2023-24 Year-End Update on KRA 1, Financial Health

Priority Activities

Year-end update

1. Improve fairness in compensation between specialties:

• Complete all aspects of the income equity measures this year, including member ratification.
• Use the full measure to influence and promote fairness in compensation including in the rates review and the financial reopener.
• Use the full measure to inform other compensation policy matters (e.g., stipends, ARPs, AMHSP).

• Stage 1 of dispute resolution process (AMACC review) is now complete.

• Stage 2 (Dispute Resolution Committee) of the dispute resolution process is nearly completed with a report from the committee pending.

• AMA has started engaging lower earning sections to gather their compensation priorities.

• The AMACC is considering ways to use the full measure to inform, influence and promote fairness in compensation and will discuss further with the Fall Representative Forum.

   

2. Ensure fair        compensation compared to other Canadian physicians and other Alberta professionals. 

• Through AMA Agreement mandates:
  • Complete the micro-allocation.
  • Prepare for an inter-provincial fee review and possible arbitration.
  • Begin preparing for the fourth-year financial re-opener.
  • Complete the Alberta Health Services (AHS) payment reviews (stipends, on-call, overhead).
  • Complete the ARP rate review.
• Through other mandates:
  • Support Clinical ARP and AMHSP negotiations.
  • Support local and provincial compensation discussions:
    • Lab Agreement
    • Cancer Care
    • WCB
    • Third party contracts

AMA Agreement Mandates

• AMA staff have engaged physician groups receiving AHS payments. The Stipend Working Group has been paused and will soon commence meetings.
• AMA representatives at the ARP Working Group have been meeting weekly since November 2023 to discuss an AMA proposal to update ARP rates and have reached agreement on a new ARP rate-setting methodology referred to as the ‘Derived Day Approach.’ The group is now seeking to have our proposal to update ARP/AMHSP rates implemented on an expedient basis. Without consensus, the AMA and Alberta Health (AH) have taken separate proposals to three meetings of the Rates Committee and are aiming for the August 28 Rates Committee meeting to reach consensus for the implementation of all family medicine ARP/AMHSP rates plus timelines for all other specialty ARP/AMHSPs rate implementations. 
• The new Lab Agreement was ratified and fully executed by all parties. Agreement implementation is underway. 
• Cancer Care negotiations with AHS commenced December 20, 2023, with three meetings held to date. The agreement expired March 31, 2024, and the parties have agreed to resolve outstanding issues through binding arbitration. 
• AMA staff have supported the Alberta Orthopedic Society (AOS) negotiations and have reached agreement in principle with the Workers’ Compensation Board of Alberta. The agreement is pending ratification by AOS and WCB. 
• Preparation is underway for negotiations with WCB for a new WCB-AMA Physician Services Compensation Agreement. The agreement expires December 31, 2024.

Fourth-Year Financial Reopener

• Preparation has begun for the Fourth-year financial reopener. The AMA has hired a consultant/analyst to assist us to prepare for negotiations. The outcomes of the Market Rate Review will also link into the reopener.

AMHSP Negotiations: 

• New AMHSP Master Agreement – long-promised, but no sign of it yet – AH indicates that other issues have supplanted this work, and although it was anticipated to commence over the summer months, activities related to health system reorganization have again delayed a new agreement. AH continues to indicate they will bring it to other parties for review when ready. 
• AMHSP rate development for the 2025 expansion groups (emergency medicine and critical care medicine) continues. The AMA is hopeful the same or a similar methodology as is being used for other alternative remuneration groups can be applied, and that the methodology can be utilized to update rates for other AMHSP groups. 
• Work of the AMHSP Negotiations Committee has been paused until further information is received regarding the status of the revised AMHSP Master Agreement. Work continues at the staff level to plan for upcoming negotiations and coordination with the overarching AMA/AH negotiations. 
• This coordination includes work in support of a motion at Spring RF directing that formal representation of AMHSP physicians in their clinical compensation and non-faculty roles be included in the next AMA/AH agreement.
• AMA has successfully negotiated policy changes in 
  • The amount claimable for non-AMHSP work – increased from $30,000 to $45,000.
  • Physician representation on the AMHSP Appeals Committee – requires further work re process to determine.

Priority Activities

Year-end update

1. Support activities that promote the effective management of practices, including:

• Supporting sections in schedule modernization/improvement efforts.
• Promoting professionalism and best practice in billing and referral practices through tools like the fee navigator and billing training tools.
• Improve the accessibility of existing practice and clinic management tools and training information through the Learn@AMA learning management system and/or the AMA website.

• AMA staff continue to support sections’ modernization efforts with allocation-based fee initiatives, acute care and primary care proposals, virtual care improvements and ad hoc initiatives. Several proposals are being discussed at various working groups, with representatives from AH and AHS.

• AMA-Accelerating Change Transformation Team (ACTT) provides a suite of courses offered through Learn@AMA amounting to 1,653 learners and thousands of hours of training delivered to a wide audience. It includes: Alberta Primary Care Explained training, CII/CPAR training, Home to Hospital to Home Transitions Process Improvement training (launched April 2023), Opioid Process Improvements training, Panel in Action training, PCN Governance training, Practice Facilitator training (re-launched in November 2023), Privacy training and Reducing the Impact of Financial Strain training. 

