Welcome to the Alberta Medical Association’s Section News – an opportunity for sections to report on their challenges and objectives. This service helps sections communicate with all AMA members as well as physicians in their own specialties. Your feedback is encouraged. Please contact Agnes E. McIntyre, Administrative Assistant, Section Services: T 780.482.2626; TF 1.800.272.9680; email agnes.mcintyre@albertadoctors.org.
December 2013
Section of Generalists in Mental Health Dr. Raju Hajela, President Addiction and Mental Health: Seeking equitable funding for efficacious and sustainable services in a continuing care framework that is essential for chronic diseases Addiction and mental health problems remain under‑recognized in our health care system, which is acute-care oriented and interventional for quick diagnoses and rapid treatment (especially pharmaceutical interventions). In an acute setting, these interventions are often life saving. However, the long-term view can be quite different: someone in chronic pain, who is given a quick prescription for opioids or someone with chronic anxiety, who is given a quick prescription for benzodiazepines, may be harmed with those interventions. Both chronic pain and chronic anxiety are complex conditions that require a bio-psycho-social-spiritual assessment and interventions that are holistic in nature. Basic ideas such as utilization of long‑acting opioids rather than short-acting opioids and avoidance of long-term benzodiazepines, prescriptions are still not widely appreciated; hence, the standards and quality of care remain compromised. Psychological and social work services, especially in the community, require out-of-pocket expenses for the general public. Even when corporate programs, such as Employee and Family Assistance Programs (EFAP) or extended health care, provide some coverage, it is usually limited in time and money. Our health care system, in its present acute‑care‑ oriented form, does not provide adequate funding for
psycho-social assessment or continuing care services. Psychiatric consultations and some addiction and mental health services are covered by Alberta Health/ Alberta Health Services. However, the timeliness, quality and continuing-care issues remain huge, such that the public needs remain unmet satisfactorily. There remains an urgent need to examine and fill the gaps that exist in funding addiction and mental health services in the community. Those who can pay out-ofpocket have better access to care than those who can’t. This represents “two-tiered” health care. Equitable and sustainable funding means that access is not limited to only those who can afford it. Efficacious and sustainable care means that the assessment and interventions are provided in the community longitudinally over time, especially when the care involves chronic disease treatment and management in an integrated continuing-care team environment. Proper training of care providers and recognition of what interventions help and what actually harm would build a better care system than the patchwork that exists currently, where physicians, psychologists, social workers and other counselors have disparate training and work at cross purposes that are confusing for the individual seeking care. Motions passed at the Fall 2013 AMA – Representative Forum state: • THAT the Alberta Medical Association (AMA) work with the Minister of Health/Alberta Health/ Alberta Health Services to: ○ Clarify the role of the chief mental health officer in setting standards and improving the quality of addiction and mental health services in Alberta.
and we wanted to proceed with fee adjustments cautiously. A 30% move toward INRV numbers reflects AAGS’ commitment to achieving fairness in fees, yet not moving too quickly. 2. To hire two consultants to review our current INRV numbers and make further recommendations before moving beyond our 30% adjustment. I am pleased to announce that we have hired Dr. Peter Roy and Dr. Bill Mackie to do this consulting work for AAGS. For those of you who may not know Drs. Roy and Mackie, they are highly regarded individuals with long careers in general surgery and extensive experience with fee allocation. As experienced surgeons who are no longer running surgical practices in Alberta, they are in an excellent position to advise us in an expert and unbiased manner. Their goal is to provide AAGS with recommendations to assist with intra-sectional fee relativity. I can think of no better way to work on what is undoubtedly a very challenging issue. By tackling this responsibly, we will not only be fair to our members but we will also be seen from the outside favorably, which may help when it comes to intra-sectional relativity. What does all of this mean in the near term for you? Remember that these changes are evidence-based and are only partial moves as we seek guidance from our consultants. When some fees go down 10 or 20%, some fees go up similar amounts. Remember that INRVs were obtained with intent of sound methodology, taking into account operative times, complexity and post-op care. These numbers have been posted to the AMA website (secure page for section member only; log in required): http://bit.ly/JPW1Tk. Please note: THIS PDF IS NOT FOR DISTRIBUTION. It is a pdf of a large spreadsheet that is extremely complicated. Part of the complexity is related to the fact that general surgeons are a diverse group, billing across a huge surgery area. Questions can be directed to me at paulehardy@mac. com. Comments sent to me will be forwarded directly to our consultants. If you would like to be physically present during discussions about fees, I would strongly encourage you to sign up and attend the AAGS meeting in Banff January 31-February 1, 2014. You can pay online at www.aags.ca. As always, your comments, questions or feedback can be sent directly to me at paulehardy@mac.com.
