The Alberta government’s proposed changes to regulations around doctor billing and comprehensive primary care, or complex care, have some physicians concerned.
The changes would affect the rates at which doctors can bill and fees for complex care plans.
The government tabled several proposals Nov. 14 and gave the Alberta Medical Association (AMA) until Dec. 20 to respond.
In a letter posted on Nov. 29 on albertadoctors.org, AMA president Christine Molnar calls the recent developments in negotiations with the government, “deeply concerning.”
The United Conservative Party (UCP) is proposing changes to physician compensation and proposing cuts (about 85 per cent) to comprehensive primary care, according to Molnar.
“This is counter to sound health policy, the government’s health platform and the interest of patients, particularly elderly ones, those with chronic and complex conditions, and those living in rural or remote areas of the province,” said Molnar.
“There will be a negative impact on care for thousands of patients.”
Primary care networks and the Medical Home were developed in order to improve Albertans’ access to adequate primary care and family doctors, says Molnar.
“The government proposals threaten to reverse the progress we have made in primary care.”
Ponoka physician Dr. Brendan Bunting signed off on the creation of primary care networks during his term as the president of AMA in 2003, and says he was “very pleased” to have been a part of that initiative.
Dr. Bunting explained during an interview on Dec. 4 that primary care networks offer services that medical practices previously couldn’t by employing people to provide value-added services such as dietitians and nurses and other allied health professionals.
Regarding Bill 21, the termination of contracts and practitioner ID restriction, Molnar says, “these proposals paint a grim picture of the kind of relationship government would like with physicians.”
Molnar’s letter concludes the proposals would be “devastating to rural family practice.”
These proposed changes are coming right on the heels of the announcement of a potential cut of 500 full-time nursing jobs over three years.
There has been some confusion around whether decision to cut nursing jobs falls under the UCP’s purview or Alberta Health Services (AHS). The short answer is they are essentially one-in-the-same.
Alberta Health Services delivers medical care on behalf of the Government of Alberta’s Ministry of Health. They are the employer of nurses in Alberta, organized under the United Nurses of Alberta (UNA).
AHS gave advance notice of their intent in a letter to UNA on Nov. 29 and UNA and AHS will head into collective bargaining next year.
The AHS provided Ponoka News with this statement on Dec. 2:
“This is a proactive disclosure of possible initiatives to unions in respect of collective bargaining. While our budget has remained stable, Alberta’s growing and aging population means we need to be more efficient and focused in terms of health care spending.
“Population growth year-over-year has been 1.64 per cent from July 1, 2018 to July 2, 2019. This places increased demand on our health care services and it means we have to do things differently in order to provide care to Albertans. There are additional cost pressures every year of about 2.5 percent.”
As AHS says the disclosure is only a list of potential initiatives and no final decisions have been made, it is unknown yet how health care in central Alberta may be affected.
Lacombe-Ponoka UCP MLA Ron Orr says primary care networks aren’t on the list of negotiations so didn’t have a response on that topic, but provided answers on other questions about recent health care announcements and proposals.
According to Orr, the UCP’s proposes to increase the amount of time a physician is allowed to spend with a patient per base rate visit, instead of doctors billing additional fees for complex care, as a “money saving effort.”
Orr says the UCP are undergoing a complete review of Alberta health care services and compensation.
“It’s an old system that needs to be updated.”
Public compensation amounts to one half of Government of Alberta expenses and Alberta pays $119,000 more per doctor per year, which is 25 per cent per capita higher than any other province and 28 per cent higher than B.C. and Ont.
From 2009 to 2017, the volume of services dropped by seven per cent, but the pay per service increased by 37 per cent.
The Alberta government pays $5.2 billion per year for doctor compensation, which has tripled since 2002, making that expense the highest rate of growth for provinces’ health care spending in the country, says Orr.
Orr says the UCP needs to work with their key partners to get the budget under control, and while they aren’t cutting health care spending, they are going to stay within current levels.
There are a total of 11 points currently being negotiated between the UCP and the AMA, and while Orr says the UCP is exploring a new model, “all points are up for discussion” and they will continue to look for ways to improve efficiency.
Regarding nursing positions, Orr says “the reality of anyone actually being fired is highly unlikely,” as the UCP’s plan is to reduce the number of jobs through attrition over three years, meaning they will simply not hire new nurses as they move out-of-province or retire.
The 500 full-time positions would be under one per cent of AHS’s total nurses and is less than the AHS’s current rate of normal turnover, which is 1.2 per cent.
The initiative’s purpose is to reduce costs and expenses, which is what the UCP was elected on, says Orr.