Provincial pilot project on new doctor pay model fails to get buy-in

An NDP government plan to entice family doctors to spend more time with their patients by adopting a new payment model has so far proved a failure.

To date, a clinic in Sylvan Lake is the only physician group in Alberta to have signed up to test the new compensation system.

The government previously vowed to have five pilot projects up and running around the province by February 2017, followed by another 10 this spring.

“Definitely we were hoping for more. We had five clinics initially sign on saying they were interested, but only one has been able to make a go of it,” said Dr. Neil Cooper, president of the Alberta Medical Association, which has been working on the initiative with the province.

“There were a few pieces of that puzzle that didn’t fall into place.”

The health ministry and the AMA both cited ongoing discomfort from doctors as a major factor behind the poor buy-in, since adopting the new pay model requires substantial changes to how clinic businesses operate.

As well, problems with a government computer system supposed to track rosters of patients also scared off potential applicants, Cooper said.

The lack of progress on implementing the model is surprising, considering Health Minister Sarah Hoffman at one point suggested reforming the payment system was an urgent necessity.

In a speech to physician leaders in February 2016, Hoffman characterized the current payment model as overly costly, obsolete, and an obstacle to important reforms for the provincial health system.

Unlike other provinces, Alberta has continued to heavily rely on a compensation system known as fee-for-service, in which doctors bill the government each time they perform a specific medical procedure. Fees are set ahead of time, ranging from a $40 office visit to a $5,500 liver transplant.

Proponents like the model because it theoretically gives doctors an incentive to be productive, by seeing as many patients and performing as many services as possible.

But opponents suggest the system tempts doctors to rush through their patient encounters, and pushes them to excessively focus on the most lucrative services.

Fee-for-service has also been described as ill-suited for patients with chronic illnesses such as diabetes or heart disease. Such patients require a significant amount of a physician’s time to sort thorough their various issues, but the payment system doesn’t reward doctors for spending that time.

The model being piloted is known as “blended capitation.”

While doctors are permitted to bill some fees, they are also given a “basket” of funding to serve a particular group of patients for a set period of time.

In the case of the Sylvan Family Health Centre, the clinic of nine physicians is responsible for caring for a roster of about 8,000 patients with the money provided.

Since doctors are not being paid per service to the same degree, they can theoretically offer more time and attention in their patient interactions, and have more flexibility in how they deliver care.

The government said it could not yet provide a price estimate for the Sylvan Lake pilot. The initiative is intended to be cost neutral, meaning it should not cost any more than what doctors were billing under the fee-for-service system.

Physician compensation is one of the province’s biggest single expenses, accounting for more than $5 billion each year.

The AMA and health ministry said a working group has been formed to make tweaks that will hopefully increase physician interest. The government is also working to develop computer systems needed to support the program,

Dr. Brad Bahler, lead physician for the Sylvan Lake group, said he believes the government may have underestimated the “changeover and emotional costs” for clinics seeking to move to the new model.

We had five clinics initially sign on saying they were interested, but only one has been able to make a go of it.