1. PHYSICIAN INFORMATION
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
Chair:
Graham W.S. Scott, C.M., Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
AHSC AFP TASK FORCE
PHYSICIAN INFORMATION
EXCHANGE SESSIONS
MAY - JUNE 2006

2. SESSION OVERVIEW Background on AHSC AFP Initiative Guiding Principles
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
SESSION OVERVIEW
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
Background on AHSC AFP Initiative
Guiding Principles
Role and Responsibilities of the AHSC AFP Task Force
Update on Task Force Activities
Discussion

3. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP PROJECT BACKGROUND
What is an AHSC alternate funding plan (AHSC AFP) and how does it work?
An AHSC Alternative Funding Plan (AFP) is a contract between the physician group, teaching hospital(s), university and the Ministry of Health and Long-Term Care (MOHLTC), the Ontario Medical Association (OMA).
The AHSC AFP merges multiple funding sources, including conversion of fee-for-service billings, for the remuneration of participating medical staff for clinical service, education, research and associated administration.
The AHSC AFP contract sets out fundamental principles and measurables that recognize and better align the goals and directions of the AFP governance organization, the hospital and the university.
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright

4. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP PROJECT BACKGROUND
What funding sources are merged for the purpose of the AFP?
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
Funding sources for the next phase of the AHSC AFP include:
Conversion of existing fee-for-service funds;
$75M in Phase I funding;
$150M in new funding negotiated in 2004 Physician Services Agreement;
Specialty Review Funding; and
Other funding sources to be determined.

5. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP PROJECT BACKGROUND
Why create AFPs for Academic Physicians?
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
AHSCs in Ontario face serious challenges, including:
Difficulty in recruiting and retaining skilled academic physicians;
Growing competition from increasing tertiary care capacity in community hospitals;
Constraints on fees for professional medical services;
Inadequate funding for academic activities; and
Increased teaching loads.

6. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP PROJECT BACKGROUND
Why create AFPs for Academic Physicians (cont’d)?
There is a lack of consistency across the province for remunerating academic physicians:
Some centres have full AFPs such as the Hospital for Sick Children, Kingston (SEAMO) and the Children’s Hospital of Eastern Ontario;
Various sites have specialty specific local APPs, examples include Medical Oncology and Geriatric Medicine; and
Additional non fee-for-service funding agreements for some services (e.g. Emergency Department Alternate Funding Agreements).
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright

7. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP PROJECT BACKGROUND
Phase I
The primary objective of the Phase I AFPs was to stabilize AHSCs, and significant progress was made in achieving this goal:
Signed Phase I AHSC AFP Agreements cover thirteen participating sites and approximately 3000 physicians in Toronto, London, Ottawa and Hamilton;
Academic physicians began receiving compensation in recognition of their academic and research contributions;
Governance structures were established at each participating site;
Some sites have noted that the prospect of a more complete AFP has facilitated recruitment; and
In some cases, practice plans have been put in place where none existed before.
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright

8. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP PROJECT BACKGROUND
Next Phase
Phase I revealed a general willingness on the part of physicians to move forward with full alternate funding plans.
An evaluation of Phase I showed that, if full AFPs are to be successful, they must include:
Development of a meaningful accountability framework;
Appropriate designation of in-scope and out-of-scope activities;
Robust governance structures;
Fairness and transparency; and
Dispute resolution.
Chair:
Graham W.S. Scott, C.M.,Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright

9. AHSC AFP PROJECT BACKGROUND
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
Chair:
Graham Scott, C.M., Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
AHSC AFP PROJECT BACKGROUND
Appendix G
Through the 2004 Physician Services Agreement, the OMA and MOHLTC agreed to make $150M in new funding available to the AHSC AFPs.
Appendix G called for the establishment of an AHSC AFP Task Force to advise the Physician Services Committee (PSC), a joint committee of the OMA and the MOHLTC, on the development of a common AHSC AFP template and the allocation and distribution of the new investment.
Appendix G also called for the creation of two Expert Panels.
The Academic Physician Human Resources Expert Panel (APHREP) which is charged with the development of an integrated human resource strategy across AHSC sites.
The Accountability Expert Panel (AEP) will advise on an appropriate methodology for measuring AHSC deliverables and on structures and processes for reporting the measurements.

10. AHSC AFP TASK FORCE GUIDING PRINCIPLES
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
Chair:
Graham W.S. Scott, C.M., Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
The Task Force is guided by principles outlined in Appendix G of the 2004 Physician Services Agreement. Some principles of note are:
The allocation of funds to AHSCs, including the allocation methodology, will be transparent;
The AFPs should not affect the professional autonomy or current status of participating physicians as independent contractors or employees.
The AFPs will respect the autonomy of practice plans;
Participation in the AFP is voluntary; and
All existing Phase I AHSC AFPs; and all existing AHSC AFPs that are not Phase I, with the exception of Hospital for Sick Children, are entitled to an allocation of the New Investment contingent on their agreement to be integrated into their local AHSC AFP governance structure.

11. ROLE AND RESPONSIBILITIES
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
Chair:
Graham W.S. Scott, C.M., Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
AHSC AFP TASK FORCE
ROLE AND RESPONSIBILITIES
Through Appendix G, the Task Force has been charged with making recommendations on fundamental elements that will form the basis of the AHSC AFP template. These components include:
Recommend how academic specialities will be categorized for the purpose of this initiative to ensure consistency across AHSCs;
Recommend a methodology to determine the number of full-time equivalent (FTE) physicians for each academic specialty in each AHSC;
Determine current funding for each specialty group at each AHSC;
Recommend best practices to strengthen and enhance existing governance structures; and
Develop an academic mission which highlights the unique contributions that AHSCs make to the health care system.

12. AHSC AFP TASK FORCE STRUCTURE

13. AHSC AFP TASK FORCE ACTIVITIES
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
Chair:
Graham W.S. Scott, C.M., Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
AHSC AFP TASK FORCE
ACTIVITIES
A comprehensive work plan with defined timelines has been developed to guide the work of the Task Force, its Working Groups and Expert Panels.
Working Groups have been working on project-specific assignments that will further the development of the fundamental elements previously mentioned.
The Expert Panels are currently working on their mandate.
An AHSC AFP Task Force website will be active by the end of June and will provide detailed information on the AHSC AFP Project. The website will include a mechanism through which questions and comments can be sent directly to the AHSC AFP Project and responded to in a timely fashion.

14. AHSC AFP TASK FORCE TIMELINES
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
Chair:
Graham W.S. Scott, C.M., Q.C.
Dr. John Brown
Dr. Ken Edwards
Dr. Robert Howard
Dr. Joel Jeffries
Dr. John Kelton
Dr. Gillian Kernaghan
Dr. Geraint Lewis
Dr. Mark MacLeod
Dr. Chris Morgan
Dr. Barry Rubin
Dr. Kevin Smith
Dr. John Wright
MILESTONES
PROPOSED TIMELINES
Draft Principles from Working Groups
June 2006
Research and Planning
July – August 2006
Preliminary Reports on HR Strategy and Accountability Framework
September 2006
Stakeholder Consultation
October – November 2006
Template Development
November – Early January 2007
Finalize and Present Template Recommendations to PSC
Late January 2007
Allocation
February 2007
Local Agreements
March – April 2007