2006 Agreement news update

The 2006 Agreement ratified by BCMA members represents a significant development in how physicians will be compensated and how they manage their practices and their quality of life.

As the Agreement is implemented over the next few years, the BCMA will provide members with news regarding fee allocation, program updates, benefits, etc. The Journal will carry this information on a timely basis as news occurs, along with the Agreement News section on the members’ web site and the monthly editions of e-News.

Please note that as this issue of the Journal went to print, the Agreement was still in a draft format. The final version of the Agreement will be posted on the members’ web site.

For easy reference, information relating to the Agreement is divided into eight sections:

General compensation changes—macro-/micro-allocation 
The new agreement provides for fee increases effective 1 April 2006, 2007, 2008, and 2009. The distribution of the fee increases is determined through the macro-/micro-allocation process that was ratified by members in 2003. The macro-allocation portion of the process involves mediation between general practitioners (SGP) and specialists (SSPS). If this is unsuccessful, the matter is arbitrated. Once that is completed, the micro-allocation portion of the process will go to the Tariff Committee and the Economics Department so the allocation can be applied at the fee code level.

General Practice Services Committee (GPSC)
The GPSC is an existing committee that will be restructured as a trilateral committee (made up of three representatives each from the BCMA, the provincial government, and the health authorities) under the agreement effective 1 April 2007. Until then, it will continue to be made up of four representatives each from the BCMA and the government. Its role is to define strategies that will allow for optimum use of the cumulative total of $382 million as earmarked to support primary care in the agreement.

Physician Information Technology Office (PITO)
The PITO Steering Committee is a new bilateral committee made up of six representatives, three from each of the BCMA and government. PITO’s mandate is to govern the implementation of the information technology products and services with electronic medical record (EMR) vendors and physicians, set the parameters for EMRs, facilitate physicians’ use of EMRs, and disburse the approximately $108 million in IT funding for physicians as defined in the new Agreement.

Specialist Services Committee (SSC)
This trilateral joint committee will:

• Determine the funding allocation for money intended to support one-time funding and income disparity initiatives ($40 million).

• Identify possible time-limited projects that have measurable patient-centred goals focused on (1) system redesign initiatives to achieve increased and faster access to medically needed surgical specialist assessment for hip, knee, and other joint replacement, and (2) working with the GPSC and based upon patient needs, determining up to four other non-surgical priority areas to expedite access to assessment and treatment for specialty care.

• Create a surgical specialist sub-committee to analyze and make recommendations designed to reduce the number of urgent and elective surgeries occurring outside of normal working hours.

Alternative Payments Committee (APC)
This trilateral committee will allocate new annual funding of $8 million to the salary and service contract payment grids (excluding emergency medicine) to address disparities and market comparisons. In addition, it will:

• Collect and analyze data on patient benefits resulting from the use of Alternative Payment Programs (APP).

• Collect and analyze data on the productivity of APPs in comparison to other payment models.

• Recommend appropriate relativity between APP funding and other payment models.

• Recommend standards and criteria for assessing any proposed movement from one payment method to another.

• Develop and recommend workload models for physicians providing services on APPs.

• Recommend minimum and maximum hours of work for service contracts and salary contracts.

• Recommend the conditions under which the Provincial Salary and Service contract ranges may be exceeded.

Joint Standing Committee on Rural Programs (JSC)
The JSC will continue to oversee BC’s rural programs and provide recommendations to the BCMA and government on matters related to rural practice.

These programs include the Rural Retention Program, the Rural Education Action Plan, the Rural GP Locum Program, the Northern Isolation and Travel Allowance Outreach Program, the Rural Continuing Medical Education Program, the Specialty Training Bursary, the Isolation Allowance Fund, the Recruitment Incentives, and the Recruitment Contingency Fund.

The JSC will determine how to allocate an additional $3.2 million between 1 April 2007 and 31 March 2010 to the following:

• Rural Education Action Plan

• Rural GP Locum Program

• Physician Outreach Program

• Rural Continuing Medical Education

Emergency Medicine Committee (EMC)
This ad hoc trilateral committee will:

• Apply new annual funding of $9 million to determine new emergency medicine service contract rates effective 1 October 2006.

• Determine criteria for placement of physicians within the new range.

• Develop recommendations on a new emergency medicine workload model.

Medical On-Call/Availability Program (MOCAP)
A tripartite team that reviews the Medical On-Call/Availability Program (MOCAP) to evaluate its impact and identify issues and opportunities to strengthen its effectiveness.

An evaluation of any implementation changes will be reviewed by the BCMA, the government, and the health authorities by 1 April 2009.

No changes can be made to the MOCAP without the agreement of the BCMA and the government. The existing MOCAP budget of $126.4 million is protected for the life of the agreement.

Benefits
This section of the web site includes information about benefit changes contained in the 2006 agreement:

• Starting in 2010, the Contributory Professional Retirement Savings Plan will receive a funding increase of $10 million per year that will be used to improve the plan in ways that support physicians remaining in practice longer.

• In 2010, the Maternity Leave Program will be converted into a Parental Leave Program, for which $4.7 million has been budgeted.

• Physician Health Plan (PHP)—a doubling of financial support for the plan.

• There are no changes to the following programs: the Physician Disability Insurance Plan, Continuing Medical Education reimbursement, and Canadian Medical Protective Association reimbursement. They will continue to be funded for the 2006 agreement.

Updates
General compensation changes
4 August 2006

The BCMA appointed Donald Munroe, QC, as the mediator/arbitrator. The mediation process used to get agreement on the macro-allocation was not successful. Arbitration is the next step and is set for late October 2006. After the macro-allocation process is completed, the micro-allocation process will proceed.

