Government review cARP & academic medicine plus AMA info session on stipends

December 22, 2020

Dear Members:
 
As discussions continue with government toward a negotiated agreement, new payment models are emerging and are being offered to physicians. This move toward new payment models seems to be accelerating, which has caused me to think about why alternative models matter in the first place.
 
Physician remuneration is one of our most powerful health policy levers. One way to look at the fee schedule is that it functions simply to incent the delivery of physician services. As we develop and implement clinical ARPs, Academic Medicine Health Services Programs, or new models yet to come, we should begin with a fundamental goal: to serve health care needs of the population. The payment structure should align with achieving our goals and properly support the physicians and health teams providing care. Alternative payment models are often seen primarily as a means to control costs, meaning that fiscal policy is retrofitted into health policy. I believe that sound health care policy can and should be fiscally responsible, but the principles should be based on the fundamentals of high-quality health care delivery.
 
Alternative compensation review
 
On December 3, Alberta Health issued a request for proposal for an Alberta Physician Alternative Compensation Review. In short, the project has two parts: (I) reviewing funding for academic medicine and (ii) reviewing clinical alternative compensation rates.
 
The RFP lists the AMA as a stakeholder. Although we do not have an agreement at present, we are determined to do our diligence and bring forward the needs of physicians and patients in this process. This voice is essential – as much so as representing the interests of physicians who will work in the arrangements themselves.
 
To provide this input, we are grateful for the expertise of the AMA’s AMHSP Council and AMA’s Clinical ARP Working Group. We will seek to ensure that broader health system aspects are considered in any decision-making around funding and rates. This includes valuing all aspects of academic medicine, honoring ARP principles and seeking reasonable contractual agreements (workload, hours and fair dispute resolution mechanisms).
 
In the interests of best patient care and the system, the AMA will be seeking a multi-stakeholder governance structure for developing and approving ARPs and AMHSPs that includes physicians through the AMHSP Council and the Clinical ARP Working Group. These groups can also update and maintain ARP rates and full-time equivalent definitions using a principled approach that will ensure the most current and relevant data sources are applied.
 
AHS stipends 
 
Stipends were developed to provide fair compensation to physicians for work done in AHS facilities that was in addition to those services covered under fee-for-service payments. Unfortunately, we are facing the potential loss of AHS clinical stipends as of March 31, 2021.  
 
Given this, there are a number of physician groups questioning the economic viability of the services that they are currently providing in an AHS facility – some physicians may be looking to practice differently, while others may be considering ways to find alternative funding, such as via moving to an ARP. Some of these physician groups have already submitted clinical ARP applications, but very few have been approved to date, and some groups have been waiting for months for a decision.   
 
The AMA is aware that plans are being developed and we are seeking more details, especially considering these plans could involve clinical ARP models that are very different from the ones we are familiar with. Although we anticipate being more involved soon, to date, AH and AHS have not invited the AMA to be a part of their discussions on this matter. For our part, we are looking to see some continuance beyond March 31, 2021 and we want to see a fair process for physicians when it comes to compensation – including a way to resolve disputes.  
 
March 31 is fast approaching, and the AMA has been meeting with affected physician leaders in recent weeks around these issues and related matters. Last night, December 21, a virtual information session for members at large was held to discuss options, details of CPSA rules and legal advice from AMA’s external counsel. The session was recorded and is available on the AMA website (member login required).
 
We will keep you informed as we learn more about all the above matters. In the meantime, please direct inquiries as follows:

• AMHSP queries to AMHSP@albertadoctors.org
• Clinical ARP queries to arpinquiries@albertadoctors.org
• Stipend queries to didi.wimmer-frank@albertadoctors.org

 Our commitment
 
The economic viability of physician practice is fundamental, and the AMA is investing significant additional resources to ensure your rights of representation are upheld. Physicians deserve fair compensation for their services. We are calling on AH and AHS to partner with us and to engage with doctors to develop a fair solution that prevents unnecessary impact to patient care.
 
With every letter, I cannot fail to express sincere gratitude to all physicians for their extraordinary dedication to patient care during this pandemic. Every day I hear from physicians across the province who are working long hours in acute care without hesitation or complaint and to the point of exhaustion. Their colleagues in the community, where about 95% of COVID-19 is actually managed, are also working hard and struggling to cover costs and remain viable with lower-paying virtual codes. They need to be supported. We also know that patients are delaying care or are unable to access the care they need. There is a growing care deficit that will take years to recover from.
 
As we head into the holiday week, please look after yourselves as you continue to look after others. If you need help, reach out to the AMA's Physician and Family Support Program by calling 1-877-767-4637 24 hours/day, 365 days/year.
 
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 Association