The Alberta government, fresh off failed contract talks with doctors, is ending its long-standing master agreement with them and putting new rules in place April 1.
Changes include new fee rules on extended patient visits that doctors have already said will devastate the bottom line for some family and rural practices.
Health Minister Tyler Shandro says ending the agreement is a difficult but necessary move, given that the province was at an impasse with doctors on how to reduce costs and improve service in the $20.6-billion health system.
“It’s not a decision we take lightly, but since May we’ve been talking to (the Alberta Medical Association) about our fiscal imperative,” said Shandro in an interview Thursday.
“Unfortunately, we weren’t successful in being able to get them to work with us on that issue.”
Agreement ends March 31
The current master agreement with physicians ends March 31.
Both sides have tried and failed to agree on new terms in negotiations since November.
Last fall, Premier Jason Kenney’s United Conservatives passed Bill 21, which gives the government the right to unilaterally end the agreement.
Starting April 1, physician compensation will remain at its current level of $5.4 billion a year. But the changes are expected to prevent $2 billion in added costs tied to physician services over this current fiscal year and the three after that.
The key change, which has also been the focus of a fiery dispute between doctors and the government, will be to a billing designation known as complex modifiers.
Under Alberta’s current fee-for-service model, doctors can bill $41 as a base fee for each patient visit no matter how short or how long.
A decade ago, Alberta added in an extra fee — called a complex modifier — to recognize that some patients have multiple or complex issues and doctors should be compensated for overly long visits.
If a visit went more than 15 minutes, doctors were able to extend it 10 minutes and bill the province a complex modifier fee of $18, for a total of $59.
As of April 1, the fee will be halved from $18 to $9, for a new total fee of $50.
As of April 1, 2021, the $18 complex modifier will return. But physicians won’t be allowed to bill for it until the 25-minute mark.
Doctors warn of cutting visits
Shandro’s ministry says the change is necessary for two reasons: more time is needed to assess complex patients and the current complex modifier is being abused, with too many doctors billing the $59 right at the 15-minute mark.
The Alberta Medical Association, the bargaining arm for doctors, has said extending the length of a visit to 25 minutes would reduce fees by a total of $200 million and devastate many family and rural practices.
The AMA has argued the complex modifiers are not only for exceptional cases and take into account all the work — preparation, follow-up and face-to-face time — needed for patients with complex needs. It also says it keeps those patients out of the hospital.
The issue has riled up some doctors, many of whom have put up signs warning patients they may have to cut future visits short to recoup funds needed to keep their practices going.
Other changes include an end to double billing for overhead, no more duplicate billing for diagnostic imaging and a cap of 65 patients a doctor can see and bill for in a day.
Starting this summer, the province will introduce a new alternative relationship plan, with built-in transition benefits, to encourage doctors to move away from charging fee-for service to new three-year contracts.
The alternative plan includes having physicians tied to specific services, locations and times rather than billing for specific visits or procedures under the fee-for-service model.
The government has made the changes based on two reports that say Alberta is paying more on physician services than other provinces, but has too many performance measures below national averages.
It estimates gross clinical earnings for an Alberta doctor at almost $390,000 a year — about $90,000 more than a comparable one in Ontario.
The AMA says the government’s position is built on flawed data that doesn’t take into account differences in fee rules and that Alberta doctors are paid in line with those other provinces.