President's Letter
Dear Members:
Last week, Bill 30, The Health Statutes Amendment Act, 2020 completed second reading in the legislature. There is no doubt that this government-sponsored bill will be passed before the session ends for summer break, likely this week.
On July 8 I wrote to members on this topic and I promised you more detailed commentary. I am providing that today with a copy of our letter to government. This is the response that we provided at their request. (Please note that the request for feedback on Bill 30 arrived after the bill had been tabled in the legislature and gave us four days to respond.)
Bill 30 is complicated and our response comments on a number of aspects. One of the most significant, though, is the issue of adding a third category to the list of those entitled to bill the Alberta Health Care Insurance Plan for the provision of insured services pursuant to an “arrangement” with the Minister. Bill 30 refers to this third category as a “person” (as opposed to a medical practitioner or dental surgeon), clearly intended to be either a corporation, a partnership, a society or another recognized legal corporate entity.
What is not clear is the scope of these contracts and what money would go to the corporate entity. Does it include the dollars for physician services? Will physician fees be agreed to upfront, or can the new single-purchaser now simply dictate the level of physician compensation? Finally, if a non fee-for-service approach is being proposed, do physicians have a choice to participate or not, and where will this be discussed? Does this approach prevent physicians from accessing billing for their services through the Schedule of Medical Benefits, the typical route for fee-for-service billing? Could this support a scenario where all physicians’ funds for a particular specialty are given to a for-profit corporation, resulting in the physicians having no option but to seek employment from that corporation to practice their specialty in Alberta?
The AMA is not opposed to moving forward with more efficient models of care. But it is critical that agreed upon rules of the game, along with the full engagement of physicians, be established at the outset. For the establishment of physician fees, there should be the right to representation, clarity on how fees are established and choice in the opportunity to participate. There may be wide variation in arrangements that eventually appear, but it is essential that these principles are preserved.
I welcome your thoughts and comments on this important issue that has the potential to fundamentally change the way we practice medicine in Alberta.
In closing, thank you to all members who have already cast their vote in our Confidence Vote Referendum on the Minister of Health. If you have not voted yet, there is still time. Voting closes tomorrow, Tuesday, July 28 at 11 p.m. Please cast your vote now. Voting is secure (member login required) and anonymous. It takes less than a minute to vote. This information is important to guide the Board on our best next steps toward a negotiated agreement.
In your service,
Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association