The AMA has been asked to support communication about PMSP, the declaration process and the distribution of payments to eligible physicians based on criteria set by Alberta Health. The AMA must keep records of payments made and report to AH on an ongoing basis and as requested.

Panel management is a proactive approach used by primary care teams to offer care to a defined panel of patients attached to a physician or nurse practitioner.

Panel Management extends far beyond episodic care and focuses on the broader needs of patients at and between care visits.

Panel management includes having clinic teams review the patient panel lists and reach out to offer care (virtually or in person). This is particularly of importance for at-risk, vulnerable, and complex patients who may hesitate to, be unaware of, or be afraid to access needed care. Panel management is even more critical during COVID 19.

Panel management includes the practice of looking at the patient status, conditions, risk factors, and care needs of patients in order to offer evidence-based care to patients.
Panel management is like building a safety net for patients, who can be comforted knowing their care team is looking out for them – even when the patient is not in the clinic.

Visit the website for more information on panel management.

Eligible physicians who start their practice in the middle of a payment period are eligible to receive funds through the PMSP as long as they meet the eligibility criteria. See Eligibility requirements on the Panel Management Support Program page.

Eligible physicians who retire, leave their practice, or are unable to finish the payment period for any reason will receive a program payment for the full quarter.

There are some family physicians and rural generalists that may not be eligible for the PMSP payment.

Physicians may not qualify:

• If your panel size is 499 patients or less.
• If you are a pediatrician or non-family medicine specialist.
• If you ended your practice prior to the initiation of the PMSP payments.
• If you are not in good standing with CPSA.
• If you are not receiving payment through the Alberta Health Care Insurance Plan.

Yes, locums are not treated any differently than other family physicians for the purposes of the PMSP. As long as they meet all other program criteria, they are eligible for funding.

PCN membership doesn’t impact eligibility for the PMSP. Both PCN affiliated and non-PCN affiliated physicians are eligible for the PMSP.

The declaration states that payments should be used to support the costs of administrative staff or the costs associated with equipment necessary to support comprehensive primary care practice. What this looks like is not specified. The declaration also explains that payments will be made directly to eligible physicians and that payments will not be made to clinics, Primary Care Networks (PCNs), or any other entity. Beyond that there is no explicit process that details how the payments should, or should not, be handled once they are received.

The AMA has been encouraging physicians and clinic owners to discuss how this will work, but there are so many variations in the business arrangements clinics and physicians have in place that it's difficult to provide guidance or sample scenarios. Each business arrangement is unique and it is up to physicians to collaborate with their clinic colleagues and determine what is fair and reasonable. 
 

Payments will be distributed from the AMA to physicians quarterly. Each quarter, panel sizes are reviewed by Alberta Health and a list of eligible physicians and payment amount is provided to the AMA to distribute funding. Individual physician payments may change accordingly depending on increases or decreases in panel size above or below the cut-offs determined by Alberta Health.

Every quarter the AMA will communicate what your panel payment is. Physicians will receive a statement by email if they are receiving payment by electronic funds transfer or mail if they are receiving a cheque.

Yes, PMSP is taxable income. The AMA is unable to provide a T4 for the PMSP payment. For further information about how this income impacts your taxes please connect with your accountant.

Signing up for CII/CPAR ensures that your patients are attached to your panel and that Alberta Health can access that information and include you as an eligible physician to receive funding through the PMSP. 

The AMA ACTT team continues to provide change management support for primary care physicians interested in learning more or registering for CII/ CPAR. Please complete the expression of interest form and an AMA team member will contact you within 2 to 3 business days. 

Through the CII/CPAR Acceleration Grant, funded by Alberta Health, funding is available to compensate physicians for their time and the administrative requirements to enroll and participate in CII/CPAR.

Visit the website for more information on CII/CPAR.

Currently, there is no appeal process in place and no retroactive adjustments to panel size.

Whether a physician is considered urban or rural for the purposes of PMSP payments depends on their practice location’s postal code. The PMSP uses Statistic Canada’s Postal Code Conversion File to classify postal codes as urban or rural.

