Provincial Academic Clinical Funding Plan (ACFP) Physician Information Package

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1 1 P age Provincial Academic Clinical Funding Plan (ACFP) Physician Information Package WHY SHOULD I BE INTERESTED? NOTICE TO READER (Please read before proceeding) The ACFP provides an opportunity to provide integrated, comprehensive, longitudinal care, inclusive of academic, administrative and research activities. The ACFP enables your practice to work more closely with the regional health authorities (RHAs) and the College of Medicine, optimizing your time and patient access while compensating at nationally competitive rates. A group of like specialty physicians on the ACFP can optimize each members time around their special interest and expertise, improve patient access and build group practice relationships. The ACFP allows you to diversify your career and experience beyond purely clinical patient service into other needed service areas, e.g. teaching, research and administration within the health system, while being equitably and competitively compensated. PURPOSE The purpose of the information herein is to: #1 Describe a new contracting alternative (e.g., alternative to your current fee for service (FFS), FFS plus College of Medicine (CoM) payments, or Regional Health Authority (RHA) contract) for eligible MD physicians currently practising, or planning to practice, in the Province of Saskatchewan. #2 Provide sufficient information to allow you to self determine whether to investigate further entering into a contract for clinical and academic (e.g., preceptor teaching) services with your proximate RHA and the University of Saskatchewan College of Medicine. PLEASE NOTE: More information, including the ACFP Framework Document, can also be found at REQUEST Please carefully read this information package and if you have interest in investigating further the possibility of leaving your current service and payment arrangement (e.g., FFS, salaried and blended salary) and entering into an Individual Service Agreement (ISA) with the ACFP, please feel free to contact one of the following: Saskatoon Health Region: Rob Gentes, Director, Practitioner Staff Affairs or rob.gentes@saskatoonhealthregion.ca

2 Regina Qu Appelle Health Region: Erin Roesch, Director, Practitioner Staff Affairs or College of Medicine: Steven Harrison, Chief Operating Officer, Once you have made contact, your interest will be recorded and any immediate questions you may have will be answered, or redirected to the appropriate organizations, if necessary. Note: there is no minimum number requirement by specialty, specialty group, region, or community. An ISA is an individual agreement. WHAT IS THE ACADEMIC CLINICAL FUNDING PLAN? The provincial ACFP development process has been led by a Provincial Oversight Committee, represented by the Ministries of Health and Advanced Education, the Saskatchewan Medical Association, University of Saskatchewan (U of S), College of Medicine (CoM), and Saskatoon and Regina Qu Appelle Health Regions. The ACFP has created a new whole time contracting opportunity for current and prospective physicians (hereinafter referred to as the Contractor ) across the province. Under the ACFP, the Contractor will enter into an ISA with their proximate RHA and the U of S, CoM. The ISA defines contractor deliverables for clinical and academic services and any enabling responsibilities of the RHA and CoM (e.g., access to facilities). The ACFP Contractor services and payment model is designed to ensure service requirements and payment rates are competitive with their clinical colleagues and other medical schools, thereby improving physician recruitment and retention in the province and ensuring appropriate access to quality services. The information that follows will provide physicians with sufficient information to determine whether to formally approach the ACFP to discuss the possibility of entering into an ISA with their RHA and the CoM and discontinue their current service and payment arrangement (e.g., FFS, salaried and blended salary). 2 P age

3 WHO IS ELIGIBLE? To enter into an ACFP ISA the physician must: A. Hold a valid, active, licensure status (in good standing) with the College of Physicians and Surgeons of Saskatchewan (CPSS); and, B. Commit to providing clinical and academic services. Academic services will include clinical supervision of learners, and may also include: (i) Education outside the patient care setting (e.g. classroom, lecture, small groups, concurrent to clinical care, etc.), curriculum development/evaluation, and educational committee work, etc.; (ii) Research, including health research and knowledge creation, and innovation, including basic, clinical, translational, and applied research; (iii) Leadership of an academic service (e.g., postgraduate training director). C. Hold clinical appointments and privileges with the relevant RHAs and an academic appointment 1 with the CoM; and, D. Not also contract to or bill any other party for the provision of clinical or academic service within the Province of Saskatchewan during the weeks of ISA contracted service; and, E. Not hold a position that requires the individual to perform management functions specific to the administration of the ACFP. Without restricting the generality of the preceding, individuals occupying the following positions are not eligible: (i) RHA Clinical Department Head, Senior Medical Officer(SMO), Vice President medicine/physician services/etc., and/or (ii) U of S/CoM of Unified Department Head, Associate Dean, Vice Dean, or Dean. For greater clarity, those occupying management positions reporting to a Clinical Department Head or Unified Department Head (hereinafter referred to as the Department Head ) are eligible to enter into an ACFP ISA, e.g. Section or Division Chief, Program Director (e.g. Clinical, Undergraduate, Postgraduate). NOTE: Interested individuals who do not currently meet all the aforementioned eligibility criteria, but intend to (e.g., senior residents or physicians new to the province), are encouraged to communicate their interest to the ACFP and obtain further detailed information. 1 i.e. Clinical Associate Professor, Clinical Assistant Professor, Clinical Professor, Professor, Assistant Professor, Associate Professor, Lecturer, or Instructor. 3 Page

