President's Letter: New Contract Options for BC Physicians
October 1, 2020
New Contract Options for BC Physicians
Dear Colleagues:
Over the last year, the BC Ministry of Health has consulted with Doctors of BC as it developed new contract options for physicians. The dialogue was positive and collaborative, with the Ministry recognizing many of the key components important to physicians in delivering quality patient care.
The consultations are now concluded, and the Ministry is announcing contract options that will provide:
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More choice for established and new-to-practice family physicians who want to move away from Fee-for-Service (FFS), and
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Support for physicians whose FFS practices continue to be significantly destabilized due to conditions resulting from COVID-19.
It is acknowledged that the new contracts for family physicians may not be a good fit for everyone, but we believe they are reasonable options for some physicians, depending on your goals, the nature of your practice, and your community’s health system service delivery approach. The options are aligned with the Ministry’s and Doctors of BC’s shared direction on Primary Care and support a plurality of payment options for physicians, to match practice styles and circumstances. Ultimately, this is about providing something doctors have been asking for – greater choice in how you are paid and the way you provide care. The new options will be added to the existing suite of contracts that the Ministry continues to develop with input from Doctors of BC.
The new COVID contracts are intended to be a short term option for FFS physicians whose volumes have been significantly reduced to ensure the continuity of public services throughout the pandemic.
The Ministry of Health and Health Authorities are presently preparing for intake for the new contracts. Physicians who are interested in moving to a new contract will be able to submit their expression of interest in the latter part of October. In the interim, we encourage interested physicians to participate in the webinar(s) noted below.
The following provides a high-level overview of the new contract options. We encourage you to visit the Doctors of BC dedicated web page for more detailed information to help you decide if the contracts might be a good fit for you.
Group Contract for Practicing Family Physicians
This contract is available to groups of practicing physicians with established patient panels working together in community-based clinics providing longitudinal patient care. It is also available to individual doctors who are not in the same clinic but are located within the same Primary Care Network (PCN).
Both the group contract and the New-to-Practice contracts (below) are designed to support the expansion of patient-centered, team-based care models. This is why clinics who wish to participate in the contract should be aligned or intend to align with the principles of the Patient Medical Home and must commit to actively support the implementation of PCNs.
Compensation is based on hours worked, the number and complexity of attached patients, and participation in Quality Improvement activities. Physicians have the option to earn additional income through work outside the clinic (e.g. in-hospital care), for services provided to third parties (e.g. WorkSafeBC and ICBC), and/or for specialized services referred by other physicians outside the clinic.
The contract compensates physicians for all time spent on the full spectrum of comprehensive primary care services, rather than just those services covered by MSC fees. As a result, it provides physicians with greater clinical freedom to provide appropriate care to patients – for example, it funds physicians for activities related to prevention of illnesses and co-ordination of care with other providers. It also provides an initial payment guarantee in the first year so that physicians can redesign their business model to match the new contract.
Where a clinic indicates interest in participating in a contract, the Ministry will analyze the practice and provide the physicians in the clinic with a determination of the first year payment guarantee. Future payments will be determined based on hours worked, the number and complexity of attached patients, and confirmed participation in quality improvement activities during the first year of the contract.
Individual Contract for New-to-Practice Family Physicians
The hours based contract provides income security for individual family physicians who wish to join a clinic and create a new patient panel.
Like the contract for established physicians, it provides options to earn additional income by providing services outside the clinic and contract requirements. When the panel size and composition warrants, physicians can transition to either FFS or to a group contract with the clinic where they work.
Simplified Temporary COVID-19 Service Contracts
The short-term contract, available to most family and specialist physicians paid by FFS, is designed specifically to provide a stable income when practices experience lower patient volumes due to COVID impacts. Depending on the level of impact of the pandemic, particularly in the event of future surges, it may be a better option for some physicians than remaining on FFS.
Physicians can continue with the contract until the number of patient visits returns to normal and/or they are able to restructure their practices, but no longer than December 31, 2021. Physicians can terminate the contract and move back to FFS on five days’ notice when service volumes recover.
The services covered under the contract will be those that physicians have historically provided, as well as compensating physicians for time spent on practice redesign. The hourly rate is based on the midpoint of the Service Contract payment range under the Physician Master Agreement divided by 1680 hours of service. Physicians are also able to bill fee for service for services to patients funded by WorkSafeBC.
More Information
We have developed a number of resources to provide you with detailed information on all the new contracts, and I encourage you to take some time to learn more:
Visit the dedicated web page on the Doctors of BC website, to find detailed information on the new contracts organized by physician groups, a physician Q & A, and resource materials.
Attend a webinar. We are offering two separate webinars: one to discuss the family practice contracts and one to discuss temporary COVID-19 contracts. Invitations to these webinars will be sent out shortly.
The Family Practice contracts webinar will take place Wednesday, October 7th for 90 minutes beginning at 6pm.
The Temporary COVID-19 contracts webinar will take place Wednesday, October 14th for one hour beginning at 6pm.
Please email the negotiations department if you have any questions at negotiations@doctorsofbc.ca
I hope you will review the contract options that government is offering and the resource information available to you, and make your own determination as to whether one of them is a good fit for your practice model. The primary care contracts are a first step in offering additional alternatives to Fee-for-Service primary care work, and the short term COVID-19 contracts will hopefully work for physicians adversely affected by the pandemic.
As always, I thank you for everything you are doing to support patients and their families at this difficult time. And I wish to acknowledge the commitment and professionalism of so many physicians as you find your path through this pandemic. We are all in this together, and our success so far is due to your dedication and hard work.
I welcome your comments and questions, please e-mail me at president@doctorsofbc.ca
Dr Kathleen Ross
President, Doctors of BC
president@doctorsofbc.ca
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