Frequently Asked Questions - 2006 Letter of Agreement


COMPENSATION ADJUSTMENTS
What will be the compensation changes as a result of the agreement?
When will physicians receive the increases?
Will every physician receive an increase of 3% in 2006-07?
Will there be increases for other fees?
Will there be funding for new fees?

COMMITTEES
What committees will be created under the agreement?
How will the joint committees make decisions?

BENEFITS
What changes to benefits will result?

FULL SERVICE FAMILY PRACTICE
What increases will be provided to support full service family practice?
How will the funding allocations be determined?
What are the additional functions of the General Practice Services Committee (GPSC)?

SPECIALISTS
What increases will be provided for specialists?
How will the funding allocations for the income disparities be determined?
What are the additional functions of the Specialist Services Committee (SSC)?

EMERGENCY MEDICINE
What funding is available for emergency medicine?
How will the funding allocations be determined?
What are the additional functions of the Emergency Medicine Committee (EMC)?

SYSTEM REDESIGN AND RENEWAL
What initiatives will be undertaken related to system redesign and renewal?

MEDICAL ON-CALL/AVAILABILITY PROGRAM (MOCAP)
What changes will be made to the MOCAP?

RURAL PROGRAMS
What changes will be made to rural programs?

ALTERNATIVE PAYMENTS PROGRAMS
What increases will be provided for alternative payments programs?
What are the additional functions of the Alternative Payments Committee (APC)?

E-HEALTH & THE PHYSICIAN INFORMATION TECHNOLOGY OFFICE (PITO)
What are the provisions with respect to information technology and support for E-Health?
How will the funding allocations be determined?

FURTHER INFORMATION
Where I can see a copy of the agreement?
Whom can I contact for more information?

COMPENSATION ADJUSTMENTS

Q:  What will be the compensation changes as a result of the agreement?

A:  There will be a combination of general and targetted increases, as follows:

General Increases
Rate increases apply to fees*, service contract rates, sessional contract rates and salary agreement rates as follows:

  • As of April 1, 2006: 3% overall (inclusive of a 5.5% increase for sessional rates)
  • As of April 1, 2007: 2%
  • As of April 1, 2008: 2%
  • As of April 1, 2009: 3%
  • As of April 1, 2010, and April 1, 2011: to be determined through negotiation or, if necessary, arbitration.
* Does not include laboratory service fees in year one.

Targetted Increases
Additional targetted compensation for market adjustments as follows:
  • $20 million to address specialist fee disparities over 2006-07 to 2007-08;
  • $9 million to address emergency physicians contract rates; and
  • $8 million to address other service contract and salary rates over 2006-07 to 2007-08.
Q:  When will physicians receive the increases?

A:  Physicians will receive the increases as follows:

General Increases
General increases will be effective on April 1st of each year. Increases will be retroactive, as required.
Fee-for-Service: In 2006-07, it will take several months for the BCMA to complete its allocation process, so fee changes may not be implemented until the fall or winter.
Alternative Payments: General increases for salary, service contract and sessional rates should be confirmed soon and implemented by health authorities and other paying agencies by late summer.

Targetted Increases
Targetted payments will be allocated by the committees created under the agreement, as discussed in following FAQs. The committees will determine the details of implementation and timing.

Q:  Will every physician receive an increase of 3% in 2006-07?

A:  For the 2006-07 fiscal year, the 5.5% additional increase to sessional rates will result in the remaining general increase being 2.84%. Therefore, sessional rates will increase by a total of 8.34% and fee for service, salary, and service contract rates will increase by 2.84%.

Identification of increases to individual fee items is yet to be determined and approved. The BCMA allocation process will determine individual fee increases subject to the agreement of the government and the MSC. As such, individual physicians may receive increases that vary from the 2.84%.

Q:  Will there be increases for other fees?

A:  Screening Mammograms: The reading fee for a screening mammogram will increase to $13.80 per screen, effective April 1, 2007. It will be further increased by 2% on April 1, 2008 and 3% on April 1, 2009.

MRI Fees: Existing MRI fees will be standardized at one rate of $143.00, effective April 1, 2007. They will be increased by 2% on April 1, 2008 and 3% on April 1, 2009.

Q:  Will there be funding for new fees?

A:  Yes, the government will provide an additional $1 million per year, effective April 1, 2008, through to 2011-12 for new fees that are added to the payment schedule.

COMMITTEES

Q:  What committees will be created under the agreement?

A:  The following trilateral joint committees (BCMA, government and health authorities) will be created:

  • Emergency Medicine Committee (EMC);
  • Specialist Services Committee (SSC);
  • MOCAP Review Team;
  • Shared Care and Scope of Practice Committee (SCSPC); and
  • Alternative Payments Committee (APC).
The Physician Information Technology Office (PITO) Steering Committee will be created as a bilateral committee. The existing General Practice Services Committee (GPSC) will be reconstituted as a trilateral committee under the agreement, effective April 1, 2007. The existing Joint Steering Committee on Rural Issues will continue in its current configuration.

