AHS and March 31: Access for patients, fairness for physicians

January 25, 2021

Dear Members: 

As I’m sure most of you are aware, Alberta Health Services has indicated that stipends for contracted services will end. Implementation of this component of the Physician Funding Framework has been delayed, but as things stand today, many of the groups affected will see their contracts for stipend services end on March 31, 2021, or sooner.  

These stipend arrangements were put in place to address areas where fee-for-service was not sufficiently covering the scope of services or was absent altogether. Many physicians have indicated to me that the arrangements are in place to ensure that essential medical services are provided within their AHS facilities. Each arrangement is somewhat unique, and they cover a wide variety of physician groups such as obstetrical care, organ transplantation, trauma and code blue teams, hospitalists care, palliative care, vascular surgery, certain types of pediatric and emergency services, thoracic surgery, geriatrics, etc. 

Many of these contracts are historical and have been instrumental in the delivery of essential services within AHS facilities. In some cases, the conditions under which they were established have changed. Undertaking a review of these programs is reasonable.   

These programs are matters of compensation and physicians have a right to (and have availed themselves of) formal representation by the AMA. In addition to advising and assisting groups in these negotiations, we also convened a webinar for members on December 22 that was attended by nearly 400 physicians. The AMA is advocating with many groups of physicians for the continuance of these essential services and for a fair process to discuss the terms for all parties moving forward. This includes access to dispute resolution should the parties disagree.

AHS has developed a principle-based approach to this review and have proposed a number of different options based on the nature of the contractual arrangement. One of these options is for physician groups to move into clinical alternative relationship plans. While this will not be the solution to all these contracts, they are an important funding arrangement option for a good number of them. Many cARP applications had already been made and were awaiting approval, while others were undertaken by AHS as a result of the stipend funding decisions. The lack of progress in these applications has been a source of frustration for some time and there is no doubt that efforts made by AHS to work with Alberta Health have facilitated a number of these applications being approved in recent months. That being said, I understand that some physician groups have not been in agreement with the solutions AHS has offered. As March approaches, there is a need to have further dialogue toward a goal of finding amicable solutions.

Disputes have arisen surrounding: the exact nature of the services covered under various contracts; the ability of fee-for-service or some alternative to cover them; and the responsibility the physicians have once their AHS contract ends. Given the fixed timeline and the essential nature of the services in question, the potential for brinksmanship is real, as is the risk of placing physicians and AHS in difficult situations. The AMA has provided advice to members and legal counsel has written to AHS (member login required) about our interpretation of physician options. Our hope is that an appropriate solution can be found that is in the best interest of Albertans.  

The AMA has been in discussions with AHS to find a way through this, with our common interests in seeing the continued and sustainable provision of these essential services beyond March 31 that offers fairness to physicians.  

The timelines are short, but it is not too late to find a solution - even in the midst of a pandemic. We believe that an approach based on cooperation and collaboration will foster positive relationships between AHS and the physicians who provide care in its facilities.  

I will keep you informed of further developments. 

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 on this President’s Letter on the AMA website (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member). 

Sincerely,

Paul E. Boucher, MD, FRCPC
President, Alberta Medical Associationv