New physician funding framework concerns local doctors

By Sean Feagan, Local Journalism Initiative Reporter

Changes to the provincial physician funding framework has some Strathmore-area doctors worried about the financial stability of their practices and their ability to provide care to complex patients.
On Feb. 20, the government of Alberta announced a new physician funding framework for the province will come into effect on April 1, 2020. The changes were made to prevent $2 billion of cost overruns resulting from physician compensation, while maintaining the current funding level of $5.4 billion per year, said Tyler Shandro, the province’s minister of health, in a published statement.
“If left unaddressed, these costs would impede efforts to reduce surgical wait times, improve mental health and addiction services, and expand the number of continuing care beds,” he stated. “The new framework announced today will prevent cost overruns, allow our province to improve services for patients, and still ensure that Alberta’s doctors are amongst the highest paid physicians in all of Canada.”
The province terminated the existing master agreement between the province and Alberta physicians, which was scheduled to expire after March 31, after negotiations between the two groups that started in November 2019 stalled. Included in the new funding framework are 11 consultation proposals to the province’s physician fee schedule, which affect how doctors bill for services provided to patients under the provincial fee-for-service model.
By terminating the existing master agreement, the provincial government has unilaterally imposed a new fee schedule without incorporating the perspectives of physicians, said Dr. Alison Clarke, the immediate past president of the Alberta Medical Association, who has practiced as a family doctor at Strathmore’s Valley Medical Clinic for the past 22 years.
“Tearing up the contract – that’s unprecedented,” she said. “Why would you not want to work with the one group in healthcare that can actually do something different next week to provide care differently to patients?”
The changes could adversely impact Strathmore’s primary care networks, said Clarke.
One of the changes to the fee system is a reduction of the “complex modifier,” an additional fee physicians can charge if an appointment’s duration exceeds 14 minutes, from $18 to $9. The fee will be returned to its current amount on April 1, 2021, but only for appointments that exceed 24 minutes.
The change is projected to save the province $197 million annually by 2022-23, according to the provincial government.
The complex modifier allows physicians to address patients with complex issues such as diabetes, high blood pressure or mental issues, said Clarke.
“For patients that are more complex, you can spend more time and bill a little bit extra to fund that extra time,” she said. “You’re not bound by having a little bit of time – you can actually spend time dealing with all the different nuances of all of their problems.”
Changes to the complex modifier fee have been worrisome for many doctors, said Clarke.
“As I talk to physicians that will have to deal with (the changes to the complex modifier fee), there’s just a lot of distress because it’s such a better way to manage patients’ problems – to actually spend time in front of them and solve it together – than it is to be under a time pressure and have to just keep up on that treadmill of keeping the patients going through.”
Altering the fee payment schedule has the potential to affect how physicians operate their practices, as they pay expenses with money earned from fees for services, said Clarke.
“I am a small business owner and need to pay expenses – I pay for my staff, the roof over our heads, the electricity and my computer,” she said. “To keep the lights on and keep our staff paid, we may have to think about how we do that differently to be able to do our work, and that’s frustrating.”
But the changes won’t shift physician priorities, said Clarke.
“The real joy of the job and being in this community, is my patients,” she said. “At the end of the day, I don’t think many physicians will lose sight of that; it’s all about patient care.”
Doctors are “absolutely invaluable” to Strathmore, said Mayor Pat Fule, who met with a group of physicians to discuss their concerns regarding the changes.
“They look after our residents – especially our senior residents – and look after them well,” he said.
While Fule stressed he cannot demonstrate any political affiliation in his role as mayor, he said that if Strathmore residents’ health and lives are affected by these types of decisions from the provincial government, then he does have concerns.
“If (the changes) are impactful to the doctors running their clinics and practices here as they say it is, then it is concerning to me, because our number one priority is our residents.”