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The long-awaited Physician Comprehensive Care Model (PCCM) for primary care has officially been announced and will be implemented in April 2025. Scroll down to review the FAQ or explore the questions by theme using the buttons below. We will continue to update this page as new program details emerge and your most frequently asked questions are answered.
The AMA has several dedicated tools and resources that will help members determine if the PCCM is appropriate for their practice style and will result in increased compensation.
The PCCM will not fit every practice style. It was created to support comprehensive, longitudinal clinic-based family medicine. We know some practices will have unique characteristics that will make other payment models (e.g. other ARPs, Capitation, Blended Capitation or FFS) a better fit. The AMA will continue to offer supports for these programs.
For rural generalists whose practice involves providing a portion of services in rural health facilities, the PCCM will address only the community clinic portion of their practices. Further discussions and action is required to address other elements of rural generalist practices and is an area of ongoing discussion with Alberta Health. Physicians who provide services in health facilities may also benefit from the elements included in the AMA’s Acute Care Stabilization Proposal.
PCCM compensation is comprised of three payment types:
1. Payment for patient encounters
2. Time-based payments for direct and indirect care as well as for practice management
3. Panel payments based on patient complexity.
These three elements combine to determine a physician’s total compensation.
No. The PCCM will be offered as a new compensation option for family physicians and rural generalists who feel that it suits their practice and community needs, offering expanded choices for physicians.
We recognize that some physicians may wish to continue on the FFS model, while others may want to utilize other forms of clinical Alternative Relationship Plans (cARPs).
Yes, these are different names for the same funding model.
To be eligible for the PCCM, physicians must
- participate in CII/CPAR
- have a minimum panel size of 500
- work 400 hours of service over 40 weeks of the year
Yes. We recommend that physicians interested in the PCCM who are not yet on CII/CPAR start the enrolment process as soon as possible.
To learn more about CII/CPAR, including how you can access the CII/CPAR Acceleration Grant, visit AMA's CII/CPAR webpage.
CPAR will be used as the source of truth to determine the patients paneled to each physician for the purposes of the panel payment component of the PCCM.
To learn more about CII/CPAR, including how you can access the CII/CPAR Acceleration Grant, visit AMA's CII/CPAR webpage.
No. Actively paneling in CPAR is a pre-requisite to joining PCCM. Alberta Health has committed additional resources to support CPAR onboarding for PCCM. For those physicians who have completed the Confirmation of Participation Form for CPAR already, it is important to respond promptly to eHealth requests to minimize the time it takes to go live.
To learn more about CII/CPAR, including how you can access the CII/CPAR Acceleration Grant, visit AMA's CII/CPAR webpage.
Yes. Rural generalists qualify for PCCM if they meet the eligibility criteria. Each physician needs to consider how PCCM will impact their practice and are encouraged to use AMA tools and resources as they consider transitioning to the new model.
No. Nurse practitioners and other health care providers are not eligible for compensation or funding under the PCCM. This model has been created for family physicians and rural generalists.
Enrollment in the PCCM has begun! Learn more here.
Step 1: Verify Eligibility and Express Interest via AMA
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Log into your AMA member dashboard
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Check CPAR panel size (must be 500+ patients)
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Use the checkbox to complete the ‘Interest & Enrollment’ form
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Receive confirmation of submission from the AMA by email
No. Joining the PCCM is a decision to be made by the individual physician. Other remuneration models, including fee for service, ARP, and blended capitation will still be available.
Each physician needs to consider how PCCM will impact their practice and are encouraged to use AMA tools and resources as they consider transitioning to the new model.
Yes. Physicians can withdraw from the PCCM model by notifying the Ministry of Health with at least 30 days' written notice. The forms for pausing and withdrawing from the model will be shared in early 2025.
Yes. If you choose to leave the PCCM you may apply to re-enroll in PCCM twelve months after departing the model.
For encounters, a single basket of Health Service Codes, typically billed by longitudinal family physicians for visits and procedures, has been defined in the PCCM and are referred to as in-basket codes. In-basket codes will be paid at a rate of 68.5% of FFS value.
Health Service Codes not defined in the list of in-basket codes are considered out-of-basket but are eligible to be billed at 100% FFS value.
In addition to your encounter payments, family physicians will bill an hourly rate for direct and indirect patient care at $105 per hour.
Physicians offering appointments in clinic after-hours and on weekends can bill for direct care time at a premium of $87.72 per hour, for a combined total of $192.72 per hour.