Q:  How will the joint committees make decisions?

A:  The joint committees will make consensus decisions. These decisions will be made by resolution of the committee that is passed by at least a majority of the members of the committee after the committee has gone through a reasonable process to reach unanimous approval. If the government or the BCMA do not agree with a decision of the committee, either party may refer the matter to the MSC who will determine the matter.

BENEFITS

Q:  What changes to benefits will result?

A:  The government will contribute $600,000 per year to the Physician Health Program to match the contributions now made by the BCMA and the College of Physicians and Surgeons. This will significantly increase the funding support for this program.

The Contributory Professional Retirement Savings Plan (CPRSP) will receive a funding increase of $10 million per year starting in 2010.

The Maternity Leave Program will be converted into a Parental Leave Program in 2010. An additional $3 million per year will be provided for this change.

The government will increase the combined existing funding for the Physician Disability Insurance Program, the Continuing Medical Education Fund, the Canadian Medical Protective Association Rebate Program, the CPRSP and the Maternity Leave Program by $6 million during the first four years to maintain the value of these benefits, and then will provide necessary funding in order to continue benefit levels in years five and six.

FULL SERVICE FAMILY PRACTICE

Q:  What increases will be provided to support full service family practice?

A:  In addition to general increases, the government will provide increases of $136.5 million over four years for:

  • one time payment to FSFPs providing guideline based care for patients with chronic diseases;
  • reinstating the Maternity Network payment;
  • incentives for improved chronic disease identification and management;
  • incentives for improved care to the frail elderly;
  • incentives for improved care to patients requiring end of life care; and
  • 5% funding for disease prevention.
Q:  How will the funding allocations be determined?

A:  The funding allocations will be determined by the General Practice Services Committee (GPSC).

Q:  What are the additional functions of the General Practice Services Committee (GPSC)?

A:  The GPSC will:
  • set patient centred measurable goals;
  • review and recommend approaches that support general practitioners' continued role in providing hospital care, including the relationship between that role and the role of hospitalists;
  • determine the key elements or models of care with indicators that demonstrate and support optimum patient outcomes and recommend how best to utilize existing allocations for primary care support of hospitalized patients;
  • develop an annual work plan, ensuring that evaluations to measure outcomes are an integral part of the plan; and
  • report annually on progress and outcomes to the government, the BCMA and the health authorities.
For details on the Full Service Family Practice Incentive Program, including eligibility requirements and billing information, see FAQs - Full Service Family Practice Incentive Program.

SPECIALISTS

Q:  What increases will be provided for specialists?

A:  In addition to the general increases, the government will provide funding to support access and improvements to specialist services as follows:

One time funding: The government will provide funding of $9.6 million to be allocated by the Specialist Services Committee (SSC) on a one-time basis.

Income disparity: The government will provide $20 million over 2006-07 and 2007-08 to address income disparity across specialist sections. This is in addition to the $10 million recruitment and retention fund from the previous agreement.

Q:  How will the funding allocations for the income disparities be determined?

A:  The funding allocations will be determined by the Specialist Services Committee (SSC). The funding for specialists will be based upon the Modified Adjusted Net Daily Income (MANDI) model or a revised version of the MANDI as agreed to by the SSC.

Q:  What are the additional functions of the Specialist Services Committee (SSC)?

A:  The SSC will:

  • identify possible time limited projects that have measurable patient-centred goals focused on the following areas:
    • system redesign initiatives to achieve increased and faster access to medically needed surgical specialist assessment for hip, knee and other joint replacement; and
    • 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 to reduce the number of urgent and elective surgeries occurring outside of normal working hours, in particular between 10 pm and 6 am; and
  • develop an annual work plan, including evaluations to measure outcomes and report annually on progress and outcomes to the government, the BCMA and the health authorities.

EMERGENCY MEDICINE

Q:  What funding is available for emergency medicine?

A:  The government will increase annual funding by $9 million ($4.5 million commencing on October 1, 2006 and $4.5 million commencing on April 1, 2007) to fund the creation of new emergency medicine service contract rates for physicians providing emergency medicine services in hospitals under service contracts.

Q:  How will the funding allocations be determined?

A:  The funding allocations will be determined by the Emergency Medicine Committee (EMC).

Q:  What are the additional functions of the Emergency Medicine Committee (EMC)?

A:  The EMC will:

  • determine criteria for placement of emergency medicine physicians within the new service contract rate range created that ensure continuity of services for the term of this agreement; and
  • develop recommendations on a new emergency medicine workload model.

SYSTEM REDESIGN AND RENEWAL

Q:  What initiatives will be undertaken related to system redesign and renewal?

