Tentative 2008 Physician Services Agreement
Executive Summary
 

The OMA Board of Directors has unanimously endorsed a tentative four-year Physician Services Agreement with government. The Tentative Agreement runs from April 1, 2008 to March 31, 2012. It is valued at approximately $1.1 billion and represents a total contract value of 15.7% over four years on fee changes, alternate payment plans and programs.

The incremental increases in each year are as follows:

2008/09  1.6%
2009/10  3.8%
2010/11  4.1%
2011/12  5.3%

Fees

The fee component of the Tentative Agreement provides for a 12.25% increase in fees over the term of the Agreement. The amount available in each year for fee adjustments is as follows:

General Fee Increase

October 1, 2008  3%
October 1, 2009  2%
October 1, 2010  3%
September 1, 2011  4.25%

Fee Allocation

Allocations will be made such that one-half of the annual increase will be allocated to OHIP specialties on an equal percentage basis, and the other one-half of the annual increase will be allocated to specialties in accordance with a relativity model to be established to correct disparities in intersectional relativity. Allocations will be done through the new Physician Services Payment Committee (PSPC), in consultation with OMA Sections.

As the allocation process will take time to establish, the first allocation will be 5% for October 1, 2009, with 2.5% being allocated to each OHIP specialty, and 2.5% to address relativity. There will be an interim 3% payment for all services provided October 1, 2008 to September 30, 2009.

For more information on fee and sectional allocations, please refer to the backgrounders that will be posted on the OMA website: (https://www.oma.org/members/negotiations/index.asp)

Non-Fee-For-Service

Non-fee-for-service physicians will receive an equivalent adjustment on payments for clinical services. General allocated fee increases will flow through to non-fee-for-service models, including APPs, AFPs, and Primary Care models. This includes the monthly comprehensive care fee, sessionals, stipends and telemedicine fee codes.

Diagnostic Services

$15 million (2%) will be allocated to technical fees in 2008-09 by the Physician Services Committee (PSC). Technical fees will be segregated into a new Diagnostic Services Budget with a new supporting structure.

Programs

The Tentative Agreement also includes an additional $240 million in new program funding, and an additional $100 million in incentive funds.

Primary Care Programs

Shared Care Nurse ($40 million)

The Ministry will provide full salary support for up to 500 licensed nurses to work with Patient Enrolled Model (PEM) physicians in three key priority areas: Aging at Home Strategy, End of Life Care, and Mental Health and Addictions.

Chronic Disease Management — Diabetes ($6 million)

All family physicians will now be eligible to bill the Diabetes Management Incentive (Q040), which will increase from $60 to $75, and the Diabetic Management Assessment (K030) will be eligible for after-hours incentives for PEM physicians. The Ministry will establish a Diabetes Registry at which time a new DMI will be introduced; physicians will receive a bonus of $500 to $1,000 for registering their patients within the first 12 months the Diabetic Registry is online.

Unattached Patient Bonuses and Registry ($16 million)

The OMA and Ministry will collaborate to address the unattached patient challenge with a target of attaching a minimum of 500,000 unattached patients. Several new fees and enhancements for rostering unattached patients and complex/vulnerable patients will be made available to family physicians.

In-Office and Out-of Office Service Bonuses ($28 million)

New bonuses will be available to support the provision of comprehensive care both in and out of the office.

PEM Group Bonuses: Reduce ED Visits; Out of Office Care ($5 million)

PEM physician groups will be eligible for incentives based on achieving targets for out of office care and for rostered patients’ use of emergency departments for CTAS IV and CTAS V visits.

Access Bonus/Focused Practice GPs ($1 million)

The designation of focused practice physicians and services, and their exemption from impacting access bonuses of harmonized physicians, will be improved.

Other

Other changes to PEM models include: the provision that work provided by a locum for a PEM physician counts towards any premiums and bonus thresholds; FHG and CCM Agreements will be extended to March 31, 2012; and fee codes to determine the hospital services bonus threshold will be expanded to include current and new MRP codes (C122, C123, C124).

Several reviews will also take place: a review of the alignment of Community Health Centre (CHC) physician compensation; a review of compensation, primary care model availability and rostering for physicians working in Student Health Clinics; and a review of the current capitation methodology, possibly to incorporate the burden of illness of patients.

Specialist Care Programs

Most Responsible Physician (MRP) ($40 million)

Enhanced funding will be provided for MRP physicians admitting unscheduled patients  where physicians receive no hospital top-ups for direct or indirect MRP care. Physicians will be eligible for a 30% increase to key fee codes for MRP care (C122, C123, C124, admission assessments, subsequent visits and hospital consultations).

