About the PCC fee review

November 10, 2015

Dear Member:

I am writing to you again about the Physician Compensation Committee (PCC), and the work being done on a fee review of six codes.

The Alberta Medical Association (AMA) Board of Directors met October 30. The PCC review was a major agenda item that involved examining the structure, function and relationships of the PCC, board, and profession. We discussed the concerns that members have raised through the Representative Forum and elsewhere. This included themes such as: governance and decision making around PCC participation; unity of the profession; equity; communication; technical aspects such as overhead; and patient-focused matters such as access and quality. Finally, we confirmed a clear need to make progress and keep moving forward.

Defining the relationships between the PCC and AMA board, sections and members is very important. The PCC was established in our 2011 contract with government. It has the authority to set fees, constrained only by the contractual stipulation that the average of all fees must remain the same.

The AMA is a participant in the PCC by way of the agreement. The board appoints representatives to the PCC, and gives them direction and support. The board is accountable to members of the AMA in providing direction to our representatives at PCC.

Such direction must reflect the overall goals and objectives of the AMA. It must be sufficient to guide, while not being so excessive as to constrain the representatives from providing credible participation at the PCC.

We need to be clear about the difference between the price authority of the PCC and the accountability of the AMA board. There are three votes at PCC: the AMA; Alberta Health; and the independent chair. The board is not accountable for the decisions made by PCC.

We are, however, responsible for making plans to address member concerns and participate effectively. The board has decided on the following actions to address the concerns.

• Engage all sections more in the fee review through information sessions and engagement by PCC or, failing that, through engagement by the AMA. One of the actions will be to hold a special educational session for RF delegates and section fee representatives (details coming soon).
• Prepare and distribute documentation detailing the function of PCC generally, and specifically in connection with the fee review process, making this available to all physicians for information (with an invitation to provide feedback).
• Create policies to guide AMA PCC representatives in considerations such as: phase-in of fee changes; periodic review and adjustment; and maintaining access for patients.
• Establish a more robust reporting process between the board and the AMA PCC representatives.
• Encourage PCC to consider section-based information on overhead with adjustments where appropriate and to report back to sections as to how the information is used. The AMA will assist sections in determination of overhead.
• Review the AMA-recommended fee review base payment rate.
• Explore alternative models of allocation used in other provinces to address equity.

While we respond to concerns about fee review with the actions above, I will add that we need to think more deliberately about how overhead costs are covered – in different practices generally and within specific fees. We also need to keep in mind the broader context of the AMA Business Plan and AMA goals and objectives related to physician compensation. The AMA Compensation Committee has defined these goals as quality, access, productivity and equity.

Finally, I suggest that there is a critical, overarching consideration in this and our activities related to compensation and system management. We must consider the province’s current fiscal situation and its potential implications for negotiation of the next agreement for 2018 – which we are already working toward.

In this context, as will be my habit, I conclude by asking you a question: Can we manage physician compensation and system management issues in a way that demonstrates to government and the public that we can be good stewards of the public health care dollar?

Please email president@albertadoctors.org or leave a comment below.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS
President

P.S. My last President’s Letter (regarding government’s new legislation that will include physician payments in a sunshine list) was sent on Friday, November 6. Thanks to the many physicians who have replied with thoughtful comments. Please note that the AMA servers were offline from 8 a.m. to 2 p.m. on Saturday, November 7. If you wrote to me during that window, you may wish to resend your message since it would not have been received. I apologize for the inconvenience.