Connections asked Mark Snaterse, Executive Director for Addiction and Mental Health, Alberta Health Services (AHS) Edmonton Zone, to explain the potential benefits of the province's first Academic Medicine and Health Services Program (AMHSP) for both patients and psychiatrists.
Below is a slightly edited and condensed version of that conversation:
Q: I recognize the benefits of the AMHSP from the Department of Psychiatry's perspective, since it offers a more competitive compensation structure for practicing fee-for-service psychiatrists who wish to teach, do research or take on academic leadership positions. But what are the benefits of the new AMHSP from the AHS perspective?
A: The AMHSP is going to be a great enabler for us to really foster good academic activity within our clinical programs. So you could look at the AMHSP narrowly, as just a different way of reimbursing people, but it will also become an enabler. Doctors who have an interest and a passion for research, education, academics and scholarly activity will now have an opportunity to embed that as a formal part of their practice, without the concern that it will be time spent without compensation.
We want the entire Addiction and Mental Health program within the Edmonton Zone to be a strong academic program. We want to see strong academics and strong clinical practice going hand-in-hand, and that's why we (AHS) are really approaching this different reimbursement strategy jointly with the Department of Psychiatry. I think there's a very strong mutual interest in this, and it could be quite transformational in the long run.
Q: But from a practical perspective how do you see the AMHSP helping you to deliver more or better addictions or mental health services to patients?
A: Well, when we look at where our system needs psychiatrists to be working with our teams, sometimes in the current fee-for-service world, it's difficult to entice psychiatrists to participate, since there are fiscal consequences to that. Quite often that relates to programs of ours that desperately need good access to psychiatrists, but in a rather unpredictable way in terms of patient volumes.
Let me explain it this way. If a psychiatrist is working in a typical clinic they can fill up their day with scheduled appointments. In a fee-for-service world that becomes kind of the benchmark for them.
But in other areas of the system - involving say an Urgent Care Clinic, or access to our ACT (Assertive Community Treatment) Team, our Inner City Team, our Community Outreach or our Crisis Teams - these are areas where we desperately need to have really good linkages to psychiatry for urgent, community-based assessment. But because a lot of the activity in these areas is unpredictable and unscheduled, it creates challenges for us. There are some days where if you can't keep the psychiatrists busy seeing lots of patients, that creates a fiscal disadvantage to them.
Q: What about the patient billing side though? Some individuals the psychiatrists see won't even have Alberta Personal Health Card numbers, so how does that work?
A: We'll often know the Alberta Health Care numbers, so we can access that when needed. It's not a matter of a psychiatrist not being able to bill. It's a matter of us not being able to predict how many patients they're going to see in a given afternoon. A physician working in their regular clinic will normally be able to predict how many patients they're going to see, which correlates with the income they'll generate for that afternoon.
For physicians to be available to an Outreach Team, an Inner City Team, a Crisis Team, a Stabilization Team, or for Urgent Care referrals, we might not be able to guarantee that they are going to see X number of patients on a given day. So there could be days when they're very busy, and days when we desperately need them to be available, but perhaps they won't be as busy. And if it's an unpredictable volume of patients for the psychiatrist, that creates a fiscal disadvantage.
So the AMHSP provides that level of certainty. It allows the psychiatrist to say, 'I can commit to spending a couple of half-days making myself available for urgent consults to our Inner City Team or our Crisis Team, and I won't have to worry because I'll know what my income is going to be for that time.' In addition, the psychiatrist will also have the ability to become involved in program development; in bringing Residents and trainees into this unique clinical practice; in Quality Improvement initiatives; or in measuring outcomes and bringing clinically-based research into some of these really great practice environments.
Q: So you're saying the AMHSP remuneration structure would also apply to activities like program development then?
A: Yes. So if you're working with the Crisis Team, let's say, you may want to spend a couple of hours working with them on program planning or on an evaluation framework. Today, if a physician participates in those activities, it could be perceived as lost income, since they could instead be seeing patients during that time. So in this kind of different reimbursement system we can say, 'Here's what we need you to do and we can collectively build a job description for it.' Or we could say, 'We'd like you to allocate a lot of time to direct patient care, but we'd also love to have you spend a focused amount of time on things like program planning, program leadership, training and team development.'
Q: So how much demand do you expect from traditional fee-for-service psychiatrists who may be interested in applying for positions under the new AMHSP structure?
A: Right now I don't have a good idea what the interest level is going to be. I hear that people are waiting for further details at this point and we're hoping to be able to give them those details very quickly. That said, I think there will be interest in it among psychiatrists who are currently in our system.
