Arbitration part IV: What to make of the new updated payment schedule in Ontario

Disclaimer: The payment schedule below is based on my personal analysis of information from the Ontario Medical Association (OMA) as of December 6, 2024. It would not surprise me if there were more changes. Do NOT use this as your sole source of planning. Contact info@oma.org with any questions.On Nov. 1, 2024, OMA Board Chair Dr. Cathy Faulds announced an update on how the arbitration award for Year I of our PSA (fiscal 2024/25) is going to be paid out. The plan was to have final numbers in a couple of weeks. Follow up information didn’t come until December 6 in an OMA news alert. Some things never change.Wait Old Country Doctor! Didn’t you already do a blog on the Arbitration Award?Yes, parts two and three of my arbitration analysis did say what was planned. But the blogs were filled with statements like “allegedly,” “supposedly,” and chances of some of the changes happening were “slim to none.”So, we read all your previous work for nothing?At the risk of sounding somewhat less than humble—most to the stuff I wrote about has come to pass—including splitting the increase with 75% of the amount going towards relativity, and 25% for across the board (ATB) raises.Well, what changed then?There are a couple of delays (of course) to some of the retroactive payments. But the big change is changing the amount of your increase based on your specialty. I don’t know who came up with the idea of doing this, and suggested it to the OMA’s Negotiations Task Force, but whoever it was deserves the thanks of our profession.This method is not perfect, because some billing codes are used by more than one speciality. For example, I’m a family physician, but I do joint injections. So do orthopedic surgeons and rheumatologists. But the billing code (and thus payment) for doing a joint injection is the same. Applying an increase to that code will affect at least three specialties. Therefore, by given specialty specific increases instead, some of the lower relativity specialists will get more of an increase sooner.The “permanent” changes to the fee codes will now not happen until April 2026 (!!). So expect your income to fluctuate some more then.Don’t tell me you’re going to toss large numbers and calculations at me!I’m going to toss large numbers and calculations at you.Here are numbers I needed to understand the contract. Numbers rounded for simplicity.Fiscal Year 2022/23 is the base year for calculations. Physicians budget was $16 billion.2.8% increase agreed to for 2023/2024 (from last PSA) = $448 million9.95% awarded by arbitrator for 2024/2025 when compounded with 2023/2024—total value =$2.085 billionThe plan was to spend 70% on fee increases, and 30% on “targeted” investments. For 2023/2024 this would be $314 million for fee increases, $134 million for targeted investments. For 2024/25—$1.460 billion for increases, $625 million for targets.Finally, as of now, it appears that we are going to stick to 25% of the total for fee increases (not the targeted money) will go to across the board (ATB) raises, and the rest based on relativity.Wait a minute Old Country Doctor—didn’t everyone get the same percentage increase this year?Yes. Under the terms of a previous agreement, if the OMA and government were not able to sort out how to divide the money for a fiscal year, ALL of it would be paid ATB on a temporary basis. Emphasis on temporary. So, we all got a 2.8% increase for 2023/24 (you should have gotten the retroactive pay in November). Additionally, your monthly remittance should be 2.8% higher beginning on the MAY 2024 statement (The increase took effect April 1, but of course, that gets paid out on May 15).For this fiscal year (2024/25) the OMA and government have conceded they won’t come up with a plan on how to divide the funds, and so everyone will get an ATB of 13% (1.028 x 1.0995). The way it’s paid out will be a mix of monthly increases and some retroactive pay.However, for fiscal year 2025-26, there will be specialty specific increases. Each physician will get another temporary increase in their billings, based on their specialty. The OMA and government will continue to argue negotiate. Probably need arbitration for this. The exact fee code changes are scheduled to be in place April 1, 2026!You’re going to bring back Drs. Alpine and Valley to explain this aren’t you?Of course, dear reader. It helps to put a “face” to the numbers. However, on this occasion, let’s assume Dr. Alpine is an ophthalmologist (speciality chosen only because they appear to get the lowest increase) and Dr. Valley is a family doctor in a capitation model (for reasons that will become clear shortly).I won’t restate the assumptions for my calculations (please refer to my previous blog on this issue). Assuming that Drs. Alpine and Valley see the exact same number of patients every year—this is what their gross income will look like.WAIT A MINUTE! Capitated family doctors’ gross will go down as well??Yes. As mentioned above, for 2023/24 and 2024/25 the OMA and government could not agree how to divide up the now $2.085 billion, so it was given ATB on a temporary basis. This was meant to get some money into doctors’ hands sooner otherwise Allah/God/Yahweh only knows how long we would have to wait for the process to complete.However, 30% of the $2.085 billion (or $626 million) was meant for “targeted funds”. The expectation is either through negotiation (very unlikely IMO) or through arbitration, a decision will be made on where to spend that $626 million for fiscal 2025/26.Therefore, there is only $1.459 billion for general increases for 2025/26 (plus whatever increase the arbitrator gives us). Of that, 25% ($365 million) will go ATB. So, everyone will get 2.03%. The remaining $1.094 billion is distributed via relativity.With less money to distribute—well, there is less of an increase. Now of course the possibility exists that some of the targeted funds will be spent on captitated family medicine too, but who knows at this point? This is why virtually every specialty sees a decline in 2025 when you look at the OMA’s spreadsheet.Keep in mind the fee increases for April 1, 2025 to March 31, 2028 have yet to be negotiated (more likely arbitrated) so there will be more money in the future—we hope.I’m not a family doctor or an ophthalmologist—how do I find out my numbers?I suggest you go to the table that the OMA has prepared for you. Use your base 2022/23 monthly income to figure out your projected numbers. If you have specific questions about your situation, I urge you to contact info@oma.org. The organization can’t really answer questions if they don’t know what they are. Also please register for the live Zoom Webinar on this process, and ask your questions there.So, this is the final word on this issue?Nope. I suspect there will be more to come. And that it will be just as confusing.You’re just a bundle of joy Old Country Doctor.I aim to please dear reader. I aim to please.Dr. Sohail Gandhi is a former president of the OMA and opinions are his and not necessarily the opinions of the OMA Board. This article is a reprint from his blog site: justanoldcountrydoctor.com.

Arbitration part IV: What to make of the new updated payment schedule in Ontario

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