As you know, a proposed physician services agreement (PPSA) was reached recently between the OMA and MOH, with the help of a mediator. We are writing to you to provide an Anesthesiology overview and perspective on the proposed PPSA. Voting will commence on Mar. 22, 2022.
Your executive has reviewed the agreement documents and attended town halls to better understand not only the agreement, but the reasoning behind it as well as the environment and context within which it was negotiated. We encourage all members to review the extensive documentation, videos, and FAQs available on the OMA website. Questions can be sent to us at info@ontariosanesthesiologists.caor to the OMA at info@oma.org.We will attempt to summarize for you the aspects most relevant to anesthesiologists. Ultimately, our recommendation is to vote to accept the PPSA. The alternative is arbitration. In the current environment, this will be risky and could very well result in a much worse outcome than what is proposed here.
The PPSA is a 3-year agreement, spanning the financial years 2021-22; 2022-23 and 2023-24 (known as years 1, 2 and 3). This is a useful maneuver as it will allow the profession to enter renewed negotiations as quickly as possible without the specter of Bill 124 (which potentially limits annual increases to 1%) hanging over us. At that time, our negotiations advisors expect us to be in a better position, for a variety of reasons, to pursue larger cost of living increases.
Fee Increases – Years 1 and 2
The permanent global fee increases to the PSB in years 1 and 2 are 1% compounded (2.01% total), 1% for Year 1 will be paid for services rendered April 1, 2021 to March 31, 2022 and 2.01% for services rendered April 1, 2022 to March 31, 2023. Given that year 1 is nearly done and year 2 about to start, the first two years will be paid out across the board as lump sums to all physicians without taking relativity into account. Please note that this lack of relativity is temporary and exclusive to the first 2 years only. A lump sum payment of 1% of our year 1 (2021-22) billings will be paid out in Feb. 2023. During year 2, 2022-23, all physicians will start receiving a 2.01% additional payment on their monthly billings for that year only.
The permanent implementation of this 2.01% (i.e., implementation by way of SOB changes) will occur on Apr. 1, 2023. It will be allocated 25% across the board and 75% according to relativity using the combined CANDI-RAANI relativity score. For anesthesiology, our share of the first 2-year increase will be 1.19%. We and the other Sections will be working with the bilateral Physician Payment Committee (PPC) this year on the implementation of that.
Fee Increases – Year 3
The year 3 increase is more complicated as it depends on the actual PSB expenditure for the year. It is based on the presumption of what the PSB should be without the pandemic effects on physician services utilization. The model uses the 2019-20 pre-pandemic base year adjusted for April 1, 2020 increases and a generous annual utilization increase of 3.6% (which is a bit higher than historic averages). Given these assumptions, the expected PSB should be $16.2 billion. Given that PSB expenditures are tracking far below the expected growth, they are not expected
to reach that level. If they fall short of this target by 2% or less, the PSB will be increased by that difference and implemented according to the relativity formula above. Any shortfalls greater than 2% of this target will also be implemented, but by only 75%, with the Ministry realizing the remaining savings. In the unlikely event that the PSB ends up higher than $16.2 billion, there is no penalty to physicians but there will also be no additional increase. To summarize the year 3 formula, the less global spending in year 3, the more of a permanent raise the profession will receive. Thus, for year 3, the PPSA establishes a floor for the total PSB but no ceiling.
The OMA has a reasonable estimate range of what they think the actual utilization will be and from that, an expected year 3 increase range can be calculated. Please see the OMA year 3 economic analysis for a more in-depth discussion. The total expected range for the year 3 increase for the profession
is 2.1-3.6%; the anesthesiology share of this would be 0.9-1.7%. The total compounded value of the 3-year contract, for anesthesiologists, is projected to range from 2.1-2.9%
. These increases for Year 3 are supposed to be implemented by the PPC starting in Apr. 2025. Lump sums will be paid out to physicians in Aug. and Dec. of 2024 and in Aug. of 2025 in lieu of year 3. This is necessary because the actual year 3 PSB will not be known yet and the implementation work with the PPC will take some time. It should be noted that some of the year 3 funding will be set aside for funding of a revised HOCC structure (up to $75 million) as well as to fund new and expanded alternative payment plans (up to $50 million) as described below.
Additional Benefits
Other financial benefits to anesthesiologists include increases to the pregnancy and parental leave benefit program, increases to the OMA priority insurance program and increases to HOCC to allow applications from new groups. In the first 2 years, HOCC will receive the global increases and $12.5 million in additional funding will be added to fund new groups or to expand existing groups. This process will be managed by a bilateral working group. There is also a plan for a joint MOH/OMA working group to establish and implement a new, burden based HOCC program using existing funding and new funding as mentioned above. This new system will differentiate between different levels of intensity of call (e.g., in-house vs. home call), with additional funding of up to $75 million. Finally, this agreement proposes to extend the 2012 CMPA agreement until the conclusion of the next PSA
(at which time there would be some form of new agreement). This means that our share of CMPA premiums will continue to go up by 2.1% per year as they have done for the past 10 years until such time as there is a new agreement.