If a physician practices in more than one clinic, their practice location for the purposes of the PMSP will be the clinic through which they submit panel data to CPAR. If they do not use CPAR, it will be the clinic they have billed from the most during a given quarter.

Panel size can be calculated in many ways. The accuracy of EMR panel sizes is dependent on clinic processes. Other variables such as time frame and billing codes may explain the different panel sizes calculations for PCN and HQCA or other panel size calculations. 

PMSP panel sizes may vary for providers on CPAR as well. Patients that are on a CPAR panel but are in Conflict (i.e. on more than one CPAR panel) will not automatically be allocated to that provider. Instead, patients in Conflict will be allocated based on billing data (allocations 2 to 5).

Alberta Health calculates the panel sizes each quarter using CPAR and the patients visit history, including fee for service and shadow billing as applicable.

There are a few reasons physicians may notice differences in their PMSP panel size from one quarter to the next. Consider if any of the following reasons may explain your discrepancy with panel size.

• Any type of leave or extended time off during the 18 months retroactive from when the payment was calculated.
• Any changes to physicians’ supply of appointments.
• Any changes with the EMR including migration or internal processes.

Alberta Health will calculate panel sizes on the first business Monday of the month following the quarter/ 3-month period.

Panel sizes of 500 or greater will be displayed on the AMA member dashboard under the PMSP widget. If the PMSP displays “AH Calc <500”, this indicates Alberta Health has calculated your panel size to be less than 500. Panel sizes will update each quarter on the AMA member dashboard. The most recent panel size calculated by Alberta Health will be available under the PMSP widget.

For physicians live on CPAR, out of province patients will upload on their CPAR panel and be allocated towards their total panel size for PMSP.

For physicians not on CPAR, PMSP relies on data from the AHCIP. Patients that do not have an active Alberta PHN have visits billed to their respective provincial healthcare insurance plan. Therefore, out of province patients are unable to be allocated to physicians and will not count towards the total panel size for PMSP.

Alberta Health has determined the method for patient allocation. Whether you are live on CPAR or not, there is no method to manually upload your panel size for the PMSP.

AMA and Alberta Health haven’t agreed on the audit process for the PMSP. Once the AMA knows the details, we will share the information with members. Rest assured that the AMA will support anyone who is selected for audit and will assist you with the process to ensure you comply.

To receive ongoing funding, the declaration will need to be signed annually. Participating physicians will be emailed a reminder.

Eligible physicians that are AMA members can log into the member dashboard to sign the declaration online. Non-AMA members must email programpayments@albertadoctors.org to receive and sign a pdf copy of the declaration.

Patients that are on a physician’s CPAR conflict report (listed on two or more CPAR panels) are allocated according to subsequent cuts based on fee-for-service or shadow billing.

CPAR allows physicians to clearly indicate which patients are on their panel. This may result in more accurate panel size estimates, as CPAR paneled patients are allocated to the physician regardless of billing history.

For a CPAR panel shared by two or more eligible physicians, program payment will be based on the total number of patients in the panel and the program payment will be split equally between the eligible physicians.

In most cases, yes. To calculate panel sizes to determine grant size, the PMSP uses panel data from both CPAR and AHCIP billing information.

If you have a patient or patients who are not included in the panel data you submit to CPAR, but they see you regularly, they will be included your panel size calculation for PMSP. This would only not be the case if there is another PMSP-eligible family physician or nurse practitioner they see more frequently, or if they are listed in another PMSP-eligible family physician’s or nurse practitioner’s CPAR panel.

No. CPAR panel data is processed on a monthly basis. CII/CPAR’s systems do not support retroactive submission of panel data.

It does not affect how the PMSP calculates a physician’s panel size; multiple panels are treated as an aggregated, single panel for the purposes of the PMSP. However, it could affect whether a physician is classified as urban or rural. When a physician has CPAR panels in both urban and rural communities, the panel with the most patients determines their classification.

In all circumstances, PMSP-eligible physicians with more than one CPAR panel will receive a single quarterly payment through the PMSP.