The Alberta government has terminated its funding contract with doctors and will impose 11 changes to physician rules and fees in what it calls a necessary move to control ballooning health-care costs in the province.
Health Minister Tyler Shandro said the province will maintain physician funding at current levels while it takes steps to avoid $2 billion in cost overruns, after negotiations with the Alberta Medical Association fell apart.
The contract with doctors, which had been set to expire at the end of March, encompassed the broad relationship between doctors and the government, including working conditions and compensation.
The UCP government says a new funding framework will be put in place March 31, which includes reforms designed to prevent cost overruns and align benefit programs and administrative fees with other provinces.
Negotiations between the AMA and UCP government broke down last Friday following a voluntary mediation session deemed unsuccessful by both sides. With no agreement reached through negotiations, which began in January, the province will instead implement terms of its final offer.
One of the key changes pertains to conditions that dictate when doctors can bill for extra time during “complex” patient visits.
Currently, doctors can bill $41 as a base fee for each patient visit. An extra fee, known as a complex modifier, allows doctors to receive compensation for overly long visits.
If a visit exceeds 15 minutes, doctors had been able to bill the province an additional $18. That fee will be cut in half to $9 as of April 1.
The $18 complex modifier will be reintroduced in April 2021 for visits that exceed 25 minutes.
Shandro said the change is being phased in to help doctors adjust to the new system. He said doctors had been billing the extra fee for 50 per cent of eligible visits.
“It was being used on patients that weren’t complex,” he said.
“We don’t think that the population of Alberta is that complex . . . That was our concern.”
The province will also no longer allow physicians to bill for overhead costs for all hospital-based services, end duplication of payments to doctors and cap at 65 the number of patients a doctor can see and bill for in a day.
Shandro said family physicians in Alberta see an average of 22 patients per day, while specialists tend to see about 13.
The provincial government will also introduce a new alternative relationship plan this summer, with built-in transition benefits, to encourage doctors to move away from charging fee for service to new three-year contracts.
The UCP will maintain spending on physician compensation at $5.4 billion.
Last fall, the government passed Bill 21, which gives the government the right to unilaterally end its current agreement with the AMA.
Shandro cited last year’s MacKinnon report, which found Alberta pays physicians at higher levels than comparable provinces and suggested the province negotiate changes with the AMA to achieve savings.
But he said that report also recommended that the government consider “legislative options” to achieve that goal.
Earlier this month, Ernst & Young also recommended the government adjust physician compensation to align with other provinces following its review of Alberta Health Services.
‘A sad day for health care’
Shandro said the province’s cost overruns were forecast to hit $2 billion over the next three years without changes to doctor pay.
“That’s just not an option. This compensation model is broken and so we’re fixing it. Another $2 billion in spending increases is not sustainable,” he said.
“At no point in the negotiations or the mediation process did the AMA come to the table with any meaningful proposals to meet that fiscal imperative.”
But in a statement, AMA president Dr. Christine Molnar said Thursday the organization made several offers throughout the negotiating process to achieve “substantial short-term savings” worth more than $150 million per year. She said the AMA had informed Shandro it intended to put forth another offer Friday and suggested moving to arbitration.
“(The) government has chosen to terminate a viable contract before the end of term. I believe this is the first time this has happened in Canada,” she said.
“This fundamentally goes against a belief that Albertans hold in common: the idea that one should stand by their contracts and live up to their word.”