○ Ensure equitable funding for addiction and mental health services that are efficacious and sustainable in a continuing-care framework. • THAT the AMA work with the Foundation for Addiction and Mental Health (FAMH), www. famh.ca, to ensure the provision of highest quality services that are stigma-free. There is a real opportunity for the AMA to pursue the slogan “Patients First®” and support better standards and funding for addiction and mental health services. FAMH is a community organization (not aligned with any one person or institution) pursuing the same goals of raising awareness, promoting timely access and delivery of quality care in a continuing-care framework for chronic illnesses.
Section of General Surgery Dr. Paul E. Hardy, President Review in the Rockies 2014 Save the date! The Alberta Association of General Surgeons (AAGS) annual meeting will be held at the Rimrock Resort in Banff, January 31-February 1, 2014. It will feature Dr. F. Charles Brunicardi, chief editor of Schwartz’s Principles of Surgery. See the notice on the AMA website (http://bit.ly/19hCDtW).
Fee relativity The AMA (and all sections including AAGS) have been working toward improving fee relativity within sections. Much of the work was done under the guidance of previous AAGS executive and section representatives in the form of sound methodology and extensive data collection. These intra-sectional relative value (INRVs) numbers were approved by the AMA board before I became president of AAGS. It has been the assignment of the current AAGS executive to decide how quickly to implement these numbers that will affect fees. Some fees will go up and other fees will go down in the April 2014 fee schedule. Overall, the general surgery allocation will not change apart from the small increase in April 2014. After extensive discussion, meetings and consultation with key members, the following decisions were made by AAGS executive: 1. To move our fees 30% toward these INRV numbers. It was felt that a full move would change some fees substantially and could result in either discontent or fee inequity. Although the process was set up to be fair in obtaining INRVs, no process is perfect Alberta Medical Association
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December 2013 Section News
Section of Occupational Medicine Dr. Kenneth J. Corbet, President kcorbet@ucalgary.ca
System-Wide Efficiencies and Savings (SWES) This is one element of the Consultation Agreement under the seven-year AMA Agreement with Alberta Health. Three dimensions of the health system must be simultaneously pursued to optimize health system performance:
AMA Representative Forum, September 27-28 Dr. Kenneth F. Harrison represented our section at the AMA Representative Forum (RF) held September 2728 in Edmonton.
• Improving the patient experience of care. • Improving the health of populations. • Reducing the per capita cost of health care.
Note that an AMA oversight group was formed in the fall 2012 to monitor the performance/compliance of individual AMA sections with respect to: • • • • •
The AMA has asked each section to suggest up to five initiatives in their respective areas of practice to improve efficiency, health outcomes and the patient experience in Alberta.
RF attendance. Section reports to RF. Reports of RF meetings to section members. Bylaw compliance. Reports of annual general meetings and changes to section executive.
These could include: • Enhancing or strengthening an existing initiative in Alberta. • Winding down an existing initiative in Alberta that is no longer providing value. • Importing an initiative from another jurisdiction (Canadian or international) that would be new to Alberta. • Developing a new initiative.
The Section of Occupational Medicine is in compliance with all of these requirements. All section members are encouraged to review the RF report. Comments or questions should be forwarded to Dr. Ken Corbet (president) at kcorbet@ucalgary.ca.
This will be an agenda item for discussion at the upcoming annual general meeting for the section.
Occupational and Environmental Medicine Association of Canada (OEMAC) 2014 Annual Scientific Conference
Continuing Professional Development
The 2014 conference will take place in Edmonton, September 27-30, 2014.
• Occupational and Environmental Factors in Infectious Disease and Updates in Occupational Health ○ University of California, San Francisco CA. ○ March 6-8, 2014. ○ Holiday Inn Fisherman’s Wharf, San Francisco CA. ○ Brochure: http://www.ucsfcme.com/2014/ MDM14N01/MDM14N01.pdf. ○ Registration: http://www.ucsfcme. com/2014/MDM14N01/info.html.
Initial meetings of the Edmonton and Calgary working groups were held this summer, followed by a meeting with the OEMAC Executive at the 2013 Montreal conference in October. A learning needs assessment will be completed with a report from the Royal College Maintenance of Certification Program and the OEMAC 2013 conference evaluation. The working groups are meeting in November/ December to confirm key themes and speakers for the conference.
• American Occupational Health Conference (AOHC) ○ American College of Occupational and Environmental Medicine. ○ April 27-30, 2014. ○ San Antonio, TX. ○ Conference information: http://www. acoem.org/aohc2014_conference.aspx.
Members interested in contributing to the planning of this conference may contact: • Dr. Jeremy R. Beach (co-chair - Edmonton) jeremy.beach@ualberta.ca • Dr. Kenneth J. Corbet (co-chair - Calgary) kcorbet@ucalgary.ca
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December 2013 Section News
Section of General Practice Dr. Ann R. Vaidya, President T 403.873.2352/F 403.873.2364 gppres@albertadoctors.org
○ Leadership and representation. ○ PCN Evolution. ○ GP Alternate Compensation model. ○ System-wide efficiencies. • See the joint SGP-SRM submission for more details on these topics.
Section of General Practice (SGP) Executive Meeting and Strategic Retreat summary
Section of Rural Medicine Dr. Tobias N.M. Gelber, President srmpres@albertadoctors.org
The SGP Executive Committee met in conjunction with the SGP Strategic Retreat in late November. Highlights of the meeting include: Primary care network (PCN) Evolution • By formal motion, the SGP Executive Committee endorsed the concepts of PCN Evolution and the draft report to the minister of health. We have informed the PCN Evolution Steering Committee of our endorsement. General Practitioner (GP) Alternate Compensation model
2014 Annual General Meeting You recently received a survey regarding the location of our section’s annual general meeting (AGM). Thank you to all those who responded. Based on the results of the survey, the Section of Rural Medicine’s (SRM’s) AGM will still take place on Saturday, January 25, 2014, from 5-7 p.m. in the Castle Room of the Banff Park Lodge. We encourage all SRM members to attend if you are able to do so. Election for executive positions will be held at the AGM, a call for nominations will go out by email and nominations will also be received from the floor. The AGM is held in conjunction with the Emergency Medicine for Rural Hospitals Conference.
• You recently received a request to review a proposal for a GP Alternate Compensation model. We received many responses and thank those who provided feedback. A compilation of the comments were reviewed. • SGP Executive agreed to continue to refine the draft proposed model. Stay tuned for more information. GP fee codes and allocation • SGP Executive reviewed some specific GP fee codes and made recommendations to change them to better reflect common practice patterns. • SGP will work with the AMA to provide feedback to Alberta Health regarding the section’s willingness and desire to collaboratively participate in discussions related to formal allocation decisions. Section establishment • SGP will request a meeting with the AMA Governance Oversight Group to discuss our concerns regarding section establishment and accountability. • SGP will request section establishment and accountability as an agenda item for Spring 2014 AMA Representative Forum when the call for agenda material circulates.
Surveys Thank you to everyone who responded to the Ambulance Services survey and the AGM survey. We appreciate your feedback! The collated results from both surveys will be discussed at our upcoming AGM and the results will be shared in an upcoming issue of Section News. 4th Annual Endoscopy Skills Day for Practicing Endoscopists - January 25-26, 2014 This course, in conjunction with the Emergency Medicine for Rural Hospitals Course, aims to advance the cognitive and technical skills of physicians and nurses who routinely participate in endoscopy procedures. • Credits: up to 10.5 MAINPRO-M1 credits; Accredited Group Learning Activity (Section 1). • Banff Park Lodge, Banff AB. • Brochure: http://medicine.ucalgary.ca/files/ med/EndoscopySkills_14.pdf. • Registration: https://cmeregistration. ucalgary.ca.
