Issue: BCMJ, vol. 48, No. 5, June 2006, Page 232 News

Six-year agreement ratified

In early May the BCMA’s proposed deal with government was ratified by members. A total of 3561 BCMA members cast their ballot, with 94% voting in favor of accepting the 6-year deal. The agreement addresses annual compensation, targets funding to deal with primary care renewal, specialist disparity, and IT, and lays the foundation for a trilateral relationship between doctors, the government, and health authorities. The settlement will provide more resources to support full-service family practice and more funding to increase patient access to specialty care physicians.

The term of the agreement is 1 April 2006 to 31 March 2012. Although it is a 6-year agreement, the compensation increases are for the first 4 years only. Negotiation and, if required, binding arbitration, will occur for the compensation for the fifth and sixth years of the agreement.

General compensation increase is 10.4% over 4 years (3%, 2%, 2%, and 3%). Particular increases will be calculated once the budgeted amounts have been apportioned between general practitioners and specialists.

Targeted compensation increase is 8.7% over 4 years. The combined increases result in an increase of 19.1% over 4 years, or an average of 4.5% annually. Some physicians will have increases that are greater than or less than this average increase.

In order to encourage more family physicians to provide complex and longitudinal care and make it more attractive for new physicians to choose family medicine as a career, new money will be allocated for the following:

• One-time payments of $10 000 to those GPs who have participated in the chronic disease management program.

• Implementing a hypertension chronic disease management fee.

• Increasing the fee for the diabetes and congestive heart failure chronic disease management.

• Implementing a Patient Case Management Conference fee and a Complex Patient Clinical Action Plan fee.

• Further supporting obstetrical services by GPs.

• Other allocations to support GPs providing longitudinal care.

In order to increase patient access to specialty care physicians and better equalize compensation to specialists to attract and retain them, funding is as follows:

• $20 million to correct disparities between lower- and higher-paid specialty sections.

• $10 million to attract and retain specialist physicians.

• $16 million to fund the transfer of specialists who wish to change from fee-for-service payments to a service contract.

• $1 million to support surgeons participating in the surgical registry project.

• $4 million for specialists treating patients with HIV/AIDS, drug-addicted patients, etc.

To attract and retain physicians in rural areas, a number of incentives will be implemented:

• The Rural Retention Program “cap” will be lifted, and the level of current payments to this program is protected for the life of the agreement.

• Radiologists and pathologists in-patient and emergency services will now be included under the Rural Retention Program.

• The Rural Continuing Medical Education (CME), Rural Locum Program, Physician Outreach Program, and the Rural Education Action Plan will receive $3.2 million between 1 April 2007 and 31 March 2010; for the following 2 years funding will be provided in order to maintain the benefit values of these programs

Initial and ongoing funding for the implementation of IT in physicians’ offices allowing them to better manage patient care:

• $20 million one-time funding and incremental annual funding totaling $24.9 million for the term of the agreement. (The provincial signing bonus money has been put toward this initiative).

• One-time funding of $10 million will be put toward helping new GPs set up their practices and pay off their student loans.

• Increased funding to maintain and enhance maternity benefits, the Physician Health Program, physician disability insurance, continuing medical education fund, among other things.

The agreement lays the foundation for a new Physician Master Agreement that supports a trilateral relationship between doctors, government, and health authorities. Existing joint committees will be changed into trilateral committees, but most decisions will require the agreement of the government and BCMA only.

The main protections of the Second Master Agreement are maintained including:

• The obligation of government to consult with the BCMA on key issues affecting the delivery of health care by physicians in the province.

• The guarantee that physicians cannot be compelled to change the form of their practice or how they are paid.

• Protection against prorationing—which removes government’s ability to unilaterally reduce physicians’ fees to stay within budget for their services.

Rebuilding costs and home insurance

How much would it cost to rebuild your home? What limit should you choose? Does it really matter since your policy contains a “guaranteed rebuilding” clause?

Almost all homeowner insurance policies today include a clause known as guaranteed replacement cost, which promises to rebuild the home after a total loss regardless of the limit shown on the policy. A common thought then is that it really doesn’t matter what limit is chosen on the policy, since the insurer will rebuild the home regardless of what it costs to do so.

However, the guaranteed replacement cost clause only applies if the home is insured to a limit as close as possible to 100% of its rebuilding value. For example, given that rebuilding costs today are over $100 per square foot for standard homes, a 3000 square-foot custom-built home insured for $275 000 is likely under-insured at $91 per square foot.

After a home is destroyed by fire, questions are inevitably asked if the limit shown on the policy turns out to be much less than the cost to rebuild the home and whether the guaranteed replacement cost clause should apply. For grossly underinsured homes, the homeowners would have to pay the difference if it transpires they knew, or should have known, the limit on the policy was inadequate. This is a safety catch for insurers and is there to stop people underinsuring their homes to obtain a lower premium, yet still wanting their home to be rebuilt after a total loss, regardless of cost.

Selecting an appropriate limit with which to insure your home can be a challenging process, especially as most people are not involved in the building trade. When purchasing a home insurance policy, the construction details of your home are typically entered into rebuilding cost calculators developed by the insurance companies. These computer programs then provide an estimate of the home rebuilding cost. However, as with most computer programs, the calculators are only a guide and are not always accurate, especially for larger, custom-built homes.

To ensure you keep the guaranteed rebuilding clause in force, it’s worth taking a few minutes to double check the amount of insurance on your home and see if the limit shown is in line with today’s rebuilding costs. Local building firms are a good resource and will be able to tell you what the current rebuilding costs for homes in your area are. For larger homes, some insurers conduct a detailed on-site rebuilding appraisal to determine the replacement cost and this report provides an excellent reference document in the event of loss or damage to the home.

If you have any questions about homeowner insurance, please contact the Mardon Group at 604 877-7762 or toll free at 866 846-4467.

—Sandie Braid, CEBS
BCMA Benefits

Screening mammography

The Canadian Breast Cancer Foundation, BC/Yukon Chapter (CBCF), recently announced the second-year launch of the GO HAVE 1 advertising campaign in British Columbia. The continuation of the screening mammography campaign follows the success of the first year of the program, which aimed to raise awareness about the health benefits of screening mammography and early breast cancer detection, and see more women book appointments for mammograms across the province.

Launched in the spring of 2005, the campaign encourages women age 40 and over to call 1 888 GO HAVE 1 (1 888 464-2831) to schedule an appointment, or visit www.gohave1.com for more information on screening mammography. At the time of the launch, statistics indicated that less than 50% of BC women over 40 were booking screening mammography appointments, a figure that falls below the World Health Organization target. Since the launch of the advertising campaign, there has been an increase of 23% in the number of first-time bookings for mammograms.

Mammography only takes a few minutes, is free, and women between the ages of 40 and 79 can book an examination without a referral through one of the centres of the Screening Mammography Program of BC. The Screening Mammography Program of BC is a program of the BC Cancer Agency.

 Boulton receives leadership award

Congratulations to Dr Basil Boulton, recipient of the 2006 Wallace Wilson Leadership Award. This award is presented annually to a graduate of the UBC Faculty of Medicine who has demonstrated high ethical standards and outstanding leadership to the profession. Recent past recipients include Drs Robert McGraw, Alexander Boggie, Carol Herbert, William Thomas, and John M. (Bud) Fredrickson.

Sandie Braid, CEBS. Pulsimeter. BCMJ, Vol. 48, No. 5, June, 2006, Page(s) 232 - News.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

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