Government consultation proposals: action to date

December 16, 2019

Dear Members:

I am writing today to provide a brief update of the work and activities that have taken place since the Special RF on December 7.

Consultation proposals

I want to thank everyone who has provided feedback on the Alberta Health and Alberta Health Services Insured Services Consultation proposals. To date, we have heard from over 1,250 of you. This includes responses sent directly to myself, to the feedback email, as well as responses posted via the online tool.

Based on feedback from sections and individual members, the AMA’s formal response to government is being drafted and will be shared with all members once it is submitted on December 20.

Engagement

All section presidents were contacted in an effort to encourage members to participate in a letter writing campaign. In addition to the letter writing campaign, members are also being asked to seek meetings with local MLAs.

I want to thank members who have been advocating at the community level and have already met with their MLAs. We have heard there are a few reoccurring themes that are surfacing during these meetings:

1) Communicating the impact of the proposals

We have heard that MLAs do not know the scale of the proposed changes. If enacted, these changes would equate to an average loss of over $47,000 per physician, per year. The amount varies by group. For example, the reduction to family medicine is $61,000 per physician, per year; and that would be even greater in rural Alberta. Further information on the real-world, dollars and cents impacts are captured in the economics paper, linked below. I encourage you to read it and share the facts with your MLAs and community members as you see fit. It is very important to talk about the impact on your practice and your patients.

2) Promoting Alternative Relationship Plans over fee-for-service

Some members were told that one of the goals of the proposals was to encourage entry to Alternative Relationship Plans (ARPs) by dis-incenting fee-for-service. In response to this, you may want to communicate a few things:

• There is no single perfect payment system and there are pros and cons associated with all models. For example, there are very successful medical homes operating in Alberta right now under fee-for-service.
• There are many elements required to change from a fee-for-service model to an ARP. This is not a simple undertaking and would require significant change management supports at both the clinic level, as well as the patient level in terms of access, etc.
• Our understanding is that even if all of the factors were in place to move a large number of physicians over to an ARP, Alberta Health does not have the capacity to make this happen early in 2020.

Therefore, it seems disingenuous to push an alternative before it is ready to be properly implemented.

3) Remaining united

It is vitally important that we remain united in the face of any attempt at fragmentation. A number of members who have met with MLAs have indicated how important it is to deliver a united message to MLAs and to let them know that these proposals are concerning to the entire profession.

Informing government

We believe it is important for MLAs to hear directly from physicians. Please share individual stories about your own situation, as it is often the personal stories that are most powerful in helping MLAs to understand the impact.

We suggest you share information with your MLAs, and to help you with this outreach we have prepared the following materials:

• Instructions and MLA template letters (for both urban and rural physicians)
• Key talking points
• An economics paper, including key aspects associated with physician compensation in Alberta that were missed by the MacKinnon report
• The latest version of the AMA’s assessment of the Alberta Health and Alberta Health Services Insured Services Consultation proposals (this version includes some of the specifics with respect to the real-life impacts the proposed changes would have on physicians and patients)

These resources are available on our How you can help web page.

Again, we are urging all physicians to take part in this important campaign so that MLAs heading home for the holidays will do so knowing that physicians are active and united.

Other plans

The Physician Advisory Group has been active and there are plans underway to reach out to and engage the public, including through social media. I want to thank members for the number of suggestions and ideas I’ve received with respect to public campaigns and other activities. These are all being considered and we will provide further information on our strategy soon. In the meantime, I encourage all members to use your own channels to share the tools and information provided in this letter.

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Thank you again for your advocacy. It is absolutely critical that we maintain momentum and focus. I will write again soon to share further updates and plans for outreach.

Please let me know what you think 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 (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

NOTE: While I am reading all correspondence, due to the amount of incoming email, my responses to you may be delayed. I sincerely appreciate your understanding during this busy time.

In your service,

Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association