Reporting on feedback, fixing virtual care

April 13, 2021

Dear Members:

I have appreciated all the emails and conversations since my April 1 President’s Letter. Many of you have shared your thoughts and hopes for the future. Your feedback demonstrates the strong engagement of members in the voting process and a thorough understanding of what was at stake.

Some of the key issues were (i) lack of a binding mechanism to resolve disputes, particularly regarding compensation; (ii) uncertainty about compensation and the withhold mechanism under the budget management model; and (iii) uncertainty around the year ahead: the COVID care deficit, implementation of PRAC ID restrictions, Bill 30 type initiatives for new kinds of contracting and the future of virtual care. There was also doubt that the proposed agreement would make a positive difference for physicians in their practices caring for patients or for the profession, as a whole, in dealing with government going forward. The feedback from members during the ratification process provided rich perspective on these issues and others. We are compiling a report drawing on all the interactions we had with members during the ratification vote, from town halls and chats to correspondence and discussion board postings. I will share this report with the membership when it is completed, and it will be a high-value resource for the Board as we plan what’s next for the AMA.
 
We would like to further engage with members. During the ratification process we heard about many of the challenges with the tentative agreement, but we need a better understanding of what members require within an acceptable future agreement. The Board meets Thursday and Friday this week and physician leaders from the Joint Task Force, Specialty Care Alliance, Academic Medicine Health Services Program, clinical alternative relationship plan leadership, Sections of Family Medicine and Rural Medicine, and Zone Medical Staff Associations will join us for this discussion. I will keep you informed of what develops as we begin making plans to engage the profession and explore our options with government.
 
In the meantime, we have important matters to address with government. I met with the Minister last week to begin considering what actions can be taken as soon as possible. I am pleased that even in the absence of an agreement, there is a desire to collaborate and work together on issues that are important to patients, physicians and the health care system. We discussed urgent issues such as virtual care, the future of the physician support programs, the development of a needs-based physician supply plan and issues related to commercial contracting in the public system (Bill 30). I expressed my strong view that the lack of an agreement is a shared problem, and that all of our collaborative activities should be working toward that goal.  
 
Virtual care: Two perspectives needed 
 
At this time, making virtual care a sustainable component of stable physician practices is a priority. There is also, however, the long-term question of what we want to achieve. Virtual care has the potential to enhance quality and access for patients, but it could also result in fragmentation of care if poorly executed. There is strong evidence that fragmentation results in lower quality patient care and more cost for the system. 
 
The AMA has continued to advocate for improvements to the existing virtual care codes. Appropriately aligning virtual with in-person fees will be a component of stabilizing practices that are struggling in the prolonged pandemic. We have presented government with a revised virtual care fee schedule and have identified priority items for implementation. We’ve also proposed a monitoring program (after implementation) for necessary oversight of the impact on patient care and utilization. 
 
For the long-term data from the AMA’s albertapatients.ca community shows that patients value the ease (and COVID safety) of virtual care. They value it far more when it is part of their ongoing relationship with their family physician in an integrated model. There are opportunities with virtual care to add value for patients, but to achieve its full potential, we need a common vision across the system. That means the parties must start immediately to coordinate and align the various strategies that they have developed. This includes physicians, Alberta Health, Alberta Health Services and commercial interests that are appearing on the scene. Our shared goals should be access, quality, innovation and value. Patients need a voice in this process, too.
 
I will write to you again in upcoming weeks about other priority areas that need a swift kick-start. As always, I look forward to your feedback.

Your comments are welcome in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org  
• Comment publicly on this President’s Letter on the AMA website (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member). 

Sincerely,

Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association