1. ACADEMIC HEALTH SCIENCE CENTRES ALTERNATE FUNDING PLAN
PLAN TASK FORCE
ACADEMIC HEALTH SCIENCE CENTRES ALTERNATE FUNDING PLAN
PHYSICIAN CONSULTATION PAPER
DECEMBER, 2006

2. SESSION OVERVIEW What is an alternate funding plan (AFP)?
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
SESSION OVERVIEW
What is an alternate funding plan (AFP)?
What is our collective interest in AFPs?
What’s in it for you?
Why are we here today?

3. WHAT IS AN AHSC AFP AND WHY?
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
WHAT IS AN AHSC AFP
AND WHY?
An AFP provides physicians with stable and more flexible funding.
An AFP provides a structure to which additional funding can be flowed direct to physicians.
An AFP structure provides a group of physicians with shared governance and accountability (allowing $ and accountabilities to be pooled and distributed).
AFPs provide better recruiting leverage (flexibility to fund physicians to come and allow their practices to grow).
AFP funding helps offset constraints in the OHIP Schedule (complexity and additional time requirements of some services, indirect services).
An AHSC AFP provides new and enhanced Ministry funding for academic work and allows local allocation decisions.

4. ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
“WHAT’S IN IT FOR ME?”
Your income will be paid partially through fee-for-service and partially through a stable monthly payment.
$225M + SRF $ are added to the system as base funding every year.
You receive increased funding to address clinical competitiveness for the work you perform in the AHSC.
You receive better funding for your teaching and research activities.
There is additional funding for new physicians.
You keep your billing number.
There is no cap on your fee-for-service activity.

5. BY MOVING INTO AN AHSC AFP WHAT CHANGES?
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
BY MOVING INTO AN AHSC AFP WHAT CHANGES?
How physicians are funded
How physicians are paid
How physicians work together and with their hospital and university
How physicians share in governance and accountability
How new physicians are recruited

6. HOW ACADEMIC PHYSICIANS ARE FUNDED
PRE AHSC AFP
PHASE I
PLANNED
OHIP
FFS
PAYMENTS
OHIP FFS
PAYMENTS
OHIP FFS PAYMENTS
(30-40% of current
services billed)
CONVERSION DOLLARS
(Paid monthly based on
60-70% of previous year’s
base income)** +
$225M
FULL AFP FUNDING
$75M
PHASE I $
SPECIALTY REVIEW FUNDING (SRF)
+ SRF $
HOSPITAL
FUNDING
HOSPITAL
FUNDING
** Any FFS increases during agreement are added to conversion fund
HOSPITAL
FUNDING
UNIVERSITY
FUNDING
UNIVERSITY
FUNDING
UNIVERSITY
FUNDING

7. HOW PHYSICIANS ARE PAID
PRE AFP
100% FFS
PHASE I
PLANNED
BLENDED MODEL AFP
% of physician’s billings (calculated using a past base year) is “converted” and paid to the Governance each month as conversion funding
10% of OHIP Payments + $75M Phase I funding flowed to Governance each month
OHIP
BILLINGS
10% of OHIP payments flowed to Governance Organization
OHIP
BILLINGS
AFP FUNDS
(Conversion + New Funding)
OHIP
BILLINGS
100% of OHIP payments go directly to physician (or to practice plan)
AFP
GOVERNANCE
90% of OHIP payments go directly to physician (or practice plan)
% of OHIP payments flow directly to physician or practice plan (no cap on fee-for-service billings)
AFP
GOVERNANCE
Physician paid a monthly amount through practice plan
Governance flows 10% and a portion of the Phase I funding directly to physicians through practice plans
PRACTICE
PLANS

8. ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
AHSC AFP COMPONENTS
The AHSC AFP Task Force has been working to develop the detailed framework for this complex process.
The overarching principle is a consistent and transparent approach across all AHSCs.
This requires development of common definitions, criteria, allocation approach, accountabilities etc.
WE ARE AT A STAGE NOW WHERE THE TASK FORCE NEEDS YOUR FEEDBACK ON WHAT IT HAS DEVELOPED TO DATE

