HQCA Evaluation: Crowfoot and Taber Clinics

December 11, 2019

Dr. Christine Molnar

Dear Members:

On December 9, the Health Quality Council of Alberta (HQCA) released its Final Report of the Crowfoot and Taber clinics case study evaluation.

The report concludes that strong team-based primary care results in better outcomes at a lower overall cost to the system. This finding is consistent with research in Alberta and other jurisdictions indicating the value of investing in the Patient’s Medical Home.

Investing in a well-supported Medical Home for all Albertans makes sense. As the AMA wrote to the Minister of Health in July:

“Evidence shows that Medical Home style primary care (continuous care and comprehensive service) dramatically reduces use of emergency and acute care services. … The Medical Home and Health Neighborhood integration should be the top priority for the health care system.”

AMA to Health Minister Tyler Shandro,
Opportunities for Government and AMA Collaboration, July 15, 2019

The HQCA report accredits much of the gains at Crowfoot and Taber to the alternative payment arrangements used by these clinics. Their payment models are supportive and aligned to their mission. The same terms should now be offered to other clinics without the undue administrative barriers that currently exist.

It is important to note that there are great Medical Homes operating today under fee-for-service payment arrangements in Alberta and in other provinces. We need to seek alignment of fee-for-service payments to the goals of the Medical Home.

If implemented, the Alberta Health consultation proposals would significantly reduce the payment support for comprehensive primary care and the Medical Home. They would also jeopardize care for patients with the greatest need for complex care management that is provided most effectively and safely in the community. Undoubtedly, this will increase costs in the acute care sector. Where is the logic in this?

Government’s proposals are penny-wise from a cost-cutter’s perspective, but pound-foolish from a system perspective. The Medical Home is an important example of cost efficiency combined with enhanced quality care. This is value.

Thank you to our colleagues, over a thousand now, who have provided feedback to us about the adverse impacts to quality care in Alberta that will occur if the Alberta Health and Alberta Health Services Insured Services Consultation proposals are unilaterally implemented.

Your comments are welcome in the following ways:

  • Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org
  • Comment publicly below on this President’s Letter.

In your service,

Christine P. Molnar, MD
President

5 comments

Commenting on this page is closed.

  • #1

    werner de vos

    Physician

    4:27 PM on December 11, 2019

    Maybe show us a study of the perception the physicians have doing fee for service in the communities surrounding these sites, since with talking to some of them it sounded as if they had to see those "enrolled" patients in neighboring towns because the waiting time for a 30min appointment at the Medical Home is too long - same with Emerge departments.
    Show us those stats - enrolled patients and their emergency needs and medical visits outside of their "Home".
    Since their care " has been paid for" why fit them in for visits when I have already booked my 10 patients for the day?
    Can not find any info in this regards so I have to guess - if you could provide more info then maybe it would be more believable?

  • #2

    John Pasternak

    Physician

    5:00 PM on December 11, 2019

    More of a question than a comment: how have these clinics managed the concept of “negation” when a rostered patient decides to go off and see a walk-in clinic instead of their own physician?

  • #3

    Alex McPherson

    Physician

    5:11 PM on December 11, 2019

    I am an MD '62 (UAB). Past President AMA '82/83, CMA '84/85, DM of AHCIP '85 - 88. Dep Commissioner, Rainbow Report '88 - 90, with Lou Hyndman, Commissioner. I have been a Board Member of the ESPCN for six years.

    IMO the PCN evolution is an important, transformative, generational development for Medicine in AB. Our Govt should exploit and further develop it for the benefit of Patients.

    Alex McPherson, MD, PhD, FRACP, FACP, FRCP(C), ICD.

  • #4

    Jo Ann Robinson, MD

    Physician

    11:35 PM on December 12, 2019

    As a member of a rural PCN in Alberta (that functions very well in the fee for service model, by the way) I share your sentiments regarding the proposed cuts. The huge improvements we have made in our rural community will be entirely railroaded by the proposed changes, and for what benefit? More care will be directed to acute care, and particularly to acute care in the tertiary centre hours away. Costs will go up and my rural patients will have a lesser quality of care than their urban counterparts.

  • #5

    Noel Corser

    Physician

    1:24 PM on December 13, 2019

    The Kenney government wants to balance the books, and believes Albertans elected them to do so. They don't believe in taxes, so this means drastically reducing spending. The recent proposals to the AMA are the tip of the iceberg - even enacting all 11 won't reduce physician costs close to what the government is aiming for.

    It's therefore particularly disappointing that the outcome of the recent emergency RF was "we back the AMA as our union - keep it up!" and "here's a great letter-writing campaign for you and your patients". The only way this government could be swayed in it's "mandate" is to risk losing an election, and no amount of letters or pressure from "rich doctors" will accomplish that They can make the laws, and so far they've shown no hesitancy to be the bull in the china shop. Only EXTREME patient frustration, probably including high-profile children's deaths specifically linked to cuts in services, would be enough to convince them to change course on this.

    As docs, we obviously don't want our patients (and ourselves) to get to that point. Why not use this moment as a catalyst for real system changes that will actually improve healthcare for our patients and ourselves? As a family. doctor, the vision of the Patient's Medical Home is very appealing - read about it on the AMA website. Among other things, it's past time we ditched fee-for-service compensation in favour of a better model - just because it's what we've always done doesn't mean it's the best way for us to get paid. Models like the Taber and Crowfoot clinics are one example, and there are lots more out there, if we pulled our heads out of the sand. My Christmas wish is for the AMA to look at the current political reality in Alberta as an opportunity for positive change, rather than simply clinging to the status quo. Otherwise, the status quo will just go from bad to worse, until the budget is balanced.

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