Virtual Care
The PPSA, for the first time, formally establishes virtual care funding in the SOB. This is important as the limited pandemic-related virtual codes expire at the end of Sept. 2022. The new virtual care structure would be implemented as of Oct. 1, 2022. There are a number of rules and nuances to it. To keep it simple,
for anesthesiologists, out-patient virtual consultations would be paid the same as in person but must be carried out by video; telephone will not be permitted for this service. Follow-up visits and assessments are also permitted virtually but only in the context of an existing physician-patient relationship.
For most of our purposes, this would mean that either a video consultation or an in-person service was provided within the last 24 months. Regarding follow-up visits and assessments in this context, those can be provided by video (payable at 100% of the in-person fee) or by telephone (payable at 85% of the in-person fee). Where the conditions of an existing physician-patient relationship do not exist, virtual care services are considered “limited” and are payable at $20 for a video service and $15 for a telephone service.
Schedule of Benefits Modernization and Appropriateness Working Group
The PPSA contains a commitment for the parties to continue the work of modernizing the SOB, including a commitment to work toward gender pay equity. This work will be carried out on an annual basis by the PPC. It also contains a commitment to proceed with development of the FAIR relativity model in time for implementation under the next PSA. Finally, it contains a commitment for the Appropriateness Working Group to finish work on the projects already started, but without any specific financial goals and it removes the liability of further savings targets that the profession was previously committed to by the Kaplan arbitration award. To our knowledge, the only project under consideration that may affect a subset of anesthesiologists is the one called
“improving care for patients with chronic pain by transitioning to a multidisciplinary model.” We are unsure of the status or full extent of this project, but we were consulted several times by the AWG regarding Ministry proposals in this area and gave them constructive feedback on your behalf. The details are covered by a non-disclosure agreement.
Claims Submission Period
The PPSA points out that the MOH has advised the OMA of its intent to bring Ontario into line with most other provinces by reducing the claims submission period from 6 months to 3 months. The PPSA contains agreement that claims rejected due to error can be resubmitted beyond the 3-month cutoff without any deadline and will be paid within 2 billing cycles once the error is corrected. There is also agreement that the submission period for RAIs will increase from the current 4 months maximum to 7 months to maintain the same total duration (10 months) on these types of issues that existed before.
Next PSA
The parties also agree with this PPSA that the next PSA will be a four-year agreement and negotiations will start no later than 6 months prior to the expiry (Mar. 31, 2024) of this PPSA.
Recommendation to Vote to Accept the PPSA
We understand that the fee increases contained in the PPSA both for the profession as well as for anesthesiologists are less than many would have liked. However, it is the opinion of the negotiating team and our legal consultants that proceeding to arbitration would likely result in a lesser award, would threaten other gains in the PPSA and expose the profession to the risks of other harsher MOH proposals that were initially brought to negotiations but do not form part of the PPSA. This is explained more extensively in the FAQs on the OMA website. Some anesthesiologists may be unhappy that our share of any increases is reduced by relativity but unfortunately, this would happen in a similar manner with any negotiated or arbitrated agreement as we cannot envision a scenario where relativity would not be applied. The fact that 25% of the increases were across the board, as opposed to 100% based on relativity is a feature which was not seen in the arbitrated award that just expired. This hybrid approach to distribution of fee increases is one which we argued for when we consulted with the NTF prior to the establishment of its mandate.
Overall, based on the totality of the PPSA and the information we have received which explains the rationale and context for it, we are recommending that our members vote to accept the PPSA. We can only foresee increased risks and a worse outcome both for anesthesiologists and for the profession if we were to reject it and end up in arbitration. The upcoming ratification vote will be the first such vote since OMA governance reform and the first time that the whole membership can vote, in a binding manner, on a PPSA. Please exercise your voting rights.
Mission To advocate for and represent the best interests of Ontario’s anesthesiologists. To strengthen the leadership role of anesthesiologists within the health system.
Vision Anesthesiologists as leading partners, delivering the highest standards of innovative, safe and sustainable patient care. The Ontario Medical Association (OMA) administers the distribution of communications for its various Constituency Groups, and therefore the views and the opinions expressed in this communication may not reflect the views, policies, and opinions of the OMA. The OMA does not warrant the accuracy, timeliness, or completeness of the information contained in this communication, nor does it accept any responsibility for its contents.
This email was sent by: Ontario Medical Association 150 Bloor St W Suite 900, TORONTO, ON, M5S 3C1 CA Your privacy is important to us - view the OMA Privacy Policy