9. Competitiveness and Retention
COMPONENTS OF THE AHSC AFP
How To
Distribute
New Investment
AHSC AFP GOALS
Allocation
Methodology
AHSC
Competitiveness and Retention
Governance
Accountability
New
Complement
AHSC AFP
AGREEMENT
Develop an appropriate approach for measuring clinical and academic deliverables and ensure agreed-to volumes are maintained
Allocate portion of investment to assist in new recruitment
Support local management of new recruitment with criteria and impact analyses common to all AHSCs
Facilitate better provincial HR monitoring and planning
Agreements that:
Stabilize the AHSCs ability to retain and recruit academic physicians
Create a climate to enhance the education of future healthcare professionals
Create an environment that stimulates innovations in clinical care and knowledge advancement
Use a fair and transparent process to allocate the new investment to all eligible physicians wishing to participate – both Phase I and current academic AFPs/APPs (except HSC)
Address income disparities, by specialty, between AHSCs and between academic and non-academic physicians
Ensure stable remuneration for the clinical and academic activities
Develop robust AFP governance structures
able to manage increased funding and increasing accountabilities

10. COMPONENTS OF THE AHSC AFP
Allocation
Methodology
TASK FORCE RECOMMENDATIONS
FOR YOUR CONSIDERATION
Task Force supports a common conversion level, likely between 60-70% conversion from FFS – meaning 60-70% of value of annual FFS billings during a recent period chosen as the base would be “converted” into the AFP fund. Physicians would then continue to bill FFS but would be paid 30-40% of the value of those billings.
The new investment ($225M) will be used to:
Address the gap in clinical income, by specialty, between academic and non-academic physicians and between AHSCs
Support academic activities
Provide each AHSC with residual funding to address local issues
Provide each AHSC with recruitment and administrative funding
It is understood that that no specialty group at each site will receive less funding then they are currently getting.
Participation is voluntary:
At the department level, minimum 80% participation
Phase I eligibility criteria for each physician
What impact will the proposed conversion approach have on your group?
What more will you need to know to make your decision to participate?

11. Competitiveness and Stabilization
COMPONENTS OF THE AHSC AFP
GOAL
AHSC
Competitiveness and Stabilization
Clinical
Academic
70%
30%
TASK FORCE RECOMMENDATIONS
FOR YOUR CONSIDERATION
Do you support this basic approach to allocating the retention portion of the new funding? Why? Why not?
Any comments on either portion of the FTE split?
Available academic measures to determine proportionate split of academic funding that are under consideration include:
Medical Trainee Days
Tri-Council Research Funding (Social Sciences and Humanities Research Council (SSHRC), National Sciences and Engineering Research Council (NSERC) and Canadian Institutes of Health Research (CIHR)
Academic physician FTE to be based on a 70% clinical and 30% academic split. Note: Not intended to represent an hourly allocation or other time considerations, rather a rough estimation of overall effort required by a group of physicians.
Clinical competitiveness addressed through blended approach:
Address competitive issues between specialties at academic and non-academic centres
Residual funding to then be distributed to AHSCs to more broadly support stabilization
The measure of the clinical portion of the FTE should be based on average income by specialty by site relative to academic average income (using the CIHI methodology)
Academic stabilization:
The measure of the academic (teaching and research) portion of the funding to be a per site proportional allocation based on relative academic contribution between sites
Academic measures being considered to determine the proportionate split are medical trainee days and Tri-Council Research Funding

12. AHSC COMPETITIVENESS AND STABILIZATION
REPAIR/ RETENTION FUND
ACADEMIC
30%
CLINICAL
70%
Clinical competitiveness fund
Allocated by specialty using clinical FTE methodology
AHSC stabilization fund
Any residual from 70% fund allocated by site likely based on total FTE count
Academic fund
Per site allocation based on relative proportion of academic (teaching and research) activity between sites

13. Determine number of FTEs Determine gap to clinical income target
CLINICAL FTE METHODOLOGY
STEP 1:
Determine number of FTEs
by specialty by site
Based on measured clinical activity
STEP 2:
Determine gap to clinical income target
by site by specialty
Based on calculation of current clinical income
Include all FFS billings
for each specialty
at each site
Calculate current
clinical base funding* per
specialty per site
*e.g. Phase I, SRF
Use CIHI methodology to
establish 40th-60th percentile
per academic specialty
Divide by FTEs
Compare average $
per FTE to clinical income target
(i.e. community average)
Assign FTE value
Number of FTEs per specialty per site
Funding gap per specialty per site

