Physician Services Analysis

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Homer Chandler
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1 Physician Services Analysis The following slides were prepared by KPMG on behalf of Alberta Health. All inter-provincial comparisons are based on data published by the Canadian Institute for Health Information (CIHI). Analysis related to growth in Alberta s physician services budget and physician benefit programs is based on AH physician services budget data. 1

2 Alberta has seen significantly higher growth of both its overall health budget and its physician services expenditures relative to comparator provinces The physician services expenditure growth is outpacing growth of total health budget growing 218% from 2000 to The next closest comparator province, Saskatchewan, grew 143% in the same time period. Cumulative Provincial Health Expenditure Per Capita Growth (Calendar Year: 2000 to 2015) Cumulative Provincial Physician Expenditure Per Capita Growth (Calendar Year: 2000 to 2015) % 195% 218% Alberta Growth % % 6% 27% 19% % 48% 92% 116% 123% 135% 66% 76% 81% 84% Calendar Year Alberta Comparator Average % 87% 59% % 41% 89% 69% 11% 47% 16% 29% 6% Calendar Year Comparator Average Provincial Health Expenditure ($ per capita) % Growth Alta. $2,068 $4, % Sask. $2,082 $4, % Ont. $2,048 $3,752 83% Que. $1,969 $3,656 86% B.C. $2,269 $3,983 76% Comparator Average $2,062 $3,798 84% Provincial Physician Expenditure ($ per capita) % Growth Alta. $333 $1, % Sask. $388 $ % Ont. $474 $947 99% Que. $353 $ % B.C. $477 $848 78% Comparator Average $434 $ % 2

3 In 2015 Alberta had the highest provincial expenditure on health per capita and physician services per capita among the comparator provinces health physicians 18% 2 AB $4,862 per capita spending on health $1,058 per capita spending on physician services health physicians 5% 11% SK health physicians 25% 19% health physicians 23% 1 ON QC Note: the percentages and arrows in the chart represent the difference in health and physician services expenditures relative to Alberta Per Capita Provincial Expenditure 2015 BC AB SK ON QC Health $3,983 $4,862 $4,621 $3,752 $3,656 Calendar Year 2015 Source: CIHI National Health Expenditure Database, KPMG Analysis Physician Services $848 $1,058 $942 $947 $852 3

4 Rate increases, population growth and utilization growth are key drivers of the total growth in the physician services budget During the 7-year period from FY04-05 to FY10-11, the PSB grew at an average rate of 11.3% During the 3-year period of rate increases (FY11-12 to FY13-14), the PSB grew at an average rate of 6.4%, driven by population growth and utilization growth 16. Key Variables Driving Growth of Alberta s Physician Services Budget 15.8% (Fiscal Year: to ) % Growth in Physician Services Budget % 11.8% 11.6% 11.6% Fee Growth 8.6% 8.2% 8.7% 6.7% 6.3% 3.3% 3.3% 2.1% 2.9% 4.3% 1.3% 1.4% 2.6% 3.9% 3.1% 3.3% 4.5% 4.5% % % 2.5% 2.6% 2.5% * Fiscal Year % Rate Increase Estimated Utilization Growth Due to Population Estimated Utilization Growth Due to Other Factors 4

5 In 2013 Alberta has a relatively young population, with the smallest share of individuals over the age of 60 among comparator provinces In 2013, Alberta had a median age of 36.0 years, lowest in Canada 59% in Saskatchewan 57% in Ontario 56% in Canada 55% in British Columbia 54% in Quebec 7.3% in British Columbia 7.2% in Quebec 7.1% in Saskatchewan 6.8% in Ontario 6.8% in Canada % of Population in Age Group Provincial Demographics (2013) Age Group 75 and Over 60 to to to to 29 0 to 14 Source: Statistics Canada CANSIM Table : Estimates of Population by Age Group and Sex

6 Alberta has a relatively healthier population, as measured by prevalence of key chronic illnesses 2 18% 16% 14% Chronic Illness Prevalence ( ) 18.5% 17.8% 17.2% 15.8% 15.1% Prevalence 12% 1 8% 6% 4% 5.3% 5.5% 6.7% 6.7% 7.2% 3.2% 4.1% 4.3% 4.4% 4.4% 5.2% 7.1% 7.8% 8.4% 9.3% 2% Diabetes COPD High Blood Pressure Mood Disorder Source: Statistics Canada. Table Health Indicator Profile Diabetes: Population aged 12 and over who reported that they have been diagnosed by a health professional as having diabetes. Diabetes includes females 15 and over who reported that they have been diagnosed with gestational diabetes. COPD: Population aged 35 and over who reported being diagnosed by a health professional with chronic bronchitis, emphysema or chronic obstructive pulmonary disease High Blood Pressure: Population aged 12 and over who reported that they have been diagnosed by a health professional as having high blood pressure. Mood Disorder: Population aged 12 and over who reported that they have been diagnosed by a health professional as having a mood disorder, such as depression, bipolar disorder, mania or dysthymia 6