SGP Strategic Retreat • The following items were identified as priorities for discussion at the retreat:
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December 2013 Section News
Section of General Practice/Section of Rural Medicine joint submission
• System-wide efficiencies ○ Discussed opportunities of working with government with a goal of working collaboratively to improve system efficiencies.
◊ Section of General Practice Dr. Ann R. Vaidya, President T 403.873.2352/F 403.873.2364 gppres@albertadoctors.org ◊ Section of Rural Medicine Dr. Tobias N.M. Gelber, President srmpres@albertadoctors.org
A full report of retreat outcomes and identified priorities will be provided in the next issue of Section News.
Information and options to provide to bariatric patients
SGP Strategic Retreat The Section of General Practice (SGP) hosted its annual Strategic Retreat at the end of November and many primary care leadership groups attended. The groups worked together to identify a clear direction, establish priorities and develop a work plan for primary care.
A recent collaborative project between Alberta Health Services and the Physician Learning Program has resulted in the development of a bariatric surgery video designed specifically to enhance referrals of appropriate patients for surgical intervention and to address misconceptions surrounding bariatric surgery.
Attendees included:
More information and the video are online at https://www.albertadoctors.org/news/newsarchives/bariatric-surgery-video-news. For additional information, contact plp@ualberta.ca.
• Current SGP Executive Committee members. • Immediate past SGP Executive members. • Section of Rural Medicine Executive Committee members. • PCN Physician Leads Executive members. • Alberta College of Family Physicians representative. • AMA president. • AMA senior staff.
Primary Care Alliance ◊ Section of General Practice Dr. Ann R. Vaidya, President T 403.873.2352/F 403.873.2364 gppres@albertadoctors.org ◊ Section of Rural Medicine Dr. Tobias N.M. Gelber (Chair), President srmpres@albertadoctors.org ◊ PCN Leads Executive Dr. Phillip W. van der Merwe, Chair pcnexec@albertadoctors.org
There were several key topics discussed at the meeting including: • Leadership and representation ○ A facilitated session that enabled the groups to gain an understanding of roles and how goals can be accomplished across the various primary care groups. • PCN Evolution ○ An update on the PCN Evolution report to the minister of health. The group developed recommendations for possible future implementation. • GP Alternate Compensation model ○ Received information on relativity, physician compensation and the proposed GP Alternate Compensation model. ○ Received information and had opportunity to understand the AMA’s current activities in physician compensation that will impact SGP’s planning and priority relative to the financial health of GPs. Alberta Medical Association
The PCA issues a joint Section News submission about issues affecting general practitioners. Please send any comments and feedback on this submission to Linda A. Ertman (Program Coordinator, Practice Management Program) at linda.ertman@albertadoctors.org. Primary Care Alliance (PCA) Board Activities of the PCA Board have largely focused on the evolution of primary care networks (PCNs). For more information, please see the PCN evolution update below.
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December 2013 Section News
Other work has included:
• A companion document has been developed that outlines some ideas for implementation. The document will be used as a discussion paper as the PCA outlines a plan to implement the priorities of the PCN Evolution framework.
• Development of a new PCA Terms of Reference. The next meeting will be held on January 16.
PCN evolution update
• A PCN Evolution working session was held at the SGP Retreat held on November 30. Members of the SGP Executive, SRM, PCN Physician Leads and Alberta College of Family Physicians discussed strategies, risks associated with and actions required for the implementation of PCN Evolution. Information gathered will be used when the implementation plan is developed.
• The PCN Evolution Vision and Framework report for the evolution of PCNs has been finalized and received endorsement from the Section of General Practice (SGP), Section of Rural Medicine (SRM) and the PCN Physician Leads Executive. The report was also reviewed at the December 13 AMA board meeting and approved. The report will be sent to the minister of health by December 31.
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December 2013 Section News