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

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1 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

2 Declaration: I probably won t cover everything you need to know and I may not be able to answer all of your questions. Either we will not have enough time or I will not have the detailed information/knowledge needed to answer your question. CIHI s Physician Databases team is available for follow up. Contacts: Francine Anne Roy, Manager Health Human Resources, CIHI froy@cihi.ca; tel Robert Kyte, Steve Slade, Program Leads Physician Databases, CIHI rkyte@cihi.ca, sslade@cihi.ca; tel (Robert), (Steve)

3 Presentation Overview Brief introduction to the National Physician Database (NPDB) Inclusion/Exclusion Criteria for Average Payment and FTE Calculations Overview of the FTE Physician and Average Payment Per Physician Reports Other NPDB-based reports Questions

4 Brief introduction to the National Physician Database (NPDB)

5 Brief Introduction to the NPDB The NPDB is an information resource for decisionmakers and analysts who need to know about physician payments and services in Canada NPDB data is submitted quarterly to CIHI by P/T Ministries of Health (administrative payment systems) Electronic NPDB data is available for the period Printed, aggregate level NPDB data is on file for the period

6 Brief Introduction to the NPDB NPDB Key Data Elements Anonymous Unique Physician Identifier For tracking over time and across jurisdictions Fee Service Code To describe the type of service being provided Remuneration Mode E.g., FFS, salary, sessional, capitation, contract Source of Payment E.g., medical care plan, WCB, Insurance Board Total Payments and Services

7 Inclusion/Exclusion Criteria for Average Payment and FTE Calculations

8 Inclusion/Exclusion Criteria for Average Payment and FTE Calculations Included in average payment per physician and full-time equivalent physician calculations: Medical care plan fee-for-service payments Reciprocal billing payments Excluded from average payment per physician and fulltime equivalent physician calculations: Facility, radiology/pathology specialist payments Rural retention premiums WCB payments Insurance corporation payments Salary and sessional payments Shadow billing data Payments made to out-of-jurisdiction physicians

9 NPDB Medical Care Plan FFS and All Other NPDB Payments as a Percentage of Total NPDB Payments, 2003 This is the distribution of all payment information submitted to the NPDB. Medical Care Plan FFS payments are included in average payment and FTE calculations. All other payments are excluded. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Total NPDB MCP FFS $ All Other NPDB $ Source: Canadian Institute for Health Information, Average Payment Physician Report, Canada and (Ottawa: CIHI, 2006)

10 Distribution of Non Medical Care Plan FFS Payments, 2003 These payments are excluded from average payment and FTE calculations 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Total Facilities, Rad/Path Specialists Out of jurisdiction physicians WCB Salary/Sessional Rural Retention Premiums Insurance Corp Shadow Billing Source: Canadian Institute for Health Information, Average Payment Physician Report, Canada and (Ottawa: CIHI, 2006)

11 Inclusion/Exclusion Criteria Summary For the 10 provinces, medical care plan fee-forservice payments comprised 78% of total payments reported to the NPDB in 2003 Average payment and FTE calculations are based on these payments Payments made to facilities and radiology and pathology specialists account for 89% of payments excluded from average payment and FTE calculations in 2003

12 Inclusion/Exclusion Criteria Summary Payment exclusions are applied to achieve comparability across jurisdictions A few provinces provide a broader range of payment information. For example, NB salary/sessional payments QC & BC Worker s Compensation Board payments SK shadow billing BC Insurance Board payments For these few provinces, a larger percentage of total NPDB payment data is excluded because the data they provide is beyond what other jurisdictions report Possibly the most significant payment exclusion is one that we do not have control over at this time

13 NPDB Medical Care Plan Fee-For-Service Payments and Clinical Alternative Payments, 2003 Alternative payments are excluded from NPDB calculations and reports because they are generally not reported to the NPDB. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Y.T. NPDB MCP, FFS Clinical Alternative Payments Source: Canadian Institute for Health Information, Alternative Payments and the National Physician Database: The Status of Alternative Payment Programs for Physicians in Canada, and Preliminary Information for (Ottawa: CIHI, 2006)

14 Overview of the FTE Physician and Average Payment Per Physician Reports

15 Full-Time Equivalent Physicians The full-time equivalent physician report provides a view on physician supply that considers variations in physician workloads Physicians may be semi-retired, they may work part-time, they may take sabbatical and they may take maternity leave At different stages in their careers, physicians may provide greater or fewer services in the same number of work hours FTE methodologies and the FTE report endeavor to account for these variations in reporting physician supply

