Implementing the Amending Agreement

November 10, 2016

Dr. Padraic E. Carr, AMA President

Dear Member:

You may have seen a feature article in Postmedia Network publications yesterday regarding the details of our newly ratified Alberta Medical Association (AMA) Amending Agreement (edmontonjournal.com/news/local-news/new-deal-looks-to-control-growth-of-albertas-physician-costs-workforce). This was the first media coverage concerning details of the agreement’s provisions and there have been more media interviews since. These are key opportunities to emphasize some important points as we move into implementation. I thought I would share some of the messaging we have been relating to the media.

The members of the AMA recognize the fiscal challenges facing Alberta. We have also been acutely aware of the contributions of health care costs to these challenges. While the main AMA Agreement with Alberta doctors does not end until 2018, we agreed it was necessary to enter into early negotiations to address the rising rate of spending increases in these difficult times. We wanted to do our part to help the province and citizens of Alberta, and this resulted in the Amending Agreement.

We believe that those serving our health care system have a responsibility to help control the costs of providing care. Physicians have a professional requirement to serve as good stewards of health care resources. Serving as stewards means we are both managers and protectors of the health care system. Our responsibilities, however, encompass more than just reducing spending growth. The solutions we choose must support quality care for patients and deliver the best value possible for them.

The agreement contains savings initiatives and tools to moderate the growth of health care spending. Implementing these will not be easy. It will take a joint effort between physicians and government; risk will be shared. Accordingly, the amendments are built around the concept of linking authority and responsibility. Savings will be achieved in a way that ensures physician practices remain viable.

There are many important provisions within the amendments that I plan to explore with you in upcoming President’s Letters, including:

  • The Schedule of Medical Benefits Rules Savings Initiative: This is already underway but I will have updates for you and thoughts about how we approach this challenge and the role that sections may have in managing budgets, savings and expenditures.
  • Physician resource planning: It’s important to know what we need and where in terms of physician supply going forward. A needs-based plan will be one of the most important elements coming from the Amending Agreement.
  • Primary care and the new primary care network (PCN) framework: I will discuss what will be included and why and how PCN physicians will have a voice in development of the framework.
  • Payment and equity: With a focus on leadership and unity, these issues can make a real difference by aligning payment with the way that care is being delivered. Considerations include equity, relativity and new payment models (including the blended capitation model for primary care), the Academic Alternative Relationship Plan and others.

In addressing these issues, we will create both short-term and long-term improvements through financial and non-financial means. Within the relationship that has been established between government, the AMA and Alberta Health Services, we can explore lasting solutions to improve integration in the system and to provide better value for patients. The balancing of roles and responsibilities is what will make the difference.

For example, with respect to the physician resource plan, physician numbers have been growing rapidly and yet there are still areas of need. I commend government for agreeing to fund any new physicians that Albertans require. We will now explore what that need is, so we can meet the financial needs of the province while maintaining our commitment to quality care. There are no preconditions or set assumptions for these discussions and we will have all the key players at the table. For our part, the AMA will work through various tools at our disposal to manage utilization. This collaborative approach is a good example of some of the real opportunities within the Amending Agreement.

I look forward to working with Minister Sarah Hoffman, Dr. Verna Yiu and their teams in the year ahead to implement these positive amendments. I am optimistic about all that we can accomplish together.

I will write again soon. In the meantime, your replies are very welcome. Please email president@albertadoctors.org or leave a comment below.

Yours truly,

Padraic E. Carr, BMedSc, MD, FRCPC, DABPN
President

4 comments

Commenting on this page is closed.

  • #1

    Gaylord Wardell, AMA Section of Chronic Pain

    Physician

    4:11 PM on November 10, 2016

    Plans to remodel the SOMB in the face of financial hardship is laudable. The support for Choosing
    Wisely Canada is also laudable, however we must be aware that the Choosing Wisely initiative, is sponsored by ABIM(American Board of Internal Medicine) and was motivated as a means of providing 'parsimonious medical care' in support of Obamacare. What is regrettable is the we,as providers,have created real programs to reduce waste in healthcare while others have done very little. Where is the reciprocal energy for reduced bureaucratic cost that is the elephant in the room. The bloated salaries, benefits and profits inthe US and the bloated salaries and benefits in Canada. Of course doctors and nurses should be parsimonious and frugal but what of our adminsitrative masters and the redundant antiquated processes in healthcare planning and delivery.
    I reviewed the past five years of the CPSO(College of Physicians and Surgeons of Ontario). When compared to population, income, inflation and most economic indicators there are some serious issues about empire building that are being ignored as we dutifully flagellated ourselves to provide yet more frugal care.
    We must be vigilant lest we allow our patients to become subservient to the bureaucratic process and not the other way around. A healthcare dollar that does not go to patient care must be husbanded even more than one which does not. Thank you

  • #2

    Donald G Seibel MD

    Physician

    11:27 AM on November 11, 2016

    I would like to comment on the fact that by eliminating code 95.94 A you have basically put me out of business . My practice consists of treating acute and chronic pain by non- drug methods. This allows a number of patients to get pain relief so they can still go to work,do recreational activities and have a better home life. I have a large FMS practice, treat OA of the shoulders knees and hips hands and feet,as well as TMJ and MVA injuries. Many of my patients can therefore avoid surgery, expensive MRI's, etc.How many 95.94A codes does it take to pay for a total knee replacement??? Will I have no alternative but to tell them I can not help them anymore and put them all on narcotics ??


  • #3

    AMA

    Member of the public

    4:57 PM on November 17, 2016

    In response to Donald G Seibel MD [comment #2]

    Hello. We typically do not respond to general website comments on this page, but we thought you would appreciate clarification.

    You may like to know that the Section of General Practice Executive carefully evaluated rule changes proposed by the AMA Ad-Hoc Committee and SGP members for Batch 1. The joint AMA/Alberta Health working group has moved the 95.94A item to the Batch 2 so a decision has not been made.

    We encourage you (if you have not done so already) to post comments to the evolving phase two ideas list. If you have any research or other documentation supporting the service, especially as it differs from 13.59J, you may wish to share that with the section executive to include in their work going forward. The link (sign in required) to comment is: https://www.albertadoctors.org/app/somb-ideas/default.aspx?id=463&nav=comment

  • #4

    Ed Mol

    Physician

    7:00 PM on November 20, 2016

    From what I can see in my rural area, the PCN\s are a huge redundancy cutting into the practices of general physicians. They are generously funded; thier workers have full benefits while I as a solo GP have only risks, liabilities and overhead. We are truly living in Alice in Wonderland times.

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