ADVOCACY

Updated: July 28, 2021

1. Virtual Care Apps
2. COVID-19
3. AHS Medical Staff Bylaw Review
4. The United Conservative Party (UCP) Attempt to Bust the AMA
5. Continued Government Cuts to Healthcare
6. Long-Term Care and COVID-19
7. Information and Privacy Review of the Health Minister’s Office
8. Radiology Contracts Cancelled
9. Patient Care Effect of the Complex Fee Modifier Changes
10. Long waitlists for publicly funded MRI and CT exams

Virtual Care Apps

On July 1, 2021 the EZMSA mailed a package of three posters to our family physician member offices.

We value the care you provide to patients and understand the significance of the patient’s medical home. It is important to convey to our patients that apps do not know the patient, nor are they connected to the health system. We hope these posters help to promote the vital work you do because primary care is the backbone of our system.

COVID-19

*Current and frequently updated information for primary care providers from Alberta Health Services is available here*

Health System Breaking Point- Physicians Call for Help

November 12, 2020
430 physicians, the United Nurses of Alberta, the Alberta Union of Provincial Employees and Health Sciences Association of Alberta all signed a letter endorsing mandatory measures of:
- directives to work from home for anyone who is able;
- limiting contacts to those within the household or support bubble;
- restrictions on group recreation/sports activities; and
- suspension of group indoor activities (including indoor dining, bars, casinos, religious services, and theatres).
Due to their vital importance, we should aim to keep schools open for in-person learning options.
WE SUPPORTED THESE MEASURES TO AVOID STRICT AND SEVERE LOCKDOWNS.
October 29, 2020
Our health system was at a critical point to boil over in Edmonton due to multiple stressors:
- the availability of all hospital beds for patients declined significantly;
- healthcare workforce burn out;
- a strained system with the provincial government’s plan to cut 11,000 AHS positions; and
- mental illness, the destruction of primary care because of recent government changes in combination with the impact of pandemic measures, influenza, and people not going to the doctor or hospital because of fear.
View our full opinion piece here and related article by CBC Edmonton.

Back-to-school COVID-19 issues

September 4th
Alberta Health’s COVID-19 back-to-school guidelines were problematic. On August 29th Alberta Health released a public health order which has created much last minute confusion. As part of our advocacy we commented on the inconsistencies in public health guidelines and the need for clear evidence based information to the public. The press release is here and CTV News article: “Government leaving doctors ‘high and dry’ during back-to-school season, say Edmonton physicians”.
August 27th
The Government of Alberta did not prepare physicians for the pandemic back-to-school season. We published an opinion piece on how Alberta Health had not prepared family physicians for the back-to-school season. The article can be viewed in the Edmonton Journal “Family doctors need more support from government when schools reopen”.

Virtual Care Fee Codes

March 23rd
The Government responded with new virtual care codes to be used during the pandemic. While this was an improvement, virtual care must continue beyond the pandemic to continue to provide patient care. The option for patients to have a virtual visit with their physician must remain to meet the needs of patients. The fee codes are still less than in-person rates by up to 30%. For virtual care to be a viable option for physicians over the long-term, virtual care must be a reasonable rate negotiated by the Alberta Medical Association.
March 20th
A letter and press release were sent to discuss the virtual care 03.01AD code. This was to address the amount of $20 per call/per patient/per day capped rate.  Many physicians were concerned about paying their office bills when needing to focus on patient care for this pandemic. $20 was the lowest virtual care fee across the country. It was also a 51-91% cut from in-person visits. We could not sustain that rate of pay for a prolonged pandemic or we would have been forced to close our doors. Dr. Erika MacIntyre, Vice-President for the EZMSA and Dr. Darryl LaBuick were interviewed:
'A lot of preparation' being done for COVID-19 peak, local ICU doc says- CTV News March 20
COVID-19 could bankrupt clinics because of low fees for virtual visits, Edmonton doctors' group says- Edmonton Journal   March 20 
March 16th
The EZMSA sent a press release and letter to Minister Shandro to expand the 03.01AD fee code to include all patients issues, not only COVID-19 cases and self-isolation. A broad fee code was needed for physicians to physically distance to prevent the spread of COVDID-19, while continuing to provide care. On March 18th, the Government released a new bulletin to expand the code. Dr. Ernst Schuster was featured in the news:
President of the Edmonton Zone Medical Staff Association- Global 630 CHED March 16 7:42  

Patients and Community Physicians at Risk for COVID-19

March 5th
The Government of Alberta put Edmontonians and community medical clinics at risk for COVID-19. COVID-19 was most likely to be detected in community medical clinics first, yet the Government had not contacted family physicians with an adequate plan or information to prepare their clinics. Alberta received its first case on March 5th, the same day the EZMSA requested emergency preparedness with a letter to the Government of Alberta and sent a press release.
Edmonton doctors say they're ill-prepared for a coronavirus outbreak – CBC News March 6
Calgary-area woman in her 50s is Alberta's first presumptive case of coronavirus – Edmonton Journal March 6
Edmonton doctors group raises concern about Alberta’s coronavirus preparedness – Global News March 6
COVID-19: Edmonton doctors say Alberta isn't ready – CTV News March 5

Alberta Health Services Medical Staff Bylaw Review

Review of AHS Medical Staff Bylaws

The Bylaws and Rules govern the relationship between us and AHS. A review of the AHS Medical Staff Bylaws and Rules was announced July 3rd by the Minister of Health. The “Alberta Health Minister orders review 4 years after noose hung at Grande Prairie hospital” media story is here.

Zone Medical Staff Associations (one for each zone) are your representation for the Bylaws and Rules. The purpose of the ZMSAs is “to facilitate the engagement and participation of the Zone Medical Staff in Practitioner-related matters, and the fulfilment of the responsibilities and duties of Practitioners pursuant to these Bylaws and the Rules”.

Details about how ZMSAs represent you for the Bylaws and Rules are here.

A memorandum from AHS on the review is available here.

AUGUST 14th, 2020 UPDATE: The scope of the bylaw review has increased in the committee Terms of Reference.

October 9th, 2020 UPDATE: The committee has wrapped up their work. A consultant has compiled a report for Minister Shandro. Despite our request to receive a copy of the report, it is confidential and the EZMSA Executive have not seen it. We have been assured that any proposed changes to the Bylaws will follow the normal process of going to members first to vote on changes before they are signed off by the Minister.

The United Conservative Party (UCP) Attempt to Bust the AMA

The UCP is attempting to bust the AMA and we, physicians, will not stand for this. The AMA has existed for over 100 years. It will outlast the short term of this government because we decide who represents us, not Government. The AMA always has been, and will continue to be, our representing body for physician rights and compensation.

Why is the Government Continuing Cuts on Healthcare?

The COVID-19 pandemic continues as the Alberta Government maintains cuts to healthcare. The Government blanket states that overall spending on healthcare remains the same, plus a $500 million addition, to sooth the public. However, they neglect to address the cuts that are still in place. The devil is in the details of how that money is spent and the way they treat their workforce. They have walked back some of the cuts but continue with many that started March 31st. These issues may only be fixed with negotiation, arbitration, and an agreement with the AMA. The Government bulletins with these cuts are here.

Long-Term Care and COVID-19

Long-term care has been considered by some to be this country’s greatest failure with the majority of deaths occurring among residents of continuing care homes (which include nursing homes, long-term care and supportive living facilities). An article from the Canadian Medical Association Journal estimated that between 62% - 82% of deaths due to COVID-19 in Canada have occurred among residents of continuing care homes.

We are fixated on blaming when we should focused on supports and improved protocol to reduce spread.

We also need to explore options that allow family members to safely see each other to connect loved ones again.

Continuing care and COVID-19: failure…or fortitude? -June 3

Information and Privacy Review of the Health Minister’s Office

On April 28th the Minister of Health’s press secretary released information via the Edmonton Journal stating the Government has looked at the Garneau Pediatric Associates individual clinic billing and publicly released billing information for this single
clinic. Many patients and physicians called out to the Office of the Information and Privacy Commissioner of Alberta (OIPC) to investigate as they were concerned for their information and privacy. The EZMSA has sent a letter to the OIPC to formally request an investigation to determine if there was a privacy breach by the Minister’s office.

“Second privacy breach complaint filed against Alberta Health Minister Tyler Shandro” - CBC News May 11

Radiology Contracts Cancelled

On March 13th the Government had quietly cancelled radiology contracts in Calgary and Edmonton. A one-year notice was given to terminate contracts with major providers to submit a request for proposal. The EZMSA addressed the inappropriateness of cancelling contracts and attacking our colleagues during a pandemic:

“Alberta radiologists 'bewildered and demoralized' as province cancels contracts amid COVID-19 pandemic” - CBC March 16

Patient Care Effect of the Complex Fee Modifier Changes

Dr. Don Wilson, our new Community Medical Staff Association President, spoke to address the need for patients to understand how the new changes affect time with patients.

‘They need extra time’: Doctor says provincial time cap on doctor visits will cost patients – CTV News February 23

UPDATE: the complex fee modifier changes have currently been postponed.

Long wait lists for publicly funded MRI and CT exams

Edmontonians are paying $375-800 out-pocket for private testing. Private fees are not covered by the Alberta Health Care Insurance Plan. In some cases doctors are paying the fees for their severely ill patients who cannot afford the fees.

Patients at risk
Physicians sounded the alarm that February wait times for MRI and CT exams put patients at risk. The average wait time was 375 days for a MRI exam at the University of Alberta Hospital. In our neighbour provinces patients wait 30 days in Saskatchewan and 44 days in British Columbia. Patients were waiting an average of 297 days today for a CT exam at the Leduc Community Hospital. Next door, patients wait 17 days in Saskatchewan and 21 days in BC.
The wait times continue to not meet the 30 day standard.

Ignoring public health care
Not providing publicly funded MRI and CT exams ignores the Canada Health Act requirements of patient access to public medically necessary services. 

Advocacy
The Council of Zonal leaders, including the EZMSA, wrote letters to express our concern to:

We contacted local media and the official opposition health critic with this press release.
We were featured in the news:

Response
The EZMSA did not receive an official response from Minister Shandro; however, he responded February 21st on social media.
Alberta Health Services provided this letter on Feb 28th.
We are encouraged by the immediate response and support of Alberta Health Services to reduce wait times. Our advocacy is not finished until the wait times for MRI/CT scans meet the 30 day standard and this commitment by Alberta Health is completed.