The big picture, SOMB savings and physician supply

December 16, 2016

Dear Member:

• Amending Agreement initiatives: We must keep our eyes on the big picture and long-term goals.
• SOMB Rules Savings Initiative: The board is considering how to recognize the contributions of sections. 
• Physician supply: Any decisions that are made to manage Alberta’s physician supply must consider the evolving needs-based physician resource plan from the Physician Resource Planning Committee. No decisions regarding conditions on billing numbers have been made.

It has been two months since ratification of the Amending Agreement. While the total percentage of members casting ballots was less than ideal, turnouts are typically low and those who voted did so strongly in favour. Due process was followed, and the results are binding. With this direction, the Board has endeavoured to carry out the commitments of the association.

I wanted to bring you up to date on what is happening and what I have heard from physicians.

Thinking about the big picture

The premise of the Amending Agreement is that physicians have a professional responsibility to serve as stewards of the resources that we use on behalf of patients. For several years now, individual members, the Representative Forum, and the Board of Directors have said that stewardship is about more than responsibility. Physician stewards face a unique challenge for which I think we are uniquely positioned. We can make decisions that support quality of care for our patients, while also thinking about how those quality services can be delivered in a fiscally responsible manner. I have heard from a few members who feel we should focus solely on our professional responsibility for individual patients – which is still a key role for members – and leave management of the system and funding to others. The difficulty with this view is that, in not focusing on the system, we actually lose an important opportunity to advocate and to improve care for the individual patients we serve. Providing care for patients and undertaking stewardship roles are not competing ideas or mutually exclusive, but are complementary functions. This is an opportunity we cannot squander.

With new resources, tools and authority, the Amending Agreement sets us on that road. By exercising the new abilities we have gained, we can begin to find long-term solutions that can deliver sustainability based on the best value for patients.

It’s important to remember that there is a big picture. It’s very easy to take our eyes off the big goals and get too focused on immediate concerns. We will achieve more in the short term if we remember to keep thinking about how we can best serve patient care in a long-term, sustainable fashion.

Schedule of Medical Benefits (SOMB) Rules Savings Initiative

As I noted in my November 15 President’s Letter, the Amending Agreement contains short timelines for the SOMB Rules Savings Initiative. These timelines were negotiated as part of the agreement. We have had a strong response from individual physicians and sections, with many suggestions for modernizing the SOMB by eliminating some things that are of limited value for patients, and streamlining rules to coincide with best practices. We were able to complete a batch one list by the early December deadline for implementation January 1, 2017.

Some members and sections have been understandably concerned with the speed and scope of changes, and our committees have done their best to answer those concerns. I want to applaud our committee members for their work. There has been a lot of information given over a short time span, and I know this has been a bit overwhelming for some members. This has not been an easy process, but few things of value are. The majority of members want to make the changes which will improve the system. They recognize that if physicians are unable to complete this work, who will?

We are currently working on batch two, due by February 3 with approved items going forward on April 1. All the proposals and physician comments on the evolving batch two list are available on the AMA website along with the finalized batch one list and other information (https://www.albertadoctors.org/leaders-partners/somb-reform – member log in required). It is positive that the first batch of items was approved by the joint AMA-Alberta Health Working Group without the need to use the arbitration provisions in the Amending Agreement. Batch two is a more complex matter but I am confident that a resolution can be reached in a timely manner.

Accountability is one of the big questions that the SOMB savings initiative has raised. We have asked all sections to contribute to the savings initiatives by submitting suggestions to the working group. When the eventual decisions are made, however, we recognize that the impact will still vary across the sections and may have an impact on equity. Accordingly, the Board will make it a priority to seek opportunities in the Reconciliation Process and future allocations to recognize the degree that sections have been impacted and the contributions they have made. We will work through the Representative Forum and with sections to develop a process to achieve this goal. At our meeting last week, the Board explored a number of options, and I will have more information to share with you on that front.

Physician Resource Planning Committee (PRPC)

I wrote in my November 29 President’s Letter that developing a needs-based physician resource plan is one of the most important goals of the Amending Agreement. Alberta’s physician supply levels have grown faster than that of the population, yet still there are wait times and pockets of needs. The plan will use the best evidence currently available to determine the optimal supply, mix and distribution of physicians.

In the past week I have heard concerns from members who are uneasy, fearing that conditions may be placed on billing numbers in the near future. I can assure you that no decisions have been made regarding any tools that may eventually be applied to manage physician supply.

Any decisions that will be made must consider the evolving needs-based plan to be developed by PRPC. Entering into this process with preconceived solutions to problems that haven’t been quantified would not be in keeping with the spirit of the agreement, and is not our intent.
I will have more to say about the work of the PRPC in another letter likely next week.

Going forward

These are interesting times; we are taking action in new ways to improve stewardship and provide better value for patients. This takes hard and not always comfortable work. I want to thank the sections and individual members of the AMA who have extended great efforts so far. Going forward, the Board’s and my priority is to keep you informed. We also hope to provide the context that connects the many activities we will be discussing. We need to look at the big picture to succeed.

Thank you to those who have written to share ideas, questions and concerns in these first months of my presidency. Please continue to do so. Email president@albertadoctors.org.

Yours truly,

Padraic E. Carr, BMedSc, MD, FRCPC, DABPN
President