Document

Report
Family Physician
Negotiation
Ruth Wilson, M.D., C.C.F.P
NYSAFP
Lake Placid, Jan 31 2009
Primary Care Score vs. Health Care
Expenditures, 1997
Primary Care Score
2
UK
DK
NTH
1.5
FIN
SP
CAN
AUS
1
SWE
JAP
0.5
GER
BEL
0
1000
1500
US
FR
2000
2500
3000
3500
4000
Per Capita Health Care Expenditures
Starfield 10/00
‹#›
Characteristics of Canadian PHC
•
•
•
•
•
•
•
50% of MDs are GPs
Public funding, free at point of access, private
provision
Fee for service has been dominant funding model
Physicians own premises, employ staff
92% of Canadians have a GP; gatekeeper role
Little public funding of other primary health care
professionals
Wait times and access issues
‹#›
How are working conditions negotiated?
•
•
•
•
•
Provincial governments are main payers
Governments choose to negotiate with provincial
medical associations
Payment and co-management issues are addressed
FPs and other specialists negotiate together (except in
Quebec!)
Teams are composed of physicians, lawyers, and civil
servants
‹#›
Ontario’s Primary Care Renewal goals (2000)
 Improving access to primary health care
 Increasing patient and provider satisfaction with the
health care system
 Improving quality and continuity of primary health
care
 Increasing cost-effectiveness of health care services
Common Elements of Renewal
•
Patient enrolment
•
Grouped/networked practices
•
Extended access hours
•
Enhanced use of information technology
•
Focus on comprehensive care services
7000
Physicians in Primary Care Renewal
Models
Participating Physicians
6000
5000
4000
3000
2000
1000
0
Jun-99 Mar-00 Dec-00 Sep-01 Jun-02 Mar-03 Dec-03 Sep-04 Jun-05 Nov-06
PCNs
FHNs
FHGs
Date
n0
t
5
04
p-
C
ur
re
n
Ju
Se
-0
3
3
2
ar
-0
n0
01
p-
D
ec
M
Ju
Se
-0
0
0
9
ar
-0
n9
D
ec
M
Ju
Number of Patients Enrolled (thousands)
Patients Enrolled in PCR Models
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
Some elements of payment
models
What is a Family Health Network?
•
A group of at least 5 primary care doctors working together
with other health care professionals to provide accessible,
coordinated care to enrolled patients
•
After-hours care through a combination of on-call
arrangements and a telephone health advisory service
•
A new method of physician payment
•
Voluntary for all patients and physicians
Patient Enrolment Requirements

To seek treatment from their doctor first, unless they are
travelling or find themselves in an emergency situation

To allow the Ministry to provide their doctor with information
about services they have received from primary care doctors
outside of the network and some preventive services

To not switch the doctor they’re enrolled with more than twice
per year
However: patients are not required to enrol to continue receiving
services, nor will they be refused enrolment due to their health status
or need for services
Telephone Health Advisory Service
•
After-hours
•
Nurse-staffed
•
Phones a physician when required, otherwise directs
patient to self-care or hospital. (Pilots reported
reduced advice call)
•
Report faxed next day to personal physician (with
patient’s permission)
Payment Overview
Blended Model:
Capitation
+ fee-for-service
+ lump sum payments
+ special premiums
= blended model
Blended approach allows FP to receive an increase in
remuneration if providing broad-based comprehensive care
Payment Overview
•
•
Base capitation payment rate
determined by age and sex of
patient
Bonuses for achieving
preventive targets (Pap,
mammogram, flu shots,
childhood immunizations,
colorectal screening
•
Fee-for-service payments for
core services (10%)
•
Fee-for-service for excluded
services
•
Premiums for obstetrics,
palliative care, house calls
•
New patient fee; after hours
fee; plus several additional
enhancements
Some observations
•
Cost control is partly by controlling access rather than
by managed care
• Canadian FPs also complain about paperwork, but our
billing system is by comparison much simpler
• Interest in Family Medicine is up—31% of medical
students make it their first choice
• Interests-based negotiations can work

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