Implementing the Amending Agreement

November 10, 2016

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