Presentation to New York State Academy of

Family Physicians Scott Wooder, MD

Chair OMA Negotiations Committee

January 31, 2009

Overview

• Ontario Medical Association

• Scope of Negotiations

• Negotiations Process

• 2008 Negotiations

• Factors necessary for successful negotiation

Health Expenditures in Ontario

• Total 2007/08 Ontario Provincial Budget: $95.96 billion

• Total 2007/08 Provincial Expenditure on Health: $42.32 billion (44.1%)

• Total 2007/08 Provincial Expenditure on Physicians: $9.52 billion (9.92%)

• 2007/08 Ontario GDP: $582.02 billion

Ontario Medical Association• Established at an inaugural meeting on June 1, 1881.

• 34,000 members: Practicing physicians, residents, and students

• Governed by an elected Council composed of 250 delegates who represent geographical and specialty divisions

• Between meetings of Council, the Board of Directors represents the OMA’s governing body and members in all business affairs, and exercises the rights and powers of the Association.

• Contractually established right and duty to negotiate physician compensation for all direct and indirect payments from government

• Membership is voluntary

• Dues are mandatory ($1730) Enshrined in legislation

Ontario Medical AssociationThe OMA negotiates

The Schedule of Benefits All Alternate Payment Programs Academic Health Science Contracts Hospital on Call Stipend All Sessional payments Primary Care Models including capitation rates and

bonuses IT grants Workman Compensation Rates* Payments from other Ministries Payment for forms* Salaries for clinical work

Negotiations 2008

Negotiations CycleNegotiations is a continuous cycle

1. Internal consultation

2. Mandate development

3. Bilateral negotiations

4. Ratification

5. Implementation

• Repeat

Consultation Process• Council Workshops

Spring 2006: Introduction to the negotiations process

Winter 2006: Priority Setting

April 2007: Plan B

• Physician Leader Consultations October 2007: Master List of

Broad Negotiating Issues

• Negotiations Survey – Fall 2007 (3800 responses)

• Negotiations Committee members at various meetings

• Negotiations Committee met with over 35 Sections

Negotiations• OMA Negotiations Committee elected July 2007

5 physicians, all in full time practice

Chair, 2 GPs, 2 Specialists and outside Negotiations Advisor

• OMA Board approved Negotiations Mandate December 2007

• Bilateral Negotiations began February 14, 2008

• Monthly meetings and updates for the OMA Board and Executive

• 45 bilateral meetings February 2008 to July 2008; 5 meetings held in

September 2008

• Each committee member spent over 100 days on this set of

negotiations

Negotiations• September 11, 2008 Board meeting - unanimous endorsement

• September 27-28, 2008 Physician Leader Meeting

• President and Negotiations Chair went on the road to explain

agreement

• Visited over 20 communities in a 3 week period

• October 8-15 2008 Member Referendum: 34% turnout with 79%

support

• October 18, 2008 Special Council meeting: Voted to accept

Agreement Highlights

Highlights

Total Contract Value

$1.1 billionPrograms

$240 million

Fees12.25%

3% October 20082% October 20093% October 2010

4.25% September 2011

April 1, 2008 to March 31, 2012

Highlights: ProgramsPrimary Care Programs

• Interprofessional Shared Care: Nurses

• Chronic Disease Management: Diabetes

• Unattached Patients: Bonus and Registry

• Bonuses: In Office Services; Out of Office Services; After Hours Care; Out of Office Care

• Other

Hospital Care Programs

• Most Responsible Physician (MRP)

• Hospital On Call Programs

Other Programs

• LHIN Physician Collaboration Incentive Fund

• Northern and Rural Programs

Relativity• Our Focus in 2008 was to address wide disparity in

income between specialties

• Our policy is to move specialists to a common net hourly rate

• Family doctors target is to earn 80% of specialist’s net hourly rate

• In 2003 Family doctors earned about 58% of specialist average

• In 2008 Family doctors earn about 76% of specialist average

• Many Family doctors involved in a comprehensive care model of care do much better than 80% of specialist average

Negotiations-Essential Factors• Internal Political harmony

Discipline

• Respectful relationship with Payor Work to achieve a set of common goals Leverage BATNA

• Commit to Deliver on Agreement Letter of agreement Spirit of agreement New issues

Trust