What happened at the Special RF and PCC Information Session

December 16, 2015

Dear Member:

A special session of the Representative Forum (RF) was held on December 12 in Edmonton to discuss the tentative agreements that I wrote to you about in my November 20 President’s Letter. The second part of the meeting was an information and education session regarding the Physician Compensation Committee (PCC).

Review of agreements

The RF considered the two tentative agreements: the Strategic Agreement/Negotiating Framework; and a set of amendments to the 2011-18 AMA Agreement.

With respect to the Strategic Agreement/Negotiating Framework, the RF endorsed the framework as a way to resolve many past and ongoing issues with Alberta Health Services (AHS) around contractual negotiations. The framework also creates possibilities for improving relationships and expediting negotiations that have dragged on in the past. The Board of Directors agreed with the RF’s assessment. Therefore, we have proceeded to ratify this part of the agreement package. (A vote by the membership before ratifying this particular element was not required because individual physicians [or groups of physicians] who would be impacted by it may opt in or opt out of the arrangement.) Please note that the AMA’s ratification alone is not enough. Alberta Health (AH) and AHS will be making their own ratification decisions.

In addition to the Negotiating Framework, the RF also considered proposed amendments to the AMA Agreement. These focused on bringing other health care stakeholders to join the AMA and AH in discussions about system improvement. It also identified a method to select a set of innovation initiatives – and then created provisions whereby resources from specified AMA Agreement benefit funds could be repurposed to pay for innovation.

A few days before the RF, we received notification from AH that they would not ratify this portion of the agreement package as presently structured, but would wish instead to continue negotiations with the AMA. At the RF, Dr. Carl Amrhein, Deputy Minister of Health, reviewed the evolving and current fiscal situation in Alberta. There is an evident need to review and possibly alter the relationship between, and roles of, the profession and government.

Historically, health expenditures have been growing at approximately 7% per year, including the costs of physician services. You have heard the phrase “bending the health care curve” from government. This refers to the intention not to cut current health care spending, but instead to slow the rate of growth of the overall health budget from 7% annually over five years to 5%, 4%, 3%, 2% and 2% beginning in 2014-15.

Alberta physicians are still covered by our seven-year agreement through 2018. Over the contract term to 2018, the average increase in payment rates is about 1%. Part of the difference between 1% and 7% is population growth, which has been 1.5% to 2% annually. The rest of the difference is increased utilization of physician services. Under the terms of the present agreement, government is responsible for all the increased costs in the system.

Alberta’s fiscal situation creates challenges for both parties and the RF appreciated the opportunity to hear about government’s concerns and then discuss our own options. The RF agreed that – even though our 2011-18 agreement remains in place – it’s important for the AMA to continue discussions with government. We need to talk about what kind of relationship we wish to have with each other, as well as the role that physicians will have in the management of the health system. For example, physicians can only accept increased financial risk for increased utilization of health care services if we are also given the tools and the ability to manage it.

I want to emphasize that we are not at odds with government over the non-ratification of the amendments to the AMA Agreement. As we move into January and explore what could be accomplished through new discussions, we can still progress on some elements of what the Amendment to the AMA Agreement contained. Several initiatives pertaining to greater involvement of additional stakeholders in the working of the AMA Agreement, and moving forward on secure messaging and a voluntary alternative payment plan for primary care, can be further developed. The board will consider such actions.

Physician Compensation Committee: A nuts-and-bolts discussion

Following the fall RF meeting and a number of resolutions about the PCC, the Board of Directors identified seven actions, one of which was increasing understanding of the nuts-and-bolts processes of the PCC among physicians at the leadership and grassroots level.

Accordingly, immediately after the agreements session I have just described, the RF adjourned and we reconvened an information/education session about the PCC. In addition to RF delegates, section presidents and fees representatives were also in attendance.

Attendees were provided with a detailed document: A Physician’s Guide to the PCC and Individual Fee Review Process. I am soliciting final changes to this document from the RF this week. Once we have the final version in place, it will be made available to all members to answer any technical questions you may have about the workings of PCC.

This session and the detailed information appeared to be well received. I believe it was a well-spent and productive day. I want to thank the delegates, alternates and section executive members who gave up a Saturday at a busy time of the year to attend. Their wisdom and input were greatly appreciated.

I will write again, possibly before the holidays and certainly very early in the New Year. As always, please let me know your thoughts on the future of our profession.

Please email president@albertadoctors.org or leave a comment below.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS
President