As you know the OMA and MOH have reached a negotiated proposed PSA contract. Voting will take place March 22- March 27.
Thank you to those who emails their questions. Below is the Section’s Summary of the Proposed Physician Services Agreement (PPSA) as it relates to both Fee for Service (FFS) and AFA Emergency Medicine.
Section on Emergency Medicine Proposed PSA ED Specific Primer March 2022
For those physicians wondering what the Section’s bottom line recommendation is: We are recommending that our section members vote yes and ratify the agreement.
Why are We Recommending Ratification (Yes Vote) of the PPSA
If we vote against the deal, we will go to arbitration. We believe the PPSA is superior to arbitration in the following respects:
1. Likely to give us a higher overall pay increase over the 3-year term than we would achieve via arbitration 2. PPSA will see pay increase flowing to physicians much sooner than an arbitrated settlement (2.01% increase starting next month). 3. No contract aspects that we think would definitely do better at arbitration. 4. Areas where OMA NTF did not achieve the asks of the Section are unlikely to be heard and/or improved by the Arbitrator
Overall Pay Increase Year 1 – 1% Year 2 – 1% Year 3 – complicated formula that the NTF and OMA Economics, Policy and Research team believe has a high likelihood of resulting in more than 1%.
Given Bill 124 and the current fiscal environment, the Section believes the OMA NTF that arbitration is unlikely to yield a higher global increase than 1% per year.
FFS: will initially see a 2.01% increase to your RA; eventually (April 1, 2023) the increase will result in fee code increases replacing the percent added to your RA AFA: will initially see 2.01% added to the monthly group payments
Timing of Pay Increase Ratification of the PPSA would result in: FFS: an immediate increase to FFS RA of 2.01% starting April 2022. EDAFA: EDAFA transfer payments will also see 2.01% increase retroactive to April 2022 (but actual payment might be slightly delayed depending on Ministry capacity to pay them out that quickly).
Retropay: FFS – will receive retropay of 1% on your total 2021-2022 RA – payment in Feb 2023 EDAFA – will receive retropay of 1% for 2021-22 paid through AFA business manager in a manner similar to retropay from the last contract – payment in Feb 2023
Should the PPSA be voted down, no pay increase will be paid out until the conclusion of arbitration which would likely be in the realm of months (or maybe even longer than 1 year).
Relativity Relativity – is not applied until 2023.
For the first 2 years of the contract – increases are being paid as a lump sum, with no relativity adjustment.
On a go forward basis, the increases will be applied to the schedule of benefits by making fee codes changes. Emergency Codes will receive an increase that takes into account relativity rankings using the CANDI/RAANI hybrid model.
Previously in arbitration the CANDI/RAANI hybrid model was imposed, so it is unlikely that arbitration this time would yield a more favourable relativity scale for our specialty compared to the PPSA.
There is agreement between the government and the OMA to attempt to transition to the FAIR model in the future, but it is unclear how easy this will be to achieve, what the timeline will be and whether the Section can improve our relativity position in the new model.
Does the PPSA Recognize Emergency Medicine’s Contribution to the Pandemic, High Level of Burnout or Ever Growing Complexity? In our opinion – no it does not.
However, given the limitations of bargaining with all other sections within the OMA and being restricted to a global increase with relativity then applied, we do not believe that arbitration would have the opportunity to adequately recognize our specialty either.
The next step in the fee code adjustment process will come either when the PPSA is ratified or when arbitration concludes (if the PPSA is voted down). At this time, the Section will continue to advocate for adjustments to current codes and the addition of new codes to reflect our work with geriatric patients and increasing complexity of our ED patients.
EDAFA Specific Issues The Section feels strongly that the EDAFA base rate is in need of a renegotiation. The OMA NTF was not able to achieve this. We do not believe that arbitration, however, would be able to address this request, due to the arbitration framework rules.
The PPSA does have a promise from the government to redo the Power study funded by the government which is important to keep the hours of coverage formula accurate to today’s practice of emergency medicine.
The PPSA mentions that a portion of the year 3 increase will be carved off for APPs. The Section does not believe that this money will address our concerns about EDAFAs. This funding is for expanding existing APPs or establishing new APPs and not for payment increases.
Virtual Care Virtual Urgent Care is addressed on page 45 of the agreement. Emergency Medicine did not succeed in achieving H codes or AFA coverage for the virtual urgent care.
Pilot urgent care sites will use the current K codes until Sep 30. If pilot virtual urgent care continues the agreement promises ongoing negotiation.
With episodic care paying $20/visit through video, Emergency Medicine certainly did not achieve what most other sections secured in virtual care negotiations. Individual physicians will need to decide if this warrants voting against the deal.
Should the PPSA be voted down, it is likely virtual care codes may still end on Sep 30, as the current SOB does not have any virtual care remuneration. If a program was looking to charge privately for urgent video care, then that might be a reason to vote down the PPSA as ratification of the PPSA will make virtual care an insured service, which it currently is not.
HOCC The PPSA has a section regarding renegotiation of HOCC funding. The Section is unclear at this time as to whether we are likely to benefit from this renegotiation. There will be additional money available for HOCC but there is no guarantee from either the government or the OMA that Emergency medicine will be prioritized to receive an increase.
While the Section will do its best to advocate for our members and the importance of our HOCC programs, any time rules are re-evaluated, the Section cannot predict whether the outcome will be favourable to our members.
Gender Pay Gap We received several email questions regarding the promise to address the gender pay gap. Our understanding is that this language in the contract is simply agreement that the fee setting committee (PPC) will favourably consider code improvements which are targeted to address the gender pay gap. Our section has made recommendations to them. One example is a proposed ED code for pelvic exams and swabs to match the similar pap fee for Family Medicine, since at centres with multiple physician coverage, such exams are more often done more often by female MDs.
Please feel free to email us at oma.sem.chair@gmail.com if you have any additional questions.
Angela Marrocco, MD CCFP(EM) Chair, OMA Section on Emergency Medicine
On behalf of the Section Executive
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