16 Conceptual Model Behind Payment Based FTE Calculations

17 FTE Benchmarks FTE benchmarks define an upper and lower payment value for a particular provincial medical specialty group FTE benchmarks are established for a base year (2000 is the current base year for reporting) Base year FTE benchmarks are incremented using fee schedule increase/decrease information sent to CIHI annually

18 Physician FTE Values Physician FTE values are calculated annually For physicians who earn below the lower FTE benchmark: FTE i = Physician i Pay / Lower Benchmark For physicians who earn within the benchmarks: FTE i = 1 For physicians who earn above the upper FTE benchmark: FTE i = 1 + ln(physician i Pay / Upper Benchmark)

19 Number of Physicians and FTE Physicians, by Age Groups, ,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Number of Physicians Number of FTE Physicians % difference 47.87% 29.40% 15.73% 9.20% 17.14% 45.38% Source: NPDB, CIHI.

20 Number of Physicians and FTE Physicians, by Province, ,000 20,000 15,000 10,000 5,000 0 NL PE NS NB QC ON MB SK AB BC Number of Physicians Number of FTE Physicians % difference 36.30% 21.61% 31.50% 29.61% 20.12% 12.99% 21.51% 19.62% 23.93% 25.61% Source: NPDB, CIHI.

Average Payment Per Physician APP reports describe average physician payments across provinces, specialties and demographic groups APP report data series include: Average payments for physicians who

21 Average Payment Per Physician APP reports describe average physician payments across provinces, specialties and demographic groups APP report data series include: Average payments for physicians who received at least $60K in payments Average payment per FTE physician Past APP data series have included: Average for physicians receiving payments above other thresholds (e.g., $50K) Average for physicians who bill once per quarter Average payment per Full-Time physician

22 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 Average Payment Per Fee-For-Service Physician, $0 NL PE NS NB QC ON MB SK AB BC Average Pay/Physician >=$60K Average Pay/FTE Physician Source: NPDB, CIHI.

23 Other NPDB Reports

24 National Grouping System Categories Report: Percent Change in NPDB Services Per 100K Population Compared to 1995/ % 8.00% 6.00% 4.00% 2.00% 0.00% -2.00% % -6.00% -8.00% % Consults and Visits Major Surgery Diagnostic and Therapeutic Total Services Source: NPDB, CIHI.

25 Reciprocal Billing Report: Percent of Total Reciprocal Billing Services Provided to Patients From Other Jurisdictions, Western Provinces, % Percent of total RB services 80% 60% 40% 20% 0% BC AB SK MB BC AB SK MB Other Source: NPDB, CIHI.

26 Physician Services Benefit Rate Report: PSBR Benefit Rates and Indices, All Physicians, Benefit Rate $50 $45 $40 $35 $30 $25 $20 $15 $10 $5 $0 NL PE NS NB QC ON MB SK AB BC Index Weighted Average Benefit Rates Benefit Rate Indices Source: NPDB, CIHI.

27 The Evolving Role of Canada s Family Physicians, , CIHI, November 2004.

28 Percentages of FP/GPs Who Provide Office Assessment, Hospital Inpatient, Mental Health, Basic Procedural Skills and Advanced Procedural Skills Services, Canada, % of FP/GPs 100% 90% 80% 70% 60% 50% Office Hospital Inpatient Mental Health BPS APS Source: National Physician Database, CIHI

29 Percentages of FP/GPs Who Provide Surgery, Surgical Assistance, Anaesthesia and Obstetrical Services, Canada, % of FP/GPs 50% 40% 30% 20% 10% 0% Surgery Surgical Assistance Anaesthesia Obstetrics Source: National Physician Database, CIHI

30 Percent Change in Family Physician Participation Rates and Average Number of Services Provided, Surgical Assistance Services, Advanced Procedures, Obstetrical Services, Surgical Services and Anaesthesia Services, Canada, 2001 Compared to 1992 Percent Change, 2001 Compared to % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% -10.0% -20.0% -30.0% -40.0% -50.0% -30.9% 57.4% -7.6% 19.4% -42.8% 32.9% -32.4% 87.9% -28.5% 35.0% Surgical Assistance Advanced Procedures Obstetrics Surgery Anaesthesia Participation Rate Average number of services provided

31 QUESTIONS

Physician Services Analysis

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