April 15, 2013, President's Letter

April 16, 2013

To comment on this President's Letter, log in with your member number and password. After you login, you'll be taken to the commenting section at the bottom of this page. (Questions about logging in? Go to Login help.)

 

Dear Member:

In this letter:

• A memorandum of understanding (MOU) has been reached with the minister of health.
• It must be finalized by April 22, and we remain alert and on a watching brief for the coming week.
• The MOU addresses what physicians have been seeking in negotiations while recognizing government’s financial situation.

A memorandum of understanding

I am writing to share with you the good news that, following several weeks of intense discussions, Minister of Health Fred Horne and I have signed a memorandum of understanding upon which negotiators will now finalize a full agreement document by April 22.

Assuming that deadline is met, the Representative Forum will review the resulting tentative agreement at a special meeting to be arranged very shortly. The Board of Directors would then direct the commencement of the ratification vote by physicians.

The MOU contains nine comprehensive elements and I have provided an executive summary at the bottom of this letter.
Read the MOU document >>

What physicians have been seeking

I want to acknowledge the solid efforts of Minister Horne in working with me to reach this accommodation that I believe addresses the goals of physicians in these negotiations: 

• A place at the table and to be involved in decision making about the health care system.
• A financial package that meets the needs of government and physicians, and treats physicians fairly, e.g.,
  • Addressing overhead costs.
  • Covering costs of Alberta’s growing population.
• A better approach to dealing with fees, programs and benefits, and finding ways to resolve disputes.

Please note that in very recent discussions parallel to negotiations, Alberta Health, Alberta Medical Association and Alberta Health Services have agreed to explore opportunities to find efficiencies and savings in the health care system. I see this collaboration as a way to evolve to a “tripartite health efficiency agreement.” It can be a key opportunity to advance health reform and apply the appropriate resources, policies and processes to things such as reducing the emphasis on institutional care in favor of robust community-based care. I would like to see this become my legacy project for the remaining term of my presidency.

Finding a way forward

The drafting of a tentative agreement still lies ahead this week to demonstrate the full commitment of both sides to what the MOU describes. I am pleased with what the MOU has achieved; I also understand that physicians may be skeptical until a tentative agreement is complete and in their hands for a ratification vote.

We will keep a watching brief and continue with plans that are already underway for the negotiations tour (first meeting is April 18 in Edmonton) and other activities we were preparing for in the event of unsuccessful negotiations.

The MOU lays out a framework by which we can return to a structured, transparent and productive relationship with Alberta Health. Working in that relationship is the way by which trust can be rebuilt, but it will take time.

As we remain alert and await the work of the week ahead, I want to extend my profound thanks for the outstanding support that physicians have demonstrated in the past two weeks. We have seen copies of about 450 emails and letters to MLAs and more arrive every hour. I have received countless messages of support and encouragement. Members have written letters to the editor, purchased advertising and engaged local media. Such contributions have never been so needed and could not be more valued. I know the profession will continue to advocate for what this health care system needs, albeit (I hope) under the umbrella of a long-term, stabilizing agreement with government.

Email me at president@albertadoctors.org or comment below.

Regards,
R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC
President

---

Executive summary: Memorandum of understanding (MOU)

The nine elements of the MOU from which a full agreement will be drafted by April 22, 2013.

1. Structure

• An overarching, ongoing “evergreen” agreement to address the relationship between Alberta Health (AH) and the Alberta Medical Association (AMA), e.g., joint goals, roles and responsibilities, scope, dispute resolution processes, etc.
• Schedules linked to the agreement to address details for rates and prices, financial re-openers and provisions of programs and benefits.

2. Financial term

• April 1, 2011, to March 31, 2018.

3. Programs

• Applies to and maintains:
  • Fee-for-service (FFS) compensation under the Schedule of Medical Benefits (SOMB).
  • Alternate relationship plans (ARPs), including the clinical component of academic ARPs.
  • All current programs and benefits including continuation of the Business Costs Program and Retention Benefit.
• AH and AMA will establish a separate agreement for a new approach to a provincial electronic medical record (EMR) strategy, including a replacement strategy for the EMR completion program (formerly the Physician Office System Program) which ends as announced in March 2014. 
• A separate agreement will also be established regarding primary care delivery. This is an evolving area and the agreement will identify how the parties will work together on a number of matters including, but not limited to:
  • A framework for primary care network (PCN) evolution (PCN 2.0) with linkages to the broader primary care system.
  • Regular review and adjustment of per capita funding for PCNs, subject to non-binding dispute resolution.
  • Physician compensation elements of primary care including physician compensation mechanisms within PCNs and family care clinics.
• Yet another agreement between AH and AMA will focus on quality while taking a provincial approach toward identifying system-wide health efficiencies. Working closely with Alberta Health Services (AHS) and involving physicians from various areas in primary and specialty care (including, e.g., AMA Sections, PCNs and Strategic Clinical Networks) will be the key to our collective success.

4. Funding for rates, programs and benefits

• 2011-12 to 2013-14: 0%.
• 2014-15 and 2015-16: 2.5% each year.
• 2016-17 and 2017-18: Cost of living adjustment (COLA) each year.
• A one-time amount (i.e., not added to base) of $68 million paid to physicians in a manner established by the AMA. Best efforts will be made to distribute these funds within 90 days of the agreement being approved.
• Alberta Health will be responsible for funding expenditure increases for all insured services and programs beyond the rate increases, including utilization (population) increases.

5. Representation

• On written request by the AMA, AH will consider entrenching a general recognition right within legislation by which AMA is the ongoing representative of physicians for SOMB and ARP rates, and core programs with evergreen provisions (e.g., Medical Liability Reimbursement, Continuing Medical Education, Physician and Family Support Program, etc.).
• The agreement itself recognizes the AMA as the representative of physicians for any and all other programs and benefits attached to the agreement.

6. Consultation

• For health matters that are not covered by this agreement but “touch and concern physicians,” AH will consult with and seek advice of AMA.

7. Arbitration and dispute resolution

• If an agreement to commence April 1, 2018, is not in place October 1, 2018, then either party can trigger arbitration, on prices only, for SOMB rates, ARP rates and funding for evergreen core programs. The ability to arbitrate this way is also an evergreen provision.
• AH and AMA may avail themselves of non-binding facilitation or mediation for all other programs and benefits.
• Disagreements about interpretation or application of the agreement can be referred to the Physician Compensation Committee (PCC) (see below), then the deputy minister and AMA chief executive officer, then the minister and president. If the dispute cannot be resolved in these ways, the minister will make a transparent and public decision.

8. Governance

• A new Physician Compensation Committee will be responsible for oversight of compensation practices and all programs (except those covered by grant agreements that address such arrangements between AMA and AH). It will consist of three representatives each from AMA and AH with an independent chair agreed upon by the minister and president. PCC responsibilities include:
  • Implementing a provincial physician compensation strategy.
  • Allocation of fee changes.
  • Managing payment schedules (FFS and ARP).
  • Reviewing and adjusting relative payment rates (FFS and ARP).
  • Determining rates.
  • Overseeing a relative value process.
• Oversight responsibility for the overall agreement will be between a representative of the AMA and of AH who will: ensure agreement terms are followed; receive reports from, provide guidance to and ensure sufficient resources for the PCC.

9. Approval

• The parties will make best efforts to conclude a tentative agreement on these fundamentals by April 22, 2013, prior to the respective approval processes (i.e., ratification vote by physicians).