physician services analysis - alberta · 2016-03-01 · 1 physician services analysis the following...

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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 (CIHI).

Analysis related to growth in Alberta’s physician services budget and physician benefit programs is based on AH physician services budget data.

Alberta has seen significantly higher growth of both its overall health budget and its physician services expenditures relative to comparator provinces

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Provincial Health Expenditure ($ per capita)2000 2015 % Growth

Alta. $2,068 $4,862 135%Sask. $2,082 $4,621 122%Ont. $2,048 $3,752 83%Que. $1,969 $3,656 86%B.C. $2,269 $3,983 76%

Comparator Average $2,062 $3,798 84%

Provincial Physician Expenditure ($ per capita)2000 2015 % Growth

Alta. $333 $1,058 218%Sask. $388 $942 143%Ont. $474 $947 99%Que. $353 $852 142%B.C. $477 $848 78%

Comparator Average $434 $902 108%

• The physician services expenditure growth is outpacing growth of total health budget growing 218% from 2000 to 2015. The next closest comparator province, Saskatchewan, grew 143% in the same time period.

11%27%

50%70%

92%

116% 123%135%

6% 19%32% 48%

66% 76%81% 84%

0%

50%

100%

150%

200%

250%

2000 2003 2006 2009 2012 2015

Grow

th %

Calendar Year

Cumulative Provincial Health Expenditure Per Capita Growth

(Calendar Year: 2000 to 2015)

Alberta

ComparatorAverage

Alberta

ComparatorAverage

11%

41%59%

87%

138%

175%195%

218%

6%16% 29%

47%69%

89%

100% 108%

0%

50%

100%

150%

200%

250%

2000 2003 2006 2009 2012 2015

Calendar Year

Cumulative Provincial Physician Expenditure Per Capita Growth

(Calendar Year: 2000 to 2015)

KPMG, Physician Services Analysis February 2016

© 2016 Government of Alberta

• $4,862 per capita spending on health

• $1,058 per capita spending on physician services

In 2015 Alberta had the highest provincial expenditure on health per capita and physician services per capita among the comparator provinces

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Calendar Year 2015Source: CIHI National Health Expenditure Database, KPMG Analysis

18% 20%health physicians

5% 11%health physicians

23% 10%health physicians 25% 19%

health physicians

QCSK

ON

AB

Per Capita Provincial Expenditure 2015 BC AB SK ON QC

Health $3,983 $4,862 $4,621 $3,752 $3,656

Physician Services $848 $1,058 $942 $947 $852

Note: the percentages and arrows in the chart represent the difference in health and physician services expenditures relative to Alberta



• During the 7-year period from FY04-05 to FY10-11, the PSB grew at an average rate of 11.3%• During the 3-year period of 0% rate increases (FY11-12 to FY13-14), the PSB grew at an average rate of

6.4%, driven by population growth and utilization growth

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Rate increases, population growth and utilization growth are key drivers of the total growth in the physician services budget

3.1% 3.3%4.5% 4.5%

2.5%

5.0% 4.5%2.5%

1.3% 1.4%

2.1%3.3%

2.6%

3.3%2.9%

2.6% 3.3% 4.0%

3.9%

6.3%

11.8%

15.8%

11.6%

13.6%

11.6%

8.6%8.2%

4.3%

6.7%

8.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

2004-05 2005-06 2006-07 2007-08 2008-09* 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

% G

row

th in

Phy

sicia

n Se

rvic

es B

udge

t

Fiscal Year

% Rate Increase Estimated Utilization Growth Due to Population Estimated Utilization Growth Due to Other Factors

Key Variables Driving Growth of Alberta’s Physician Services Budget (Fiscal Year: 2004-05 to 2014-15)

0% Fee Growth



In 2013 Alberta has a relatively young population, with the smallest share of individuals over the age of 60 among comparator provinces

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– 59% in Saskatchewan– 57% in Ontario– 56% in Canada– 55% in British Columbia– 54% in Quebec