For clinic practice management, physicians will be compensated an additional 10% of their total hours billed for direct and indirect care multiplied by a rate of $105 per hour. This is paid automatically based on the time claimed.
For panel payments, the average annual payment per paneled patient is $70.25 and can range from $32.87 - $136.73 depending on the patient’s age, sex and complexity.
The PCCM uses existing fee-for-service (FFS) Health Service Codes (HSC). Approximately 94% of HSCs used by community Family Medicine are included under the PCCM and these HSCs are referred to as “in-basket.” Information about the Fee Codes can be found here.
In-basket HSCs are paid at 68.5% of the FFS value and complexity modifiers CMGP and CMXC30 are not paid under the PCCM. The proration does not apply to the tray fees which are paid according to the Alberta Schedule of Medical Benefits (SOMB) rules.
Any HSCs not defined in the list of in-basket codes is considered out-of-basket and paid at 100% of the FFS amount. Remember, the time-based payments and complexity-adjusted panel payments apply under the PCCM.
Compensation under the PCCM is provided to individual physicians and is based on a combination of: encounter payments (accounting for approximately 40% of total compensation), time-based payments (accounting for approximately 40% of total compensation), and complexity-adjusted panel payments (accounting for approximately 20% of total compensation).
Physician compensation will depend on several factors, including patient panel size, the complexity of the physician's paneled patients, and time spent on both direct and indirect care. The PCCM Financial Calculator will help physicians estimate potential earnings.
The anticipated increase in annual income is estimated to be approximately 25% more for the average full-time family physician practicing longitudinal care. The actual increase for each physician may vary.
AMA Members can utilize AMA's Financial Calculator (login required) to provide a daily or weekly estimate based on an individual physician's practice characteristics.
No. There is no maximum or ceiling for physician earnings under a PCCM Business Arrangement Number (PCCM BA).
No. The PCCM offers compensation to an individual physician and does not fund care provided by other practitioners.
Complexity is determined using the patient's age, sex, and the CIHI Population Grouper. The CIHI Population Grouper categorizes patients based on their age, sex, diagnoses and their use of the entire health system. It is anticipated that the average annual payment per patient will be $70.25.
More information on the CIHI Population Grouping Methodology, visit the CIHI website.
Services claimed under a PCCM BA, including time, follow the same payment distribution schedule as claims submitted under a FFA BA. Rules regarding claims submission, processing and timelines remain the same as FFS.
Panel payments will be paid retrospectively on a monthly basis.
A single basket of Health Service Codes for visits and procedures has been defined for PCCM and represents approximately 94% of all family physician service claims.
Health Service Codes that are not defined in the list of PCCM in-basket codes are considered out-of-basket but are eligible to be billed at 100% FFS value.
No. Complexity modifiers are not billable or payable under the PCCM.
Business Costs Program (BCP) payments are not billable or payable under the PCCM.
The encounter component of the PCCM is eligible for Rural Remote Northern Program (RRNP) payments. For the purposes of calculating the RRNP payment, encounter rates are valued at 100% of their FFS values.
Please note, the RRNP is currently under Alberta Health review.
Three main factors determine your PCCM Panel size calculation:
- EMR Panel Size & Processes
- CPAR Panel Size
- Out-of-Province Patients
For more information explore our dedicated resource for PCCM Panel Size Calculation.
It depends. If you plan to use a PCCM BA at multiple locations, the panel size will be combined for one panel payment.
If you operate under different funding models at each location, the panels will not be combined.
The risks associated with growing your panel largely fall within the realm of access. As panel size increases, the amount of demand for appointments will also increase, which can lead to longer delays for appointments.
Metrics like Third Next Available Appointment (TNA) can be useful in monitoring access as a panel grows.
Calculating your Ideal Panel Size is a good first step in determining a maximum panel size. For more information visit the AMA's Enhanced Access Resources webpage.
For Alberta physicians who practice near other provincial borders, you cannot submit claims through PCCM for patients who do not have an Alberta Health Care Card.
Patients who do not have an Alberta Health Care Card will not be counted toward your panel for PCCM.
Supports
The AMA has developed a range of support tools, webinars, and resources to assist with the transition to the PCCM. These resources will support you in determining if the PCCM is right for you, offer guidance on the enrollment process, changes to billing, panel management and more.
Available resources include, the Financial Calculator, Essentials Guide and the Alberta Physician Compensation Comparison Table.
As more details emerge, new resources, tools and webinars will be made available on the AMA’s PCCM webpage and through the AMA Member Dashboard.