• AMA-ACTT maintains and develops a suite of practice enhancement resources on the AMA website and includes access to networks and Communities of Practice, change packages, learning resources (toolkits, guides, documents). 

2. Support members participating in or considering alternate compensation models including: 

• Clinical alternative relationship plans
• AMHSP arrangements
• Third-party contracting models

• The AH-AMA Clinical ARP Working Group has been meeting weekly since October 2023 to discuss and influence clinical ARP policy, models, rate methodology and removing barriers to uptake. In November 2023, the AMA tabled ten recommendations to improve clinical ARP uptake and both organizations agreed with the need to prioritize areas into short-term wins versus longer-term solutions. The AMA team is supporting physicians in existing plans and those considering prospective ARPs.

3.    Prepare members for team-based funding conversations including:

• Developing options for both clinic and primary care network (PCN) team funding flow and policies that could be implemented between clinics and PCNs for team-based funding, including contract templates. 
• Through the ACTT program, host a PCN Strategic Forum that focuses on teams in primary health care, showcasing successful examples of team deployment and options for implementation in Alberta.

• Prepared a high-level proposal for team-based funding to flow either to clinics or PCNs, as part of a larger Strike Team proposal to AH. AH and the Minister of Health understand the proposal; however, no further discussions have been held to explore the details given to other more pressing topics around primary care stabilization. It is also expected that team-based funding may be addressed as the Modernizing Alberta's Primary Health Care System (MAPS) initiative rolls out. A one-pager was developed outlining all of ACTT’s resources for team-based care. 
• The 24th PCN Strategic Forum was held November 2-4, 2023. The theme was “Teaming Up, Moving Forward.” Not only were a few breakout sessions devoted to team-based care (including Practice Facilitation), but the overall theme was designed to inspire the audience into the future of team-based care and leadership. Internal planning has begun on the next provincial conference and it is expected to be held Spring 2025 in Edmonton. Key highlights included speakers such as Minister LeGrange, Keynote speaker Alan Gregerman and MAPS engagement. Attendance increased by 25% over last year.

Priority Activities

Year-end update

1. In partnership with MD Financial Management (MD) and the Bank of Nova Scotia (BNS), promote and provide educational sessions on the Medicus Pension Plan, created for physicians to provide predictable monthly income in retirement. 

• After opening for deposits in June 2023, MD reports that they have identified 260 qualified prospects who may be suitable fits for the pension plan and completed 117 discovery meetings with Alberta physicians. One of the founding members of the pension plan is Albertan. Over 100 physicians nationwide have officially joined the pension plan and MD reports that they are gaining new enrollments weekly.
• ADIUM has worked with MD to complete an information session for ADIUM staff (Public Affairs attended as well) to ensure ADIUM advisors are well equipped to make referrals to MD for consideration of the pension plan (completed February 1, 2024).
• A cobranded, educational member webinar took place at 7 p.m. on May 2, 2024, on this topic. This session was broadly advertised to members through a variety of mediums.
• MD will be present at the Fall RF and will be pleased to provide additional resources on Medicus at that time, if desired.

2. In partnership with MD and BNS, complete a market assessment to ensure competitive rates and coverage of products offered to members through the financial services alliance. 

• ADIUM will be undertaking surveys to assess the member perception of value of the MD Financial/BNS relationship. These surveys will also cover multiple other partnerships affecting member financial well being including TD Insurance Meloche Monnex, AMA Health Benefit Trust Fund, Manulife and ADIUM’s services. 
• ADIUM is working with MD leadership to vet their processes and their research as it pertains to product and service development and their offerings that are specific to physicians. Although their quantitative data is proprietary, by vetting MD/BNS’ market scanning and review processes and policies, the AMA can assess and affirm the competitiveness of products and service offered to members and their families.

3. Assess the feasibility of providing members with subsidized medical education subscriptions, previously available through the Canadian Medical Association (CMA). 

• The CMA informed the AMA that it discontinued clinical tools included within CMA membership (some of which offered continuing medical education [CME] credits) to focus on its new strategic plan, Impact 2040. They began sunsetting clinical tools in April 2023 and completed the process by year-end.
• Most of these clinical tools are accessible to many Alberta physicians through affiliations with AHS or the universities, including DynaMed (AHS, University of Alberta [U of A], University of Calgary [UofC]), UpToDate (Calgary Foothills PCN), ClinicalKey (U of A, U of C) and Calgary Police Service (CPS) (AHS, U of A, U of C). Essential Evidence Plus has no institutional subscribers in Alberta due to its high cost. These tools (other than UpToDate, to which a discount was offered) were included in CMA membership.
• The most popular tool used and requested by CMA members was a subset of Essential Evidence Plus called Patient Oriented Evidence that Matters (POEMS), which offers continuing professional development (CPD) credits. 
• POEMS was a highly customized, proprietary experience that was deeply integrated into the CMA CRM, making it difficult to replicate elsewhere. We have asked the CMA to keep the AMA informed as to the potential transitioning of this program to another vendor.