SOMB savings complete – Results and next steps
February 2, 2017
As outlined by our Amending Agreement, we have been working with government to identify $100 million in savings via changes to Schedule of Medical Benefits (SOMB) rules. Guided by consultation with sections and also considering input from individual physicians, a joint Alberta Medical Association (AMA)/Alberta Health working group developed a list of SOMB rule changes which were based on the following principles:
Rule changes should …
- Where applicable, be informed by one or more of the Choosing Wisely Canada recommendations.
- Be driven by best-available evidence and national guidelines for high-quality patient care.
- Consider the need to reduce inappropriate variation in physician practices.
- Be objective, transparent and driven by peer-reviewed literature, other reliable data or necessary consultations with field experts.
- Improve alignment of incentives driving high-quality patient care practices across different modes of payment.
- Simplify existing complexity and modernize the SOMB.
- Be easily and quickly implemented.
- Not impact quality of care.
- Impact the broad range of sections as equitably as possible.
- Be clear and easy to interpret.
The timelines set by the Amending Agreement were extremely short and were also negotiated under the Agreement. This challenge notwithstanding, we have successfully completed the initiative – with huge efforts involving the sections and an AMA working group formed to develop our own submission to the joint working group.
The parties were able to reach agreement on two lists for recommendation to Sarah Hoffman, Minister of Health. She has approved both. Batch Two items go into effect April 1, while Batch One items were implemented January 1. All this took place within the ambitious timelines and without having to resort to dispute resolution mechanisms that the Amending Agreement provided in case the parties were unable to agree.
I want to thank the section executives and individual members who contributed to this initiative with forward-thinking and evidence-based proposals. Our working group and staff also deserve a vote of thanks.
As I wrote to you in November, we asked all sections to contribute to this initiative and most did so. We are pleased with the level of participation. At the same time, discussions and decision-making were difficult. As with so many aspects of the Amending Agreement, we are laying new ground with what we are doing. Change is usually uncomfortable and the SOMB Rules Initiative has been no different. Nonetheless, sections in particular persevered and firmly spoke in the interest of their members while considering the overall impacts for the profession and our patients.
Now comes implementation. We have recognized – and the Board of Directors is acutely aware – that the impact varies across sections and could negatively affect equity. Accordingly, the Board will make it a priority to seek opportunities in the Reconciliation Process and future allocations to recognize the degree that sections have been impacted and the contributions they have made. Throughout the implementation and eventual reconciliation process, we will monitor the actual effects and consult and act together as needed in response.
Beyond the impact of rule changes, the SOMB rules outcome triggers issues of equity within and among sections that we have been addressing for many years. It also gets into larger issues of what equity is, what it aims to do, and how to account for it and measure it. The spring meeting of the Representative Forum (RF) will devote significant time to the issue and the Board will be looking for the advice of the RF, as we chart our approach to implementation of the Amending Agreement and look ahead to Negotiations 2018. Our willingness to work with government on complex issues has been noted and appreciated by our partners. It will serve us well in other activities to come.
The SOMB rule change process is just one component of our Amending Agreement. The great majority of SOMB rule changes that have been implemented came from sections and physicians. The concept of physicians taking on more responsibility in managing our health care system has been an underlying theme for many aspects of the agreement. In taking on these responsibilities, there are risks. One of those risks is that when decisions are made, we all share in the consequences of those decisions and bear the responsibility for them. To some, this may seem unacceptable. The reverse posture of letting others control health care concerns allows us the luxury of avoiding criticism of ourselves, but also gives us little recourse for the development of policies with which we may disagree. Given a choice, we must always insist on having a seat at the table. It is imperative that we play a major role in shaping the future of health care for Albertans. We owe it to our profession and to the patients we serve.
As always, your comments and insight are welcome. Please email firstname.lastname@example.org. Be sure, also, to let your RF delegate know what you think.
Padraic E. Carr, BMedSc, MD, FRCPC, DABPN