14. DETERMINING THE CLINICAL COMPETITIVENESS PORTION OF THE ALLOCATION FOR AHSC #1 Department Xology Dr. Ross, Dr. Smith, Dr. Jones
Step 1: Determine number of clinical FTEs
FFS billings: Dr. Ross $200K (0.8 FTE score)
Dr. Smith $400K (1.2 FTE score)
Dr. Jones $300K (1.0 FTE score)
$900K
40th percentile = 264K, 60th percentile = 325K, FTE Score = 3
AHSC #1 Department FTEs = 3
Step 2: Determine gap to clinical income target
Department’s total FFS billings: $ 900K
Department’s total Phase I $: $ 90K
Department’s total SRF $: $ 100K
$ 1090K
Average funding/FTE = $1090K/3 = $363K
Average community Xology FTE: $400K
Gap to be funded = $37K x 3 = $111K
*Done using CIHI methodology

15. DETERMINING THE OTHER PORTIONS OF THE FUNDING ALLOCATION FOR AHSC #1 Department Xology Dr. Ross, Dr. Smith, Dr. Jones
ADDITIONAL AFP FUNDING SOURCES
Retention Residual
Portion of stabilization fund to be used for a more flexible per site allocation
Academic Contribution
30% of retention portion of new funding to be distributed per site based on academic contribution
TOTAL FUNDING SOURCES FOR DEPARTMENT XOLOGY AT AHSC #1
Pre AFP Phase I of AFP Full AFP
OHIP 900K OHIP 900K Conversion of current funding
Total $900K + Phase I 90K % of billings 540K
+ SRF 100K -Value of Phs I/SRF 190K
Total $1090K Current OHIP (40%) 360K Competitiveness 111K
+ Residual K
+ AFP Academic K
Total $1276K
In addition are hospital, university and other funding sources (e.g.
HOCC) not rolled in to AFP but continuing to fund the MD group

16. COMPONENTS OF THE AHSC AFP
GOAL
Effective
AFP
Governance
TASK FORCE RECOMMENDATIONS
FOR YOUR CONSIDERATION
The Governance Working Group has drafted a series of recommendations which include the principles and requirements prescribed in the 2004 OMA Agreement:
AFPs will respect the autonomy of the practice plans
Democratic participation by physicians in the distribution of physician funds
Practice plans must have a written process and methodology for determining and distributing compensation to members including a dispute resolution mechanism
Establishment of a Signatories Committee/Agreement by each governance organization (consensus committee of three AHSC parties)
Full and effective physician participation in the planning and negotiation of AFP deliverables and accountabilities
Alignment of physician, hospital and university strategies and priorities
Governance organization to ensure deliverables are met
Do you support these principles?
Are there any barriers that you might experience in implementing these recommendations? Is there anything that the Task Force could do to help facilitate?

17. COMPONENTS OF THE AHSC AFP
GOAL
Clear and
Appropriate
Accountability
TASK FORCE RECOMMENDATIONS
FOR YOUR CONSIDERATION
We are working towards an accountability framework that integrates with the fee-for-service system. Do you have any thoughts or advice for us?
What considerations should be kept in mind as the framework is developed?
e.g. Accountability is a responsibility of all the parties, not just the physicians.
The mandate of the Accountability Expert Panel is to develop a new accountability framework for physician services recognizing the limitations of using FFS data only.
The Task Force recommends a phased process:
Stage A ( ): Develop AHSC-level indicators for initial AFP agreements
Stage B (2007): Develop specialty-level performance measures/deliverables and data sources/systems to support them
Stage C: Develop physician-level measures, as needed and appropriate

18. COMPONENTS OF THE AHSC AFP
GOAL
Attracting
New
Complement
TASK FORCE RECOMMENDATIONS
FOR YOUR CONSIDERATION
The Task Force is looking at targeting $25M of new AFP investment to support recruitment efforts.
This funding would be proportionately allocated to each site to support their own HR needs.
The Academic Physician HR Expert Panel is developing a recruitment strategy with common elements to be used across all AHSCs:
Local flexibility and priorities across all AHSC sites within shared provincial HR planning principles.
A common and inclusive definition of academic physician between sites.
Use of a common impact analysis template to ensure all parties locally understand and can support HR decisions.
Do you have any particular questions/concerns that you feel that the HR Panel should consider?
What recruitment challenges do you face and how might this process support them?