This will also give us opportunities to create new positions in future that we can recruit for. So those types of positions would be for local psychiatrists, Residents who are just completing their training, and also for persons with an academic interest and background who are considering coming to Edmonton from other places in Canada or outside the country.
Below is a slightly edited and condensed version of that conversation:
Q: I recognize the benefits of the AMHSP from the Department of Psychiatry's perspective, since it offers a more competitive compensation structure for practicing fee-for-service psychiatrists who wish to teach, do research or take on academic leadership positions. But what are the benefits of the new AMHSP from the AHS perspective?
A: The AMHSP is going to be a great enabler for us to really foster good academic activity within our clinical programs. So you could look at the AMHSP narrowly, as just a different way of reimbursing people, but it will also become an enabler. Doctors who have an interest and a passion for research, education, academics and scholarly activity will now have an opportunity to embed that as a formal part of their practice, without the concern that it will be time spent without compensation.
We want the entire Addiction and Mental Health program within the Edmonton Zone to be a strong academic program. We want to see strong academics and strong clinical practice going hand-in-hand, and that's why we (AHS) are really approaching this different reimbursement strategy jointly with the Department of Psychiatry. I think there's a very strong mutual interest in this, and it could be quite transformational in the long run.
Q: But from a practical perspective how do you see the AMHSP helping you to deliver more or better addictions or mental health services to patients?
A: Well, when we look at where our system needs psychiatrists to be working with our teams, sometimes in the current fee-for-service world, it's difficult to entice psychiatrists to participate, since there are fiscal consequences to that. Quite often that relates to programs of ours that desperately need good access to psychiatrists, but in a rather unpredictable way in terms of patient volumes.
Let me explain it this way. If a psychiatrist is working in a typical clinic they can fill up their day with scheduled appointments. In a fee-for-service world that becomes kind of the benchmark for them.
But in other areas of the system - involving say an Urgent Care Clinic, or access to our ACT (Assertive Community Treatment) Team, our Inner City Team, our Community Outreach or our Crisis Teams - these are areas where we desperately need to have really good linkages to psychiatry for urgent, community-based assessment. But because a lot of the activity in these areas is unpredictable and unscheduled, it creates challenges for us. There are some days where if you can't keep the psychiatrists busy seeing lots of patients, that creates a fiscal disadvantage to them.
Q: What about the patient billing side though? Some individuals the psychiatrists see won't even have Alberta Personal Health Card numbers, so how does that work?
A: We'll often know the Alberta Health Care numbers, so we can access that when needed. It's not a matter of a psychiatrist not being able to bill. It's a matter of us not being able to predict how many patients they're going to see in a given afternoon. A physician working in their regular clinic will normally be able to predict how many patients they're going to see, which correlates with the income they'll generate for that afternoon.
For physicians to be available to an Outreach Team, an Inner City Team, a Crisis Team, a Stabilization Team, or for Urgent Care referrals, we might not be able to guarantee that they are going to see X number of patients on a given day. So there could be days when they're very busy, and days when we desperately need them to be available, but perhaps they won't be as busy. And if it's an unpredictable volume of patients for the psychiatrist, that creates a fiscal disadvantage.
So the AMHSP provides that level of certainty. It allows the psychiatrist to say, 'I can commit to spending a couple of half-days making myself available for urgent consults to our Inner City Team or our Crisis Team, and I won't have to worry because I'll know what my income is going to be for that time.' In addition, the psychiatrist will also have the ability to become involved in program development; in bringing Residents and trainees into this unique clinical practice; in Quality Improvement initiatives; or in measuring outcomes and bringing clinically-based research into some of these really great practice environments.
Q: So you're saying the AMHSP remuneration structure would also apply to activities like program development then?
A: Yes. So if you're working with the Crisis Team, let's say, you may want to spend a couple of hours working with them on program planning or on an evaluation framework. Today, if a physician participates in those activities, it could be perceived as lost income, since they could instead be seeing patients during that time. So in this kind of different reimbursement system we can say, 'Here's what we need you to do and we can collectively build a job description for it.' Or we could say, 'We'd like you to allocate a lot of time to direct patient care, but we'd also love to have you spend a focused amount of time on things like program planning, program leadership, training and team development.'
Q: So how much demand do you expect from traditional fee-for-service psychiatrists who may be interested in applying for positions under the new AMHSP structure?
A: Right now I don't have a good idea what the interest level is going to be. I hear that people are waiting for further details at this point and we're hoping to be able to give them those details very quickly. That said, I think there will be interest in it among psychiatrists who are currently in our system.
This will also give us opportunities to create new positions in future that we can recruit for. So those types of positions would be for local psychiatrists, Residents who are just completing their training, and also for persons with an academic interest and background who are considering coming to Edmonton from other places in Canada or outside the country.