics and Gynecology, Otolaryngology, Plastic Surgery
Group 5: Anaesthesiology, Critical Care, Gastroenterology, General Surgery, Ophthalmology, Orthopedic Surgery, Urology
Group 6: Cardiology
Group 7: Cardiac Surgery, Neurosurgery, Thoracic Surgery, Vascular Surgery
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Data Adjustments
During the specialty or specialty group claims data review, non-typical days and non-representative physicians are filtered out. This includes:
- Physicians who bill less than 11 months of the year
- Physicians with annual billings in the top and bottom 5% of their group
- Highly specialized community practice physicians
- Non-FFS shadow billing
- Physicians assigned to surgical sections who don't perform major procedures
- Secondary specialty days with $0 in FFS payments, excluding paediatrics
- Adjustments for cross-over days (shifts that cross over midnight) where 50%+ of a section’s days have TNTP and/or TNTA 03.01AA modifiers - see FAQ for more details
- Non-hospital days with $0 in FFS payments for sections with hospital-based cARPs
Further adjustments take place, including additional data exclusions. For some data points, a separate application of the methodology is applied:
- Weekly patient management fees representing multi-day careare equally distributed across all service days worked per calendar week
- Surgical vs non-surgical days are adjusted to account for bundled payments when a physician in a proceduralist role
- Days where total FFS payments are ≤ 10% of the average payment per service day (net of 03.01AA)
- 03.01AA after-hours time premium payments are excluded
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Determining a Typical Clinical Workday
Using adjusted FFS billings, a typical clinical workday is established for each specialty or specialty group. Service day values that fall in the 40th-60th percentile of daily billings are considered typical and form what’s known as a Derived Day – the key building block of the methodology.
All service days, including outliers, are assigned a Derived Day value:
- Typical days are assigned a value of 1
- Slower days are given a value less than 1, example: 0.8
- Busy days are assigned a value greater than 1, example: 1.2
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Derived Day Rate (daily cARP rate)
Derived Days worked by each specialty or specialty group are then added together. The total number of days is then divided by the total FFS payments to generate the Derived Day Rate or daily cARP rate, which serves as the base for cARP program funding.
At this time, the DDA has been applied only to the family medicine rate. New rates for all specialties are awaiting ministerial approval. See current rates for the annualized cARP model.
After-hours premium
After-hours time premiums are not included in the base cARP rate calculation. Instead, physicians in eligible programs can bill the 03.01AA premium for regularly scheduled after-hours services with payments provided on top of the base clinical ARP funding.
Learn more about after-hours billing for family medicine physicians.
Expanded eligibility for 03.01AA is awaiting ministerial approval.
Future DDA Updates
The DDA reflects the variability of physician practices and is intended to be regularly reviewed and updated through a formal policy, at minimum every three years, in line with:
- Schedule of Medical Benefits (SOMB) changes
- New AMA Agreement
- Non-FFS payments
As funding models evolve, additional elements may need to be integrated into the methodology to ensure fairness and alignment with provincial physician compensation strategies. This may include:
Historical PBPR vs New DDA Approach
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PBPR |
DDA |
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DDA FAQ
Crossover days are shifts that extend past midnight. In the claims data, a crossover shift is represented as two partial shifts, which can misrepresent daily payments during the claims data review.
Days where only one modifier is used are excluded as they don't represent the entire shift. When consecutive crossover shifts occur and both TNTP and/or TNTA 03.01AA modifiers are billed, the daily payment data is included.
Example: When a physician works three consecutive crossover shifts starting late-night Monday through to early morning on Thursday, claims data for Monday and Thursday are excluded as they don’t represent a full shift. Daily billings on Tuesday and Wednesday include both modifiers, which reflect a typical day for inclusion in the data.