19. SUMMARY OF ALLOCATION OF NEW INVESTMENT
REPAIR
$200M*
RECRUITMENT
$25M
CLINICAL
70%
ACADEMIC
30%
Clinical competitiveness fund
Allocated by specialty
AHSC stabilization fund
Residual funds allocated by site likely based on total FTE count
Academic fund
New complement fund
Allocated by site
Per site allocation based on relative proportion of academic (teaching and research) activity between sites
*Some amount (e.g. 5%) to be used to support administration and local issues

20. WHAT DO I NEED TO DO TO BE A PART OF THE AHSC AFP?
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
WHAT DO I NEED TO DO TO BE A PART OF THE AHSC AFP?
Meet physician eligibility requirements as defined in Phase I (medical staff appointment and hospital privileges attached to that appointment, member of a hospital department, university appointment or makes a major contribution to the academic mission)
Have a defined relationship with a practice plan (i.e. contractual not necessarily membership)
Participate in a democratic process around distribution of funding
Maintain current clinical and academic workloads (incentives to grow)
Sign a Declaration and Consent to allow AHSC billings to be shared between MOHLTC and OMA

21. ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
NEXT STEPS
Written feedback and comments are encouraged and can be submitted to the Task Force though your Department and/or Governance Organization
Task Force will finalize its recommendations based on the feedback it receives and we will continue to communicate updates to you through your Governance Organization
We will be coming back to you in the near future to discuss next steps such as the D&C process
Your Governance Organization will meet with you to define your local process
Task Force is targeting April 1st 2007 agreements

22. ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
CONSULTATION PROCESS
The planned AHSC AFP will represent change for Governance Organizations and participating physicians and the Task Force would like your feedback on the proposed directions and recommendations outlined in this document. This consultation period (physician sessions will also be held in November and December 2006) is your opportunity to voice your support for, or concerns about the proposed components of the AHSC AFP template. It is an opportunity for you to ask questions and get clarification on any outstanding issues you may have. The AHSC AFP initiative is about academic physicians and your thoughts and opinions are important to shaping the direction of the Task Force going forward.
Comments and feedback should be submitted to the AHSC Task Force through your department or Governance Chair. Comments can also be copied to the Task Force directly through the comments and feedback button in the Working Documents section of the Task Force website at - password mohahsc or via to

23. ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
TASK FORCE REPORTS
The following reports are currently available on the Task Force website at: password – mohahsc.
Calculation of Current Funding Update
Governance Working Group Report and Recommendations
FTE Working Group Report and Recommendations
Draft Prototype Academic Mission, Goals and Responsibilities
Notification will be forwarded to all governance administrators as new reports and documents are posted. Questions, feedback and comments can be submitted directly to the AHSC AFP project using the contact information posted on the website. Messages will be responded to within 24 hours.

24. FREQUENTLY ASKED QUESTIONS
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
FREQUENTLY ASKED QUESTIONS

25. FAQs What is the process for joining and exiting the AFP?
ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
FAQs
What is the process for joining and exiting the AFP?
Participation in the AFP is voluntary and physicians will be permitted to exit the AFP should they desire to do so. Physicians must participate in the AFP to be eligible for the new investment funding. Physicians exiting the AFP would no longer be entitled to AFP funds and would return to fee-for- service billing. Processes will be implemented to enable physicians exiting the AFP to return to full billing practices and to make the necessary adjustments to the base AFP funding allocation.
Do I need to give up my OHIP billing number to participate in the AFP?
No, under the proposed blended model, physicians will continue to bill the schedule for their clinical work and will maintain their current OHIP billing practices.
Will my funding allocation go down in the planned AFP?
The Task Force is committed to adhering to the principle in Appendix G that states that no specialty group at any site will receive less.
Is there a cap on the amount of fee-for-service that I can bill?
The AHSC AFP Task Force wishes to ensure that patients in Ontario continue to have access to specialist services and that service volumes are maintained. Therefore the Task Force is recommending that no cap be placed on fee-for-service billings.

26. ACADEMIC HEALTH
SCIENCE CENTRES
ALTERNATE FUNDING
PLAN TASK FORCE
FAQs
How does this initiative fit into the Physician Services Agreement re- assessment?
We do not know if it does. The Task Force has its mandate and funding. The key will be getting the agreements in place in a timely manner. The Task Force is currently targeting an April 1st agreement date.
How does the AFP accommodate physicians doing more clinical work?
The agreement will set out deliverables, including clinical volumes. We will discuss looking at a range or band of service volumes to provide some flexibility. All parties to this agreement will have to negotiate and then agree to these deliverables. In addition, by implementing blended AFPs, physicians can continue to bill and receive a portion of their funding based on those billings. Those billings will not be capped.
How often will the numbers on clinical and academic deliverables be negotiated?
Generally, deliverables and funding for those deliverables are negotiated for the term of the agreement. If there is an unexpected changed that may impact those deliverables, the Parties will discuss what to do.