This process will continue into 2007, so it is unlikely that the fee increase will be implemented before 1 April 2007. However, you will receive retroactivity back to 1 April 2006.

Although this process is taking longer than originally planned, all four years of the general fee increase are being dealt with. Therefore, it will not be necessary to repeat this process in subsequent years.

PITO
4 August 2006

• The committee is in the early stages of its work. Details on the program will be available later in 2006.

• A Privacy Working Group has been created to look at matters concerning the core data set. Please refer to Appendix C of the Agreement (A#4).

• A representative from the Office of the Information and Privacy Commissioner will attend the steering committee as needed.

Emergency Medicine Committee
4 August 2006

Discussions on developing the new workload model started in May 2006 and have focused on:

• Developing a new workload model using discrete event simulation which considers each hospital’s ED volume and patient CTAS scores.

• Ensuring that the time spent per learner providing clinical teaching services is recognized in the new workload model.

—Fiona Youatt
BCMA Communications

 Metabolic Syndrome Clinic opens to referrals

The Metabolic Syndrome Clinic, part of St. Paul’s Healthy Heart Program, is now accepting referrals.

The clinic focuses on helping patients not only understand their risk factors, but also how to take the necessary steps to reduce their chance of developing diabetes or cardiovascular disease. About one in five British Columbian adults have metabolic syndrome, an assessment made based on a patient having three out of five risk factors: central obesity plus any two of the following:

• Raised blood pressure.

• Raised fasting blood sugar or previously diagnosed type 2 diabetes.

• Reduced HDL cholesterol in the blood or specific treatment for this lipid abnormality

• Raised triglyceride level in the blood or specific treatment for this lipid abnormality.

Physicians who would like to find out more or get a referral form can call 604 806-8591.

Call for nominations

2007 BCMA awards
Nominations may be made by any BCMA member in good standing. Submit the candidate’s curriculum vitae (CV) and your reasons for nominating the individual to the BCMA Membership Committee, 115–1665 West Broadway, Vancouver, BC V6J 5A4 by 30 November 2006 (unless otherwise noted).

BCMA Silver Medal of Service Award
Nominees may be physicians or laypersons. Physician nominees must have 25 years of membership in good standing in the BCMA, the CMA, and the BC College of Physicians and Surgeons of British Columbia. Non-medical candidates may be laypersons of Canadian or foreign citizenship. Criteria for the award include one of the following:

• Long and distinguished service to the BCMA, or

• Outstanding contributions to medicine and/or medical/political involvement in British Columbia or Canada, or

• Outstanding contributions by a layperson to medicine and/or to the welfare of the people of British Columbia or Canada.

CMA Honorary Membership
Candidates must be age 65 or over and a member of both the BCMA and the CMA for the immediately preceding 10 consecutive years, including the forthcoming year 2007. They must have distinguished themselves in their medical careers by making a significant contribution to the community and to the medical profession (previously called CMA Senior Member Award).

Dr David M. Bachop Gold Medal for Distinguished Medical Service
Awarded to a BC doctor who has made an extraordinary contribution in the field of organized medicine and/or community service. Achievement should be so outstanding as to serve as an inspiration and a challenge to the medical profession in BC. Only one award will be made in any one year; there is no obligation to make the award annually. Deadline: Friday, 6 April 2007. A letter of nomination including a current CV should be sent to Ms Lorie Janzen, BCMA, 115–1665 West Broadway, Vancouver, BC V6J 5A4.

2007 CMA special awards
Further information on criteria, including nomination forms, can be obtained from the CMA web site at www.cma.ca/index.cfm/ci_id/1368/la_id/1.htm [9]. Or contact Ms Kathy Hannam, Strategic and Corporate Affairs, 800 663-7336, extension 2280 to obtain a nomination form. A letter of nomination and the individual’s CV must be sent by 30 November 2006.

F.N.G. Starr Award
Awarded to a CMA member who has achieved distinction in one of the following ways: an outstanding contribution to science, the fine arts, or literature (non-medical); serving humanity under conditions calling for courage or the endurance of hardship in the promotion of health or the saving of life; or advancing the humanitarian or cultural life of his or her community or in improving medical service in Canada.

CMA Medal of Service
Presented to a CMA member for excellence in at least two of the following areas: service to the profession in the field of medical organization; service to the people of Canada in raising the standards of medical practice in Canada; personal contributions to the advancement of the art and science of medicine.

CMA Medal of Honour
Bestowed upon an individual who is not a member of the medical profession who has achieved excellence in one of the following areas: personal contributions to the advancement of medical research, medical education, health care organization or health education of the public; service to the people of Canada in raising the standards of health care delivery in Canada; service to the profession in the field of medical organization.

Sir Charles Tupper Award for Political Action
Awarded to a member of the CMA’s MD-MP Contact Program who has demonstrated exemplary leadership, commitment, and dedication to the cause of advancing the policies, views and goals of the CMA at the federal level through grassroots advocacy efforts.

May Cohen Award for Women Mentors
Submitted by the mentee and presented to a woman physician who has demonstrated outstanding mentoring abilities.

CMA Award for Excellence in Health Promotion
Awarded for individual efforts or a non-health sector organization to promote the health of Canadians at the national level or with a national positive impact.

CMA Award for Young Leaders
Presented to one student, one resident, and one early-career physician (5 years post-residency) member who has demonstrated exemplary dedication, commitment, and leadership in one of the following domains: political, clinical, education, research, or community service.

Dr William Marsden Award in Medical Ethics
Recognizes a CMA member who has demonstrated exemplary leadership, commitment, and dedication to the cause of advancing and promoting excellence in the field of medical ethics in Canada.