7 Relative to comparator provinces, Alberta ranks last or second to last in access to primary care as measured by 4 key indicators % of Respondents % 85% % Access to Primary Care ( ) 46% 43% 42% 4 36% 44% 42% 37% 33% 32% 75% 67% 65% 62% 58% 2 1 Have a Regular Doctor Same/Next Day Appointment Ease in Finding After Hours Care Same Day Answers to Phone Calls 7

8 Among the comparator provinces, Alberta was ranked middle of the pack or worse across five of the six care coordination metrics % of Respondents % 84% 82% 81% 8 49% 44% 33% 32% 3 Care Coordination Metrics ( ) 68% 66% 64% 63% 48% 62% 61% 57% 54% 51% 57% 54% 54% 49% 46% 64% 63% 6 55% No Conflicting Information from Different Doctors Access to Medical Test Results Doctors Informed about Visits to Emergency Department Doctors Seem Knowledgeable about Medical History Doctors Spending Enough Time with Patients Doctors Sharing in Decision Making with Patients 8

9 Alberta is ranked third or fourth among comparator provinces across each of the 5 key wait time indicators % Procedures Meeting Benchmark % 81% 78% 77% 61% Procedures Meeting Benchmark Wait Times (2014) 93% 88% 87% 84% 67% 89% 86% 81% 81% 57% 88% 88% 81% 71% 7 99% 99% 97% 97% 95% Emergency Department Hip Replacement Knee Replacement Cataract Surgery Radiation Therapy Benchmark Wait Time 4 hours 182 days 182 days 112 days 28 days (CIHI). CIHI National Health Expenditure Database. 9

10 While Alberta ranks second across all readmission metrics relative to comparator provinces, it has the second highest age-standardized average hospital length of stay 2 Readmissions to Hospital within 30 Days ( ) Age Standardized Avg. Length of Stay for Acute Inpatient Hospitalizations ( ) 30 day Readmission Rate 15% 1 5% 12.6% 13.3% 13.6% 14.3% 14.9% 6.3% 7.2% 7.2% 7.5% 7.7% Days Medical Patients Surgical Patients 0 10

11 Average FFS earnings in Alberta (All Physicians) total $386K and are $73K higher (23%) than the average of the comparator provinces ARP payments and benefits Alberta Health Services contributions FFS Payments $400,000 $350,000 $300,000 $250,000 FFS % of Total: 86.1% 32% Growth Over 8 Years Alberta $386,044 19% Growth Over 8 Years Average Gross FFS Payment > $60,000 for All Physicians (Fiscal Years: to ) FFS % of Total: 65.2% $30K less than Alberta 14% Growth Over 8 Years FFS % of Total: 63.2% $66K less than Alberta 2 Growth Over 8 Years FFS % of Total: 81.2% $94K less than Alberta 48% Growth Over 8 Years FFS % of Total: 77.1% $102K less than Alberta 23% Growth Over 8 Years FFS % of Total: 71.7% $73K less than Alberta $200,000 $150,000 AB SK ON BC QC Comparator Average Source: CIHI National Physician Database Fiscal Year 11

12 Across all comparator jurisdictions, fees have increased while services per FTE has declined or remained flat for Family Medicine Practitioners Alberta has seen a 1 decrease in services provided by a Family Medicine Practitioner FTE from to Alberta continues to be the leading jurisdiction in FFS payment rate per service with an average FFS Payment of $ Note: Quebec is a close second at $57.73 Number of Services per Family Medicine FTE Saskatchewan Ontario Saskatchewan Alberta Ontario BC BC Alberta Quebec Quebec $25 $30 $35 $40 $45 $50 $55 $60 Average FFS Payment per Service Source: CIHI National Physician Database 12