4 WHO WILL SIGN MY INDIVIDUAL SERVICE AGREEMENT? ISAs will be signed by: the contracting physician, Office of the Dean at the CoM, and the SMO or VP Medical for the RHA. WHO WILL EVALUATE MY INDIVIDUAL SERVICE AGREEMENT PERFORMANCE? Individual ISA performance will be evaluated formally on an annual basis by the Clinical Head of the Department for clinical service and Associate Dean College of Medicine for academic service. Where a Unified (Clinical/Academic) Department exists, the Head will evaluate both clinical and academic services. Mid year informal two way feedback is strongly encouraged. Individuals can appeal their evaluation directly to the Office of the Dean at the CoM and the SMO or VP Medical for the RHA. Their decision is final. WHAT ARE THE TERMS OF THE ACFP AND INDIVIDUAL SERVICE AGREEMENTS? A. Contracts are Whole Time The ACFP ISA is a whole time contract. Whole time refers to all physicians clinical and academic time and services during the weeks of contracted ISA service. Contracted service can be either: (i) Full time comprised of 44 weeks (i.e., 220 scheduled worked days Monday to Friday or 440 half days), plus hours on call, of full time service per year. The remaining eight weeks of the year are outside the ACFP contract scope and terms, or (ii) Part time at not less than 50% of full time, i.e., 22 weeks at five days (M F) per week or 110 days. Part time can be any portion between 50% and 100% of full time. Such time need not be consecutive. Whether full or part time, a whole time Contractor cannot provide compensated clinical or academic service to a party other than the ACFP at any time during the: (i) 44 weeks of contracted ACFP service in the case of a full time contractor; or, (ii) 44 consecutive identified (in ISA) weeks in the case of a part time contractor. This stipulation prevents in particular the following unintended outcomes from occurring: (i) individual burnout from overwork; and/or (ii) conflicting obligations undermining quality of work. 4 P age

5 B. Participation in On Call The Contractor is required to participate fully in clinical on call service as determined by the Department Head. The ACFP payment rates to Contractors are set based on full on call participation (however on call stipend payments (Tier I and Tier II) are provided separately by the region outside the ACFP contract). If a Contractor does not wish to participate fully in oncall as determined by the Department Head, the Contractor must first request and obtain Department Head approval to participate less than fully in the required on call service. If given written approval by the Department Head the Contractor payment rates for clinical service are discounted as follows: (i) Non participation in Tier II call will result in a 9% reduction in the base rate of pay. Partial participation will result in a proportionate rate reduction. (ii) Non participation in Tier I call will result in a 12% reduction. Partial participation will result in a proportionate rate reduction. Variation in stipulated (i.e., 9%, 12%) payment rate reduction may be considered by the ACFP on a specialty by specialty basis based on billing and service data for the last complete fiscal year. C. Split Service with Differing Payment Rates Individuals providing regularly scheduled services paid at differing payments rates will be paid at the rate applicable to the service for the time spent on the service. Such situations relate to a very limited number of services (e.g, specialist whom in addition to their regular work also provides regular scheduled shifts on an adult tertiary intensive care service). The sum of the two services work hours and total payments cannot exceed a 1.0 full time equivalency. D. Term and Renewal Terms will be set at time of signing of ISAs. The minimum term is three years with three, or longer, mutually agreed renewals thereafter. A Contractor choosing not to renew with the ACFP at the end of contract term is free to pursue any and all other practice options. For example, a Contractor can return to FFS (and be paid for teaching through a stipend, as arranged with the CoM) should they not renew their ACFP ISA. A contract may be terminated prior to the end of contract term but only based upon mutual agreement. E. Reporting Physicians will be expected to maintain, on a timely accurate basis, their work data (such as One 45 for teaching, shadow billing for clinical services, etc.). This reporting is mutually (ACFP and Contractor) beneficial and essential for workload and performance measurement within the ISA F. Appeal A Contractor can appeal their evaluation directly to the Office of the Dean at the CoM and the SMO or VP Medical for the RHA. Their decision is final. 5 P age

6 HOW WILL SERVICE AND COMPENSATION RATES BE DETERMINED? A. PRINCIPLES Service and compensation rates (hereinafter Rates ) will be based on the following key principles: Transparent: Rates will be based on a transparent methodology supported by benchmarked data. (See Payment Model and Rate section below) Competitive: Rates will ensure specialties are able to recruit locally and nationally. Net compensation for service, adjusted for relative workload, will be competitive with other alternate payment plans and FFS within the province and with Ontario, Manitoba, Alberta and British Columbia. Rate benchmarking across the five provinces will continue to occur at regular intervals to ensure the competitiveness of service and net compensation rates. The Rate benchmarking methodology will be clear, robust, and consistently applied to national comparison values. Consistent: Service and compensation models are the same within/by specialty across the province. The plan will respect pre existing Ministry or Saskatchewan Medical Association programs, on a case by case basis (e.g. rural/remote differentials, family practice comprehensive care program). Equal Value: Within each specialty there will be equal value for clinical, teaching, education, research, and leadership/administrative services. As noted above, a physician, under special circumstance may opt out of on call duties (if approved by the Department Head) and will receive discounted service and payment rates. Inclusive (of all professional services within the scope of the ACFP): All professional services income, within the scope of the plan, are declared and reconciled to ACFP Rates. Consistent and Transparent Scope: Third party services (e.g. WCB, private insurance) and payments are part of the 1.0 FTE workload definition for the physician, and are therefore assigned within the scope of the ACFP. Payment for these services will be directly assigned to the ACFP. Services and payments outside of the scope of the ACFP include: Group 1 income exceptions certain intellectual property (i.e. book royalties); Group 2 income exceptions Service related: hourly on call stipend payments (e.g. Tiers I and II Specialist Emergency Coverage Program) and services and payments other than insured medical services within the province earned during the eight weeks outside the 44 week per year contract period; Group 3 income exceptions external incentives: including SMA paid supplementary amounts (e.g. recruitment and retention bonus, rural and remote differentials). 6 P age

7 B. FULL TIME EQUIVALENCY (1.0 FTE) Full time equivalency (FTE) means ISA service workload levels are within the 40 th to 60 th percentile range for each specialty as determined by the ACFP specialty specific payment/workload model and methodology. C. SERVICE AND PAYMENT MODEL AND RATES (i) MODEL AND RATE The service and payment model is a simple two step grid. Level 1 applies to the first three year contract and Level 2, subject to satisfactory performance, to the second three year contract and contracts thereafter. The mid point between Level 1 and Level 2 service and payment rates is equivalent to the mean 1.0 full time equivalent services and gross (inclusive of the cost of overhead support services) income for Saskatchewan FFS, Saskatchewan blended FFS plus salary, and FFS across Ontario, Manitoba, Alberta, and British Columbia. Service and workload requirements are set at a level consistent with payment rates. Prior experience will be considered in deciding whether the individual is offered Level 1 or Level 2 service and payment rates for their first contract. (ii) INCENTIVE A five percent (5%), of the Level 1 and Level 2 payment, incentive payment is paid for exceeding the ISA quantitative (weighted 2 ) measures by 10% or more. A second 5%, of the Level 1 and Level 2 incentive payment is paid for exceeding, as determined by the Department Head, the ISA qualitative 3 measures by 10% or more. The measures used to determine the incentive payment are outlined within the position profile (see below) and will vary by specialty due to the differences in time intensity and complexity of certain services. (iii) WITHHOLDING Ten percent (10%) of the Level 1 and Level 2 payment is withheld and paid out in full after the last day of each contract year upon achievement of a satisfactory or higher performance evaluation 4 from the Department Head. In addition to the Department Head evaluation, satisfactory performance requires the timely and quality completion of the following relevant reporting information each year: (i) Teaching Service : One45 (data collection system for preceptor feedback on learners); 2 e.g., exceeding comprehensive first visit assessments by 10% has a higher relative time weighting than exceeding repeat visits by 10%. Thus, also, a Contractor can be under the quantitative target for one service and exceed the quantitative target in another service and still achieve an overall satisfactory (3) rating, and potentially also, receive a bonus payment for exceeding overall quantitative targets by 10% or more. 3 Qualitative measures will be specialty specific and informed by direct consultation with specialty representatives. 4 Four point Likert Scale from unsatisfactory (4), poor (3), satisfactory (2), and excellent (1) 7 P age