– 7.3% in British Columbia– 7.2% in Quebec– 7.1% in Saskatchewan– 6.8% in Ontario – 6.8% in Canada

• In 2013, Alberta had a median age of 36.0 years, lowest in Canada

Source: Statistics Canada CANSIM Table 051-0001: Estimates of Population by Age Group and Sex 2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% o

f Pop

ulat

ion

in A

ge G

roup

Provincial Demographics (2013)

75 and Over

60 to 74

45 to 59

30 to 44

15 to 29

0 to 14

Age Group



Alberta has a relatively healthier population, as measured by prevalence of key chronic illnesses

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Source: Statistics Canada. Table 105-0502 Health Indicator Profile 2013-14Diabetes: Population aged 12 and over who reported that they have been diagnosed by a health professional as having diabetes. Diabetes includes females 15 and over who reported that they have been diagnosed with gestational diabetes. COPD: Population aged 35 and over who reported being diagnosed by a health professional with chronic bronchitis, emphysema or chronic obstructive pulmonary diseaseHigh Blood Pressure: Population aged 12 and over who reported that they have been diagnosed by a health professional as having high blood pressure.Mood Disorder: Population aged 12 and over who reported that they have been diagnosed by a health professional as having a mood disorder, such as depression, bipolar disorder, mania or dysthymia

SK, 3.2%

AB, 4.1%

ON, 4.3%

BC, 4.4%

QC, 4.4%

COPD

AB, 15.1%

BC, 15.8%

QC, 17.2%

SK, 17.8%

ON, 18.5%

High Blood Pressure

QC, 5.2%

AB, 7.1%

SK, 7.8%

ON, 8.4%

BC, 9.3%

Mood Disorder

AB, 5.3%

BC, 5.5%

SK, 6.7%

ON,6.7%

QC, 7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Prev

alen

ce

Diabetes

Chronic Illness Prevalence (2013-14)



Relative to comparator provinces, Alberta ranks last or second to last in access to primary care as measured by 4 key indicators

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ON, 91% BC,

85% SK,80%

AB,80% QC,

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% o

f Res

pond

ents

Have a Regular Doctor

BC,46% SK,

43%ON,42%

QC,40% AB,

36%

Same/Next Day Appointment

BC,44%

ON,42% SK,

37% AB,33%

QC,32%

Ease in Finding After Hours Care

QC,75% BC,

67%ON,65% SK,

62% AB,58%

Same Day Answers to Phone Calls

Access to Primary Care(2013-14)



Among the comparator provinces, Alberta was ranked middle of the pack or worse across five of the six care coordination metrics

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QC, 91% BC,

84%ON, 82%

SK, 81%

AB, 80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% o

f Res

pond

ents

QC, 49% BC,

44%ON, 33%

AB, 32%

SK, 30%

ON, 68%

AB, 66%

SK, 64%

BC, 63%

QC, 48%

ON, 62%

QC, 61% BC,

57% AB, 54% SK,

51%

BC, 57% ON,

54%AB, 54% QC,

49% SK, 46%

ON, 64%

BC, 63% AB,

60% SK, 55% QC,

50%

Care Coordination Metrics (2013-14)

No Conflicting Information from Different Doctors

Access to Medical Test Results

Doctors Informed about Visits to

Emergency Department

Doctors Seem Knowledgeable about

Medical History

Doctors Spending Enough Time with

Patients

Doctors Sharing in Decision Making

with Patients



Alberta is ranked third or fourth among comparator provinces across each of the 5 key wait time indicators

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http://waittimes.cihi.ca (CIHI). CIHI National Health Expenditure Database.

SK, 83%

BC, 81% AB,

78%ON, 77%

QC, 61%

0%

20%

40%

60%

80%

100%

% P

roce

dure

s M

eetin

g Be

nchm

ark

Emergency Department

SK, 93% ON,

88%AB, 87% QC,

84%

BC, 67%

Hip Replacement

SK, 89% ON,

86% AB, 81%

QC, 81%

BC, 57%

Knee Replacement

SK, 88%

QC, 88% ON,

81%AB, 71%

BC, 70%

Cataract Surgery

ON, 99%

QC, 99%

SK, 97%

AB, 97%

BC, 95%

Radiation Therapy

Procedures Meeting Benchmark Wait Times (2014)

BenchmarkWait Time

4 hours 182 days 182 days 112 days 28 days



http://waittimes.cihi.ca/

While Alberta ranks second across all readmission metrics relative to comparator provinces, it has the second highest age-standardized average hospital length of stay

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QC, 12.6%

AB, 13.3%

ON, 13.6%

BC, 14.3%

SK, 14.9%

0%

5%

10%

15%

20%

30 d

ay R

eadm

issio

n Ra

te

Medical Patients

QC, 6.3%

AB, 7.2%

ON, 7.2%

BC, 7.5%

SK, 7.7%

Surgical Patients

Readmissions to Hospital within 30 Days (2013-14)

ON, 6.4

SK, 6.6

BC, 7.2

AB, 7.7

QC, 7.9

0

2

4

6

8

10

Days

Age Standardized Avg. Length of Stay for Acute Inpatient Hospitalizations

(2011-12)



$386,044

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

AB SK ON BC QC Comparator Average2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14

Average FFS earnings in Alberta (All Physicians) total $386K and are $73K higher (23%) than the average of the comparator provinces

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– ARP payments and benefits– Alberta Health Services contributions

Alberta 2013-14FFS % of Total: 65.2%

$30K less than AlbertaFFS % of Total: 63.2%




$73K less than Alberta

32% Growth Over 8 Years






Source: CIHI National Physician Database

FFS % of Total: 86.1%Average Gross FFS Payment > $60,000 for All Physicians

(Fiscal Years: 2006-07 to 2013-14)

Fiscal Year

FFS

Paym

ents



Across all comparator jurisdictions, fees have increased while services per FTE has declined or remained flat for Family Medicine Practitioners

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Num

ber o

f Ser

vice

s pe

r Fam

ily M

edic

ine

FTE

Average FFS Payment per Service

Quebec 2008-09

Ontario 2008-09

Saskatchewan 2008-09

Alberta 2008-09

BC 2008-09

Quebec 2013-14

Ontario 2013-14

Saskatchewan 2013-14

Alberta 2013-14

BC 2013-14

3900

4400

4900

5400

5900

6400

6900

7400

7900

$25 $30 $35 $40 $45 $50 $55 $60

• Alberta has seen a 10% decrease in services provided by a Family Medicine Practitioner FTE from 2008-09 to 2013-14

• Alberta continues to be the leading jurisdiction in FFS payment rate per service with an average FFS Payment of $57.77. Note: Quebec is a close second at $57.73

Source: CIHI National Physician Database



• Alberta ranks 2nd, 2nd, and 4th in the total number of family medicine, medical specialists, and surgical specialists per 100,000 population

Relative to other provinces in the study, Alberta has the second most physicians per 100,000 population

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QC239 AB

229B.C.229

ON214

SK189

Comp.Avg.218

0

25

50

75

100

125

150

175

200

225

250

275

Phys

icia

ns p

er 1

00,0

00 p

eopl

e

B.C.125 AB

118QC118 ON

107SK

106

Comp.Avg.114

QC85

AB81 ON

76B.C.72

SK56

Comp.Avg.72

QC31

B.C.27

ON26

AB24

SK23

Comp.Avg.27

Physicians per 100,000 population by Specialty and Province (Calendar Year: 2014)

Total Physicians Family Medicine Medical Specialties Surgical Specialties



Alberta performs well at attracting and retaining physicians as demonstrated by interprovincial migration, net in migration, and a physician retention rate of nearly 99%

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ProvinceTotal

Physicians Retention Rate Retention Rate RankNet Interprov.

Migration Rank

Change in Physician-100,000

from Prior YearTotal In Migration

Rank

Alberta 8,851 98.70% 4 2 8 1

N.L. 1,211 96.80% 10 6 7 2

Sask. 1,988 96.90% 9 8 5 3

Ontario 28,144 99.30% 2 4 5 4

B.C. 10,178 98.80% 3 1 4 5

N.B. 1,687 97.60% 5 7 2 6

Quebec 18,952 99.80% 1 3 2 7

N.S. 2,361 97.60% 6 5 -1 8

Man. 2,538 97.30% 8 10 -3 9

P.E.I. 264 97.30% 7 9 -11 10

% of physicians who continued to practice in the same province

(2013-2014)

# of physicians moving to practice in selected province from the rest of

Canada (2013-14)

Net increase in # of physicians including new graduates, physicians from abroad, physicians who

did not practice the previous year (2013-14)

2013-14

Source: Scott’s Medical Database, KPMG Analysis



10 Years - 2004-05 to 2013-14

Alternate compensation platforms in Canada have been on the rise since 1999-00, but adoption in Alberta has been the lowest

15

16.73%

36.80%

23.71% 22.89%

19.80%18.77%

25.27%

34.81%

10.77%

13.87%

21.38%

28.32%

0%

5%

10%

15%

20%

25%

30%

35%

40%

1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14

Annual APP % of All Clinical Payments(Fiscal Years: 1999-00 to 2013-14)

ON QC BC SK Alberta Comparator Average

10 Year Change in

Basis PointsON: 20.1%

SK: 9.5%

QC: -0.8%

Comparator Avg: 6.9%

BC: -1.0%

AB: 3.10%

APP

% o

f All

Clin

ical

Pay

men

ts

Source: CIHI National Physician Database, KPMG Analysis



TotalAH Administered AHS Administered AMA Administered

Infr

astr

uctu

re to

Su

ppor

t Phy

sici

ans

Dire

ct P

hysi

cian

Rem

uner

atio

n16 AH-funded physician benefit programs total $396M in FY15-16 forecasted expenditures

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Description FY15/16 EST $MRemuneration intended to compensate physicians based on availability and burden 101.2

Established to address rising costs of medical office and diagnostic imaging in Alberta 85.4

Provide physicians with a benefit amount in recognition of past years’ service in Alberta 71.6

Reimbursement for costs incurred in respect of medical liability insurance premiums set by CMPA 48.8

Compensates physicians who practice in under-serviced areas in Alberta 46.9

Reimburse physicians for continuing education costs 21.5

Provide support to physicians not practicing as a result of the birth or adoption of a child 4.1

Provide support to physicians and their dependents with dealing with life management issues 2.2

Ensure regional centers outside of Calgary and Edmonton have access to specialist coverage 1.1

Ensure that residents living in communities with four or fewer physicians have continuous access 1.3

Provide support to physicians on compassionate grounds 0.4

Supporting PCNs assisting with development, implementation and accountability processes 3.0

Assist physicians with developing and implementing PCNs including support services 2.3

Identifies learning needs of physicians and provides assistance in the pursuit of educational activities 3.7

Assisting with the development, implementation and accountability processes of individual ARPs 1.9

Support development of products and services that facilitate best practice and quality initiatives 1.1

396.2

Physician andFamily Support Program

Retention Benefit

Medical LiabilityReimbursement Program

Continuing MedicalEducation Program

Rural RemoteNorthern Program

Practice ManagementProgram

Physician LearningProgram

Alternative RelationshipProgram PMO

Towards OptimizedPractice Program

Regular LocumProgram

Specialist LocumProgram

Physician On-Call

Business CostsProgram

Primary Care Network PMO

CompassionateExpense Program

Note that there is an additional $13.7M in benefits (outside of AMAA) for physicians practicing in rural communities (Rural Physician Action Plan, Rural Locum Service Program, Rural Community Clerkship)Sources: AHS Contracts & POC Program, Benefit Programs Financial Results & Forecasts, KPMG Analysis



physician services analysis - alberta · 2016-03-01 · 1 physician services analysis the following...

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