Alternate Payments

New salary scales will be established for Psychiatrists working in Divested Provincial Psychiatric Hospitals, Psychiatrists working on Assertive Community Treatment (ACT) teams, Public Health Physicians, and Geneticists. Additional funding of $18 million is available to support these salary scales.

Alternate Payment Plans and funding of $11 million will be made available for Geriatricians and Infectious Disease Specialists.

The sessional rates paid to physicians under the Ontario Psychiatric Outreach Program, Ministry of the Attorney General, Ministry of Children and Youth Services, and Visiting Specialist Clinic program will be aligned, along with sessional payments for travel time — a $9 million enhancement.

Recruitment funding of $20 million will be provided for Laboratory Physicians, Academic Health Sciences Centre AFPs, and Community APPs.

Hospital On Call Coverage

A new $22 million On Call Coverage Collaboration Initiative Fund will be established. The OMA, Ministry, and Local Health Integration Network Tripartite Committee will undertake a joint review of HOCC, and $20 million is available for HOCC changes and expansion. The Ministry will undertake administration of the current HOCC program.

Other

The number of allowable psychiatric sessionals provided in the community will be expanded by 40%. Additionally, a technical advisory group is to advise on the harmonization of psychiatric sessional payments.

In the area of Interprofessional Health Care, the Physician Services Committee will evaluate the effectiveness of existing pilots and will consider options to move effective pilots into programs with ongoing funding.

Northern and Rural Programs

NOSM

A new Northern Ontario School of Medicine alternate funding program will be established by April 1, 2009, aligned with existing AHSC template agreements.  Consistent with Phase I and Phase III funding allocated to existing AHSC AFPs — $7 million has been committed.

NPRI ($6 million)

The Northern Physician Retention Initiative will continue for the duration of the Agreement.

Hospital Bonuses

An enhanced hospital bonus will be provided to physicians in northern and rural harmonized models, estimated at $2 million, along with adjustments to the requirement for hospital privileges.

Medical Students/Residents

Student Loan Interest Relief ($7 million)

A new program will allow medical students to defer payments on the principal of the eligible debts during training and the Ministry will pay the full interest on the eligible debt through the end of the residency training program.

Clerkship Stipend ($2 million)

The clerkship stipend will be increased to $750/month effective July 1, 2008.

Clinical Rotations

Funding for clinical rotations will be made available for all training more than 100 km from the border of the student’s home community within Ontario.

LHIN-Physician Collaboration Incentive Fund

The OMA will work with the Ministry and LHINs to implement a new $100 million incentive program. This funding will recognize and reward the local efforts of physician groups who work together and in collaboration with other service providers to support the needs of patients in targeted areas of care.

• $33 million for a MRP Collaboration initiative.

• $14 million for an ED Collaboration initiative.

• $31M for an Unattached Patients Collaboration initiative.

• $22M for an On Call Coverage Collaboration initiative.

Incorporation

The Ministry will recommend to government that the definition of family members be expanded.

Health Benefits

Funding of $25 million committed to under the March 2005 Memorandum of Agreement will continue and administrative issues have been clarified.

Health Card Validation

The Ministry has committed to make “real-time” health card validation accessible to office-based providers by 2010/11.

Implementation Committees

In consideration of the ongoing bilateral relationship, and to implement and oversee the results of this Agreement, the Parties will continue the Physician Services Committee (PSC) and establish a number of additional committees.

The PSC will continue as previously with the exception that financial matters will be dealt with by a new committee. The following will report to the PSC: Laboratory Physicians Committee, Academic Medicine Steering Committee, Third Party Implementation Advisory Committee, Program Review Committee, Forms Committee, and Ad Hoc Working Groups.

The Financial Planning and Oversight Committee (FPOC) is a new committee established to deal with financial matters and system management issues, including but not limited to tracking Agreement-related expenditures, reviewing utilization, negotiating any outstanding compensation matters arising from the Agreement, and monitoring expenditures from the LHIN Physician Collaboration Incentive Fund and making any necessary adjustments.

The Physician - LHIN Tripartite Committee will continue with a revised mandate. The Committee will build upon the mandate of the existing Physician-LHIN Tripartite Committee, and now include responsibility for establishing programs and targets for the LHIN Physician Collaboration Incentive Fund; conducting reviews identified in the 2008 Agreement (HOCC, CHC) and receive status reports from LHIN Physician Leads.