8 (ii) (iii) (iv) Research Service: CVMS (Curriculum Vitae Management System); Leadership Service Academic Profile System: including: Leadership Education, Leadership Research, Leadership Managerial, and Leadership Clinical; and Clinical Service quantitative reporting i.e., Shadow Billing (iv) PAYMENT RATE CHANGES ACFP payment rates will be adjusted according to MOH/SMA negotiated changes (e.g. annually) for insured clinical services under the Medical Services Plan. These changes will flow to the ACFP payment rates Levels 1 and 2 by specialty. (v) BENEFITS The ACFP ISA is an independent contract and therefore does not pay benefits (e.g., health, dental, life insurance coverage, etc.) of any type. (vi) PAYMENTS Payments will be monthly based upon the number of scheduled days worked in the month as a percent of total scheduled days to be worked in a year, less 10% withholding. Such payment will be paid to the Contractor on the last day of each month following submission of their monthly services invoice. (vii) OVERHEAD Level 1 and 2 payment rates are gross payments inclusive of overhead support service costs (per A above). The Contractor can either: (i) In the case of a private office and practice location pay for and manage their own support services and costs based at a private office location, e.g., office space, utilities, transcription, secretarial, shadow billing clerk, etc.; or (ii) In the case of an RHA (e.g., hospital) or College (e.g., faculty building) facility based office and practice location purchase support services from a menu of services provided by the building owner/operator. The Contractor physician will be invoiced monthly at a standard cost recovery based rate for overhead support services. WHAT IS INCLUDED IN EACH INDIVIDUAL SERVICE AGREEMENT? A Contractor schedule of deliverables (see template example on last page) will be developed by the Department Head in consultation with the Contractor consistent with the ACFP specialty specific service workload standards at the 40 th to 60 th percentile. The Department Head will prepare a draft position profile, which will then be discussed, revised and agreed upon with the Contractor. Position profiles will list the services of the physician, the physician s objectives and agreed upon supporting resources needed to achieve the services. 8 P age

9 The profile will also include the responsibilities of the CoM and RHA (such as provision of operating room time, etc.). The duties and responsibilities in the position profile will include: clinical care services by setting (e.g. inpatient, ambulatory/office, OR, etc.); on call services (e.g. frequency, duration); and concurrent clinical teaching. The duties and responsibilities in the position profile may include: academic services (e.g. education, concurrent clinical teaching); leadership services (clinical and academic, e.g. clinical program director, residency coordinator); and other contracted responsibilities. A standard whole time position profile will be consistent with the FTE definition by specialty. The general definition is 44 weeks, comprised of 440 half days, plus on call service. The remaining eight weeks of the year are not contracted or paid and can be used for personal time, CME, statutory holidays, skills training, etc. Exceptions to the general definition will exist where warranted by the specific clinical service requirements, e.g., Emergency Medicine. The ACFP will determine the exceptions in consultation with RHA and CoM management and with input from specialty representative(s). Each specialty has unique attributes; therefore specialty specific ISA detail will be developed in consultation with each individual specialty. The position profile will be reviewed annually to ensure it continues to meet the needs of the RHA, CoM, and physician. Changes to contracted services can be made at the annual yearly review based upon mutual agreement. HOW WILL ONGOING WORKFORCE PLANNING BE INCORPORATED FOR MY DEPARTMENT/DISCIPLINE? Throughout the ACFP process, concerns have been raised about workforce planning within departments/specialties. A quality workforce plan is integral to the ACFP. A provincial physician resource plan is currently being developed, with an expected completion date of fall Ongoing workforce planning will continue to occur at regular intervals within the ACFP. The plan will be evidence based, sustainable, transparent, and will strive to ensure population need is being met. 9 P age

10 WHEN WILL THE ACFP BE IMPLEMENTED? Implementation will begin in a phased approach in the Fall 2014 time period. Prioritization, if necessary, will be determined by the ACFP Provincial Oversight Committee once the level of interest of physicians across specialties in the province is determined. 10 P age

11 Appendix Individual Services Agreement Sample Template 11 P age