Clinical ARP Models

Overview

• The annualized funding model is the most commonly used model in Alberta.
• The model was designed to fund physicians for full-time practices, although part-time participation is allowed. 
• Clinical ARPs provide funding to physicians to deliver defined program services, to a defined patient population, at a defined site. 
• Medically insured services outside the scope of the clinical ARP must be billed fee-for-service (FFS).

Model Elements

Funding

• Funding is based on number of physician full-time equivalents (FTEs) required to deliver services. The proposed FTE amount is determined through the application process, which includes extensive data analysis, and is subject to AH approval. The maximum funding is determined by multiplying the number of approved FTEs by the annual payment rate.
• As with FFS, overhead is included in the cARP rates; therefore, any current overhead expenses would be paid from the cARP revenue, unless other arrangements are made (e.g., partnership with AHS or a third party). 

Payments

• Funding is transferred prospectively. In most cases, the program receives their funding monthly in 12 equal installments, even if there are fluctuations in monthly FTEs worked. The program can request a change in the monthly amount if there will be a sustained increase or decrease in FTEs worked, within the maximum annual approved funding limit. A reconciliation is done at the end of each fiscal year to ensure the funding paid equals the actual FTEs provided.
• Physicians are required to manage their work schedules and ensure that they provide the required number of program service hours during the fiscal year (April 1 to March 31).
• If a program provides more service hours than are funded, then they are not entitled to additional payments.

Program Services

• Each program needs to define the basket of service that will be in-scope for the practice. For example, a practice may decide low risk maternity and delivery are out-of-scope.
• Program services include both direct and indirect patient care. 
• Program services do not include physician on-call availability. Only the actual time physicians spend delivering program services while on-call is funded. 
• Program services include any out-of-province (medical reciprocal) patients.

Physician Benefit Programs

• ARP physicians are entitled to the same physician benefit programs as they would qualify for in FFS. For example, ARP physicians still receive Specialist On-Call Program payments if they qualify.

Locum Services

• Locum services are included in the FTEs for the program and are paid out of the clinical ARP funding. The actual amount required to attract locums for a weekend or evening may be higher than the AH funding generated by the locum hours worked. Therefore, the difference would be considered an overhead expense that needs to be paid by ARP physicians.
• Urban practices are required to engage private locums.
• The AMA’s Physician Locum Service supports rural practices in obtaining locum coverage.

Workload

• Physicians determine when and how program services will be delivered.
• The program must submit a proposed typical weekly clinic work/shift schedule as part of the application process.

Reporting Requirements

• As part of the application process, the program proposes approximately five key performance measures (e.g., service volumes, quality measures, physician-patient continuity, etc.).

Exclusions

Clinical ARP funding only pays for medically insured services; lecture-based teaching, practice management, travel, CME and vacation are not funded.

Overview

• The sessional funding model is used by many physician groups in Alberta.
• The model was designed to fund physicians for part-time practices. 
• Clinical ARPs provide funding to physicians to deliver defined program services, to a defined patient population, at a defined site. 
• Medically insured services outside the scope of the clinical ARP must be billed fee-for-service (FFS).

Model Elements

Funding

• Funding is based on the number of hours required to deliver ARP services, multiplied by the hourly funding rate.
• Allows for part-time physician participation approximately 16 hours per week and to a maximum of 832 hours annually.
• The funding rate is currently $228.45 per hour for all specialties. 
• As with FFS, overhead is included in the cARP rates; therefore, any current overhead expenses would be paid from the cARP revenue, unless other arrangements are made (e.g., partnership with AHS or a third party). 
• Smaller, specialized programs generally use the sessional model, but it can also be used for a smaller segment of overall services.
• As with the annualized model, physicians can bill FFS for-service for non-ARP services outside of the hours they are providing ARP funded services.

Payments

• Funding is transferred to the program or directly to the physician based on time-modifiers utilized with the shadow billing.
• If a program provides more service hours than are funded, then they are not entitled to additional payments.

Program Services

• Each program needs to define the basket of service that will be in-scope for the practice. For example, a practice may decide low-risk maternity and delivery are out-of-scope.
• Program services include both direct and indirect patient care. 
• Program services do not include physician on-call availability. Only the actual time physicians spend delivering program services while on-call is funded. 
• Program services include any out-of-province (medical reciprocal) patients.

Physician Benefit Programs

• ARP physicians are entitled to the same physician benefit programs as they would qualify for in FFS. For example, ARP physicians receive Specialist On-Call Program payments, if they qualify.

Locum Services

• Locum services are included in the FTEs for the program and are paid out of the clinical ARP funding. The actual amount required to attract locums for a weekend or evening may be higher than the AH funding generated by the locum hours worked. Therefore, the difference would be considered an overhead expense that needs to be paid by ARP physicians.
• Urban practices are required to engage private locums.
• The AMA’s Physician Locum Service supports rural practices in obtaining locum coverage.

Workload

• Physicians determine when and how program services will be delivered.
• The program must submit a proposed typical weekly clinic work/shift schedule as part of the application process.
  Exclusions
• Clinical ARP funding only pays for medically insured services. Lecture-based teaching, practice management, travel, CME, and vacation are not funded.

Reporting Requirements

• As part of the application process, the program proposes approximately five key performance measures (e.g., service volumes, quality measures, physician-patient continuity, etc.).

Exclusions

• Clinical ARP funding only pays for medically insured services; lecture-based teaching, practice management, travel, CME, and vacation are not funded.

Overview

• The capitation clinical ARP (cARP) is a legacy funding model in Alberta that enables a team-based approach to primary care. The two legacy capitation cARPS are the Taber Clinic and the Crowfoot Village Family Practice.

Model Elements

Program Services

• Each program needs to define the basket of service that will be in-scope for the practice. For example, a practice may decide low risk maternity and delivery are out-of-scope.
• Program services include both direct and indirect patient care.
• Program services do not include physician on-call availability. Only the actual time physicians spend delivering program services while on call is funded.
• Program services include any out-of-province (medical reciprocal) patients.

Physician Benefit Programs

• ARP physicians are entitled to the same physician benefit programs as they would qualify for in FFS. For example, ARP physicians still receive Specialist On-Call Program payments if they qualify.

Locum Services

• Locum services are included in the FTEs hours for the program and are paid out of the clinical ARP funding. The actual amount required to attract locums for a weekend or evening may be higher than the AH funding generated by the locum hours worked. Therefore, the difference would be considered an overhead expense that needs to be paid by ARP physicians.
• Urban practices are required to engage private locums.
• The AMA’s Physician Locum Service supports rural practices in obtaining locum coverage.

Workload

• Physicians determine when and how program services will be delivered.
• The program must submit a proposed typical weekly clinic/shift work schedule as part of the application process.

Exclusions

• Clinical ARP funding only pays for medically insured services. Lecture-based teaching, practice management, travel, CME, and vacation are not funded.

Reporting Requirements

• As part of the application process, the program proposes approximately five key performance measures (e.g., service volumes, quality measures, physician-patient continuity, etc.).

Annualized Funding

Funding based solely on hours worked:

• The model was designed to fund physicians for full-time practices; part-time participation is allowed. 
• Funding is based on number of physician full-time equivalents (FTEs) required to deliver services. The proposed FTE amount is determined through the application process, which includes data analysis and is subject to AH approval. The maximum funding is determined by multiplying the number of approved FTEs by the annual payment rate.

Annualized Payments

• Funding is transferred prospectively. The program receives their funding monthly in 12 equal installments, even if there are fluctuations in the monthly FTEs worked. The program can request a change in the monthly amount if there will be a sustained increase or decrease in FTEs worked, within the maximum annual approved funding limit. A reconciliation is done at the end of each fiscal year to ensure the funding paid equals the actual FTEs provided.
• Physicians are required to manage their work schedules and ensure that they provide the required number of program service hours during the fiscal year (April 1 to March 31).
• If a program provides more service hours than are funded, then they are not entitled to additional payments.

Overview

• The Blended Capitation Model (BCM) compensates family physicians based on the number of patients they have, and the type of services provided. 
• The BCM provides funding to family physicians to allow them to customize their service delivery in innovative ways. Participating physicians can dedicate more time to each patient and provide a wide range of care that focuses on health promotion, wellness, and collaboration with other health care providers.
• The primary goal of BCM is to enhance Albertans' access to primary health care by establishing stronger and lasting relationships with their family physicians. Simultaneously, the BCM supports the long-term stability of the health care system, increased predictability for oversight of health care expenditures, and a more resilient and sustainable health care system.

Please refer to the AMA's BCM webpage for full details.