More from the Spring RF - and plans for a Special RF

March 29, 2017

Dr. Padraic E. Carr, AMA President

Dear Member:

In my last letter I promised you more information about what occurred at the March 10-11 meeting of the Representative Forum. It was a particularly influential meeting in many ways.

Role of the AMA: As an association, we have been very successful over the years in balancing the needs of members with those of patients and the system. We will be called upon to do this more than ever in the years ahead.

The Amending Agreement commits us to seeking more integration of care, primary care reform, advancing evidence-based improvements to care, and directly involving physicians in stewardship of health care dollars and managing physician supply. The Board of Directors has asked the RF to help determine what our role, and our philosophy, will be. The RF received a presentation on the Board’s initial discussions, and then broke into discussion groups to provide insight that will be compiled and used by the Board at our June strategic planning meeting. I am impressed with what I have seen of the results; as usual the RF has provided wise and valuable commentary.

Physician supply: Dr. Ruth Collins-Nakai is the AMA’s representative to the Physician Resource Planning Committee (PRPC). She presented to the RF about what has transpired so far with government and the committee, and a question and answer period followed. She also shared the principles that the Board has developed to guide us in these discussions. These fall into two categories. There are broad principles, e.g., maintaining quality care, basing decisions on the needs of the population, etc. There are also a number of process principles such as clear and transparent processes and active, robust physician engagement. Please click here to view the full set of principles. There was support for the concept of working with the many stakeholders around the PRPC table to develop a needs-based physician resource plan. Additionally, the RF asked that we not support billing restrictions at this time, while we continue to support the process of examining patient need and physician growth. Looking out for the needs of medical students and residents was a common theme: we must ensure our physicians in training and early career are appropriately supported. Direction from the RF will serve to guide our own members in what is a multi-party process. The different parties have varying views on all the possible options and the pros and cons of each. The specifics on how any particular option would be implemented will have to be weighed by the PRPC.

Informatics and e-health: Health care transformation requires access to information by health providers and patients for care delivery, for secondary research, and to understand our own practices. The RF received a brief presentation from Calgary delegate Dr. B. Wayne Chang regarding the Personal Health Record (PHR) that government will provide for every Albertan through the website. We can’t engage patients as responsible partners in their care without giving them tools to do so and access to their own health information. At the same time, we must continue to protect patient privacy and ensure there are adequate safeguards so that the sharing of information does not cause harm.

In another session, Dr. Doreen Rabi (author) and Dr. Heidi Fell (contributor and AMA representative to the provincial Continuity of Care Leaders’ Group) presented the highlights of a white paper. The paper, commissioned for the provincial Health Information Executive Committee on which our Executive Director Mike Gormley sits, is entitled: Health Information Exchange - Engaging Providers in Innovation. Delegates heard about and discussed the ways that enhanced health information exchange could improve continuity of care.

Peer review: Under the Amending Agreement, both AMA and Alberta Health recognize the need to develop mechanisms for reviewing the clinical appropriateness of physician claims and best billing practices. The agreement does not prescribe how this will occur. The Board has a preference for a strong educational role for the AMA, including an “early warning system” for members to advise when they are trending away from best billing practice. The RF asked that there be an option to refer to AH’s compliance branch for audit only for those unusual cases when education and communication failed to change behavior. To support this approach, the RF supported a two-committee structure, with an AMA-only committee focused on education and a joint AMA/AH committee, expected to begin in April, to liaise on billing issues. The RF heard about a range of activities and work done by the AMA’s newly formed Peer Review Committee team: Dr. Jonathan Choy, cardiologist; Dr. Craig Hodgson, rural general practice; Dr. Peter Jamieson, general practice; Dr. Allan Poole, radiologist; Dr. Leslie Scheelar, anesthetist; Dr. Brian Wirzba, internal medicine.

Negotiations 2018: The Board has appointed Dr. Noel Grisdale as chair of the Negotiating Committee for 2018. Under the Amending Agreement, the parties will open discussions toward a new Master Agreement. A date has not yet been set, but the AMA has begun several preparatory activities, including preparing to identify the Negotiating Committee. The Board has also directed that we add a professional negotiator to the team. Negotiating the Master Agreement is simply too important not to have this expert advice. Dr. Grisdale provided an overview to the RF and received initial guidance for an opening position to be developed with the Board, which will be brought to the Fall RF for review and approval.

Relativity and equity: As you may recall from my last letter, the Spring RF was extended three hours for a comprehensive session on equity and relativity. AMA Compensation Committee Co-chairs Dr. Steve Chambers and Dr. Jeffrey Way joined Executive Director Mike Gormley, Health Economics staff and me for this panel presentation.

As I have stated before, the RF provided clear direction and guiding principles to the Board coming out of this session. We have been instructed to proceed to work toward income equity, for which Adjusted Net Daily Income (ANDI) is one tool that is to be adopted. Reallocation was approved as a tool to move toward income equity. Finally, a five-year timeline was set for implementation. A proposed approach to implementation is to be brought to the Fall 2017 RF.

Many motions were passed and debated. Unfortunately, there was simply not enough time to address all motions related to income equity. The Board, however, took all of these for review to our meeting last week (March 23-24). Recognizing the importance of these motions, and the profession’s natural concern that we take these steps in the right way, the Board agreed that we will convene a Special RF meeting on Saturday, June 10, to discuss income equity. Details will follow.

The Board will respect the RF’s direction regarding income equity. We will begin immediately to move as expeditiously as possible, but I want to emphasize that this will take place with robust and continuous engagement with the sections.

Here is a link to a timeline to get us to the Fall RF meeting, showing multiple consultation periods. We will do our best to comply with timelines set out by the RF. There is much work to be done and information to be gathered. In addition to the AMA’s internal work, equity issues will be discussed at the Physician Compensation Committee with government and Alberta Health Services.

Sections will be hearing from us in the immediate future. I encourage all members to stay in touch with your executive members and RF delegates. They will want to know what you think. I trust, as always, that you will continue to let me know also. Please email or leave a comment below.

Yours truly,

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

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