The big news is that we finally have a ruling from the Kaplan Arbitration Board in our long running contract dispute with the Ministry of Health.
Phase 1 Arbitration Award Highlights
Term:
- A 4-year term for new physician services agreement (PSA), from April 1, 2017 to March 31, 2021
Physician Services Budget (PSB):
- NO cap
- This means government, and not doctors, will be responsible to fund the physician services that Ontarians require
Normative Compensation Increases:
- Effective April 1, 2017 – 0.75% global payment increase (excluding only hospital technical fees and OPIP)
- Effective April 1, 2018 – 1.25% global payment increase (excluding only hospital technical fees and OPIP)
- Effective April 1, 2019 – 0.5% global payment increase (excluding only hospital technical fees and OPIP)
- Effective April 1, 2019 – 0.5% used to remove the 0.5% payment discount from the 2012 PSA*
- Effective April 1, 2020 – 1.0% global payment increase (excluding only hospital technical fees and OPIP)
- Allocation to Specialties to occur in Phase II
- The above increases are on top of any increases in spending resulting from utilization
Redress:
- Effective April 1, 2019 – elimination of the unilateral 2015 2.65% non-fee for service and 3.95% fee-for service payment discounts*
- No changes to previous targeted unilateral cuts
* For clarity – this means that all payment discounts (4.45% FFS and 3.15% NFFS) will cease effective April 1, 2019
Appropriateness:
- Bilateral committee to discuss and agree on reducing the provision of medically unnecessary or inappropriate medical services without compromising patient access to medically necessary services
- Identify $100M in changes by May 1, 2019 for the 2019/20 fiscal year
- Identify $360M in changes by September 30, 2019 for the 2020/21 fiscal year
- Fees can NOT be set, changed or reduced to address appropriateness.
- If parties cannot agree on whether a service is appropriate or the total value of the inappropriate services, the board of arbitration will decide
- No tracking of potential savings resulting from appropriateness changes, i.e. no adverse consequences for the profession under the 2017-21 PSA if government claims that the appropriateness changes do not achieve the estimated value of the changes
Other issues:
- All other proposals by either party, including governments’ proposal for cuts due to technological change, are dismissed.
Answers to some FAQs about the arbitration result
Is the Charter Challenge continuing?
This award has no bearing whatsoever on the OMA Charter Challenge, which continues and if successful, will address the unilateral changes imposed for the period between April 1, 2014 and March 31, 2017.
OMA sought to receive funding to account for changes to federal tax legislation. Is there any funding for that?
The OMA argued that the right of physicians to incorporate and ability for income-splitting with family members was achieved through collective bargaining with the government. The OMA submission to the arbitration board requested a compensation increase to make up for the loss of this benefit. The government argued that tax changes should not be and in fact are never a factor which should determine or impact the decision of an Interest Arbitration panel as it relates to changes or levels of compensation. The award by the board of arbitration was for an overall compensation increase and did not include specific compensation increases to account for changes to the federal tax legislation.
Normative Compensation Increases. When will normative increases be paid out?
Phase II will resolve matters relating to how compensation changes resulting from Phase I are to be allocated and distributed to specialties. This is where relativity adjustments will be addressed and determined. Implementation details such as timing of any payments will be determined once Phase II is complete. The OMA will keep the membership appraised of any implementation details.
Normative increases are retroactive to April 1, 2017, will I see a lump sum payment amount retroactive to April 1, 2017?
Phase II will resolve matters relating to how compensation changes resulting from Phase I are to be allocated and distributed to specialties. This is where relativity adjustments will be addressed and determined. Specialties that are allocated funding increases will receive retroactive payments.
How will normative increases be applied to each specialty?
Phase II will resolve matters relating to how compensation changes resulting from Phase I are to be allocated and distributed to specialties. This is where relativity adjustments will be addressed and determined. At this point it is not known which specialties will receive normative increases or the scale of these increases.
What happens if the savings targets are not achieved?
The Appropriateness Working Group is tasked with identifying $100M ($120 M annualized) in appropriateness changes by May 1, 2019 for the 2019/20 fiscal year and a further $360M in appropriateness changes by September 30, 2019 for the 2020/21 fiscal year. However, as proposed by the OMA, the AWG cannot set, change or reduce fees for the provision of individual services. Furthermore, there will not be any consequences for the OMA or physicians during the term of this PSA should the estimated value of changes not materialize.
Phase II
When will Phase II negotiations start?
Phase II discussions will begin as soon as possible. The OMA will keep members appraised as to the status of these discussions.
How will the Phase II process work?
Discussions around the process for negotiating Phase II issues will begin immediately. At this point we expect the process to be similar to Phase I discussions where the parties try to settle any outstanding issues through a short negotiations/mediation prior to having disputes resolved by the board of arbitration.
What are the issues being negotiated/arbitrated as part of Phase II?
Phase II will resolve matters relating to how compensation changes resulting from Phase I are to be allocated and distributed to specialties. There may well be further arbitration to address implementation issues and any remaining unresolved proposals.
When will the Phase II process end?
Given that Phase II discussions have not yet started, it is too early to speculate on the end date of the process.
LATE BREAKING NEWS ON PHASE 2 OF ARBITRATION
The OMA will pursue an allocation-only relativity approach in Phase II: all new monies will be used to address relativity and not be allocated to the top 5 specialties (Ophthalmology, Gastroenterology, Diagnostic Radiology, Cardiology, Radiation Oncology).
More information about Arbitration can be found on the OMA website www.oma.org
APPROPRIATENESS WORKING GROUP(AWG)
We are actively engaged with this process-see info above. Dr. Kovacs submitted proposals on behalf of our Section to the OMA. Dr. Baer is the OMA District 11 lead on this file and also submitted proposals to the Negotiations Committee, which is the OMA’s representative in this process.
Areas of focus are Choosing Wisely Canada initiatives on inappropriate and duplicated lab testing in rheumatology, inappropriately frequent bone density tests, inappropriate MRI tests for the spine and brain in patients with simple headaches or mechanical back pain, and surgical procedures such as knee arthroscopy and shoulder decompression which are being performed far in excess of what guidelines recommend.
If you have other suggestions for areas where savings might be found without jeopardizing health care outcomes, please send them to Dr. Kovacs or Dr. Baer or directly to negotiations@oma.org.
OMA Positions Available
The OMA is looking for engaged members – particularly colleagues who may be new to the Association – to drive our organization forward.
Click on the links to learn more about the mandate, the type of work involved, the time commitment and how to help the OMA listen to your views!
The deadline to apply is Friday, April 26, 2019 at 5 p.m.
- Awards Committee
- Insurance Committee
- Member Relations, Advocacy and Communications Committee
- Member Services Committee
- Outreach to Women Physicians Committee
- Relativity Advisory Committee
- Uninsured Services Committee
2019-2020 OMA President-Elect Nominee Selection.
There were three candidates:
- Dr. Rachel Forman
- Dr. Samantha Hill
- Dr. Hirotaka Yamashiro
Member Referendum
The OMA held a referendum of members to support Council’s election of the next President-Elect. Dr. Yamashiro was the winner. The OMA is bound by the Ontario Corporations Act, so this referendum is non-binding. The official election for President-Elect will take place at this year’s Spring AGM in Ottawa in May, which Dr Julie Kovacs will attend.