A:  In addition to the important roles established for the GPSC and SSC, the following initiatives will support system redesign and renewal:

  • establishment of a Shared Care and Appropriate Scopes of Practice Committee in year two to enable shared care between general practitioners, specialist physicians and other health care professionals and to facilitate appropriate care for patients;
  • increases in the annual funding level of the APP to increase the number of specialist physicians practising under alternative payment arrangements to better meet patient needs and align with health authority strategic priorities;
  • $10 million to recruit full service family practitioners to communities with demonstrated need;
  • funding to medical consultants for health authorities to provide additional support to primary care for specific at risk populations and those with complex care needs;
  • $1 million to support specialist participation in the surgical registry;
  • support for the Specialty Services Committee to identify system redesign initiatives to achieve increased and faster access to medically needed surgical specialist assessment for hip, knee and other joint replacement; and
  • introduction of a ninety-day notice period to health authorities and the College of Physicians and Surgeons by physicians who intend to withdraw services. A Conflict Resolution Team will define the issues in dispute and make recommendations to facilitate resolutions.

MEDICAL ON-CALL/AVAILABILITY PROGRAM (MOCAP)

Q:  What changes will be made to the MOCAP?

A:  A tripartite review team, made up of government, health authority, and BCMA representatives, will be established to review the MOCAP program to evaluate its impact and identify issues and opportunities to strengthen its effectiveness. It will then develop evaluation criteria, and provide recommendations to government, the BCMA and the health authorities by December 31, 2006. The current MOCAP budget will continue to be funded at $126.4 million per year for the term of the agreement.

An evaluation of changes implemented and recommendations on appropriate further revisions to the MOCAP must be provided to the government, the BCMA and the health authorities by April 1, 2009.

RURAL PROGRAMS

Q:  What changes will be made to rural programs?

A:  From 2007-08 to 2009-10, the government will provide $3.2 million in combined additional funding for the Rural Education Action Plan, the Rural Locum Program, the Physician Outreach Program and the Rural Continuing Medical Education Program. The funding will be used to continue attracting physicians to rural practices in BC.

Starting in 2010-11, the government will provide additional funding as necessary to maintain the value of the benefits paid to individual physicians under the above mentioned programs, subject to the rules, guidelines and/or policies applicable to each of the rural programs.

The Joint Standing Committee on Rural Issues (JSC) will conduct a review of the rural programs to assess their effectiveness in achieving appropriate levels of physician services and will provide recommendations to the government and the BCMA by October 1, 2009.

ALTERNATIVE PAYMENTS PROGRAMS

Q:  What increases will be provided for alternative payments programs?

A:  The government will increase annual funding by a total of $8 million to fund adjustments made by the trilateral Alternative Payments Committee (APC) to the payment grids (emergency medicine services to be reviewed separately) to address income disparities among physician classifications and market comparisons. A total of $4 million will be provided, effective April 1, 2006, and an additional $4 million will be provided, effective April 1, 2007.

Q:  What are the additional functions of the Alternative Payments Committee (APC)?

A:  The responsibilities of the APC will include:

  • collection and analysis of data on patient benefits resulting from the use of APPs;
  • collection and analysis of data on the productivity of APPs in comparison to other payment models;
  • recommendations on appropriate relativity between APP funding and other payment modalities;
  • recommendations on standards and criteria for assessing any proposed movement from one payment method to another;
  • in collaboration with the relevant physician sections, the development and recommendation of workload models for physicians providing services on APPs (emergency medicine to be reviewed separately); and
  • recommendations on minimum and maximum hours of work for service contracts and salary contracts (emergency medicine to be reviewed separately).

E-HEALTH and the PHYSICIAN INFORMATION TECHNOLOGY OFFICE (PITO)

Q:  What are the provisions with respect to information technology and support for E-Health?

A:  The government will provide funding increases of $24.9 million by year six of the agreement, as well as $20 million in one-time funding, to purchase information technology products and services as defined by the Physician Information Technology Office (PITO) including:

  • licensing, hosting, support and maintenance of an approved electronic medical record (EMR) application for physician offices
  • suitable hardware and software packages
  • secure high speed internet and email for physician offices
  • access to chronic disease management toolkit within EMRs
  • access to e-prescribing of pharmaceuticals and lab test results, if available
  • training and technical support for EMR, Internet, email and other technology available through the program
  • change and implementation support.
Q:  How will the funding allocations be determined?

A:  The funding allocations will be determined by the Physician Information Technology Office (PITO), an office established by the government to facilitate the timely and optimal care of patients by encouraging and supporting the continued implementation of information technology by physicians. Consistent with the Ministry's e-Health Strategy, the PITO will be responsible for the disbursement of information technology funding to physicians.

For more information, see FAQs - Physician Information Technology Office.

FURTHER INFORMATION

Q:  Where I can see a copy of the agreement?

A:  The agreement, once signed, will be available on the Ministry of Health website.

Q:  Whom can I contact for more information?

A:  For more information, please contact the B.C. Medical Association at (604) 736-5551 or
1 800 665-2262.



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