13 Relative to other provinces in the study, Alberta has the second most physicians per 100,000 population Alberta ranks 2 nd, 2 nd, and 4 th in the total number of family medicine, medical specialists, and surgical specialists per 100,000 population 275 Physicians per 100,000 population by Specialty and Province (Calendar Year: 2014) QC 239 AB 229 B.C. 229 ON 214 Comp. Avg. 218 Physicians per 100,000 people SK 189 B.C. 125 AB 118 QC 118 ON 107 SK 106 Comp. Avg. 114 QC 85 AB 81 ON 76 B.C. 72 SK 56 Comp. Avg. 72 QC 31 B.C. 27 ON 26 AB 24 SK 23 Comp. Avg Total Physicians Family Medicine Medical Specialties Surgical Specialties 13

Alberta performs well at attracting and retaining physicians as demonstrated by interprovincial migration, net in migration, and a physician retention rate of nearly 99% % of physicians who continued

physicians from abroad, physicians who did not practice the previous year (2013-14) 2013-14 Province Total Physicians Retention Rate Retention Rate Rank Net Interprov.

14 Alberta performs well at attracting and retaining physicians as demonstrated by interprovincial migration, net in migration, and a physician retention rate of nearly 99% % of physicians who continued to practice in the same province ( ) # of physicians moving to practice in selected province from the rest of Canada ( ) Net increase in # of physicians including new graduates, physicians from abroad, physicians who did not practice the previous year ( ) Province Total Physicians Retention Rate Retention Rate Rank Net Interprov. Migration Rank Change in Physician-100,000 from Prior Year Total In Migration Rank Alberta 8, N.L. 1, Sask. 1, Ontario 28, B.C. 10, N.B. 1, Quebec 18, N.S. 2, Man. 2, P.E.I Source: Scott s Medical Database, KPMG Analysis 14

15 Alternate compensation platforms in Canada have been on the rise since , but adoption in Alberta has been the lowest 4 35% Annual APP % of All Clinical Payments (Fiscal Years: to ) 10 Years to % 10 Year Change in Basis Points ON: 20.1% SK: 9.5% APP % of All Clinical Payments 3 25% 2 15% % 25.27% 23.71% 22.89% 21.38% 18.77% % 13.87% 10.77% Comparator Avg: 6.9% QC: -0.8% BC: -1. AB: 3.1 5% ON QC BC SK Alberta Comparator Average Source: CIHI National Physician Database, KPMG Analysis 15

16 Direct Physician Remuneration KPMG, Physician Services Analysis February AH-funded physician benefit programs total $396M in FY15-16 forecasted expenditures Infrastructure to Support Physicians Physician On-Call Business Costs Program Retention Benefit Medical Liability Reimbursement Program Rural Remote Northern Program Continuing Medical Education Program Physician and Family Support Program Specialist Locum Program Regular Locum Program Compassionate Expense Program Primary Care Network PMO Practice Management Program Physician Learning Program Alternative Relationship Program PMO Towards Optimized Practice Program AH Administered AHS Administered AMA Administered Total Description FY15/16 EST $M Remuneration intended to compensate physicians based on availability and burden Established to address rising costs of medical office and diagnostic imaging in Alberta 85.4 Provide physicians with a benefit amount in recognition of past years service in Alberta 71.6 Reimbursement for costs incurred in respect of medical liability insurance premiums set by CMPA 48.8 Compensates physicians who practice in underserviced areas in Alberta 46.9 Reimburse physicians for continuing education costs 21.5 Provide support to physicians not practicing as a result of the birth or adoption of a child 4.1 Provide support to physicians and their dependents with dealing with life management issues 2.2 Ensure regional centers outside of Calgary and Edmonton have access to specialist coverage 1.1 Ensure that residents living in communities with four or fewer physicians have continuous access 1.3 Provide support to physicians on compassionate grounds 0.4 Supporting PCNs assisting with development, implementation and accountability processes 3.0 Assist physicians with developing and implementing PCNs including support services 2.3 Identifies learning needs of physicians and provides assistance in the pursuit of educational activities 3.7 Assisting with the development, implementation and accountability processes of individual ARPs 1.9 Support development of products and services that facilitate best practice and quality initiatives 1.1 Note that there is an additional $13.7M in benefits (outside of AMAA) for physicians practicing in rural communities (Rural Physician Action Plan, Rural Locum Service Program, Rural Community Clerkship) Sources: AHS Contracts & POC Program, Benefit Programs Financial Results & Forecasts, KPMG Analysis

The National Physician Database: Data and Reports 2006 National Meeting on Physician Compensation Vancouver, British Columbia, Canada

The National Physician Database: Data and Reports 2006 National Meeting on Physician Compensation Vancouver, British Columbia, Canada Presented by Steve Slade, Program Lead Physician Databases, CIHI Declaration: