Overhead Working Group report and what comes next

August 6, 2019

Dear Members:

I’m writing as promised in my July 9 President’s Letter to provide all members with a copy of the Overhead Working Group Assessment and Review Report regarding the overhead study commissioned by AMA and Alberta Health for the Income Equity Initiative. It is available here: albertadoctors.org/leaders-partners/income-equity/related-documents (member login required).

Why we did it and where we landed

You may recall that sections raised concerns in the spring with business costs model arising from the overhead model study. In response, the Board formed an Overhead Working Group, chaired by Dr. Rick Johnston (a past president and 16-year chair of the AMA’s Negotiating Committee) and with representation from the Specialist Care Alliance and the Sections of General Practice and Rural Medicine. Their task was to assess and review the study, including:

• Review of section concerns and seeking additional information from the vendor as needed.
• Assessment of the usability of the study.
• Recommendations for next steps.

Details of the concerns are laid out in the report. They relate to constraints of the study and its design, participation rates and limitations of data. In the end, the working group recommended to the Board that the results are not usable in their current form, and identified some alternative options (which are also described in the paper).

The Board considered these and has elected to proceed with a process to rewrite our 2009 Physician Business Costs Model and update its data. This process could include incorporating certain usable elements of the recent study and useful components from a study out of British Columbia. Additionally, the AMA has compiled many previously recommended enhancements to the 2009 model that will be reviewed and considered for implementation. The OWG will remain in place to provide advice; it has shown that it is both nimble and effective.

What does it mean?

While we implement the OWG recommendations, we will keep moving forward on other activities that surround the IEI. This is important not only because all the individual projects are valuable, but also because they contribute to a larger whole.

We need to keep our eyes on the big picture. In recent months, the Board has been talking about the need to pursue affordability and value in the system. We see a way to achieve both these things through increased integration and advancing the medical home. These broad objectives guide us, and they are powered by a number of elements. The role of physician payment through the Board’s Physician Compensation Strategy is an important element, based on the principle that the primary purpose of physician compensation is to (i) ensure Albertans have timely access to quality services and (ii) fairly incent physician productivity.

Seen in that light, we can all remind ourselves not to become focused on the Income Equity Initiative as an end it itself. The initiative, the Business Costs Model, Adjusted Net Daily Income and other components are all moving pieces within the compensation strategy. It’s the strategy that is one of the main drivers of value and affordability. This is our motivation to keep moving forward, to balance care and diligence with strong intention and measurable progress – and to be more effective because we keep our eyes on overall goals in all that we do.

I will have more to say about value and affordability in future letters. For today, you should know that over the past few weeks the Board has discussed the OWG with section presidents. It was also shared with Representative Forum delegates, resulting in other feedback. If you have a personal perspective at this stage, please share it with your section and RF delegate, but also let me know. You can reach me:

You can reach me directly or comment as follows:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
• Share your perspectives with colleagues on our member-only Discussion Board (member login required).
• Comment publicly below on this President’s Letter.

We have been offering the AMA-built Discussion Board as an option for conversation about President’s Letters, but few have taken us up on it and no one at all recently. If you are so inclined, I’d encourage you to try. We are seeking to offer new ways for members to engage with AMA and with colleagues. If you’ve tried it but didn’t care for the experience, I’d be glad to know what you thought.
Comment publicly on this President’s Letter on our website.

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP
President