A Primer on Relativity and CANDI Presentation to OMA Council, - - PowerPoint PPT Presentation

A Primer on Relativity and CANDI

Presentation to OMA Council, October 21, 2018

Presented by Jasmin Kantarevic, OMA Economics, Policy and Research

1

2

Overview

• 1. Overview of relativity and OMA past initiatives
• 2. Primer on CANDI
• More details available at:

https://www.oma.org/sections/billings-and-agreement/research-analytics/relativity/

3

What is Relativity?

• Equal pay for equal work
• Two main types:
• 1. Fee-based relativity: e.g. equal pay for services that have equal time requirement, intensity, complexity, risk, overhead cost, etc.
• 2. Income-based relativity: e.g. equal pay for physicians with equal hours of work, overhead, length of training, etc.

4

OMA Experience with Relativity

Fee Based

• 1992 – 1997 : OMA Resource-Based Relative Value Scales (RBRVS)
• 1997 - 2002 : RBRVS Commission

Income Based

• 2003 – 2009: Relative Value Implementation Committee (RVIC) model
• 2009 – 2018: Comparison of Adjusted Net Daily Income (CANDI) model

5

History of CANDI

• 2008-2009: RVIC Methodology Review Committee
• CANDI approved by Council
• 2009-2012: CANDI Relativity Implementation Committee
• October 2011: PricewaterhouseCoopers Study
• Revisions to hours of work and overhead
• 2017-2018: Relativity Review Committee
• recommendations based on technical reports and new data on after-hours
• 2018 -

: Relativity Advisory Committee

6

CANDI Allocation in 2008 PSA

Income-Based Inter-Sectional Relativity Fee-Based Intra-Sectional Relativity

• Each Specialty receives

CANDI score

• Based on CANDI score,

each Specialty receives funding allocation

• Each Specialty proposes changes

to their fee codes

• Proposals based on fee relativity
• Proposals assessed by bilateral

members of MSPC

7

CANDI Formula

Gross Income Overhead Training Premium Adjusted Net Daily Income

8

Gross Income: Income Sources

Included

• Professional fee-for-service billings ($7.1B)
• Clinical Primary Care payments (e.g. capitation, access bonus, CCM fee) ($1.8B)
• Clinical Alternative Payment Plans payments ($1.125B)
• Hospital On-Call Coverage (HOCC) payments ($223M)
• Workplace Safety and Insurance Board (WSIB) payments ($25M)
• Other Specialty-Specific payments (e.g. psychiatric sessional payments) ($137M)

Excluded

• Technical billings
• Non-clinical payments
• Private, non-insured income

Data Source: MOHLTC Administrative Data Files ($10.4B)

9

Gross Income: Time Period

Weekday (Monday to Friday) daytime (7:00-17:00) standardized daily income

Exclude Weekends and Holidays Exclude After-Hours Payments

7:00 – 16:59 00:00 – 6:69 17:00 – 23:59

Based on Schedule

• f Benefits fee

codes/RRC Survey Based on Schedule

• f Benefits fee

codes/RRC Survey

10

Gross Income: Hours of Work

Weekday (Monday to Friday) daytime (7:00-17:00) standardized daily income

7:00 Start time: e.g. 8:30 Finish time: e.g. 16:00

Hours of Work Data Source

• PricewaterhouseCoopers 2010 Study
• Questions about start time, finish time, percent of work that

is strictly clinical

• OHIP specialties with low response rates assigned average

hours of work for their respective Assembly

16:59

11

Overhead

Data Sources

• 2009 OMA Human Resources Committee Survey
• 2011 OMA Human Resources Committee Survey
• PricewaterhouseCoopers 2010 Study

Validation

• 400 site visits for PwC Study
• 1997 Canada Revenue Agency

(overhead within ± 20% of CRA)

Weighted average of three surveys

12

Training Premium: Concept

PGY1 PGY2 PGY5

A

Retirement

B

A = lost opportunity cost B = opportunity cost + skill premium

PARO earnings for Family Physician PARO earnings for Specialist Practice earnings for Family Physician Practice earnings for Specialist Specialist Family Physician

13

Training Premium: Estimates

Opportunity Cost Premium

• Actuarial study (Prof. Hyatt, Rotman)
• About 2.4 percent for additional year

Skill Acquisition Premium

• 4 percent per additional year

Years of Training CANDI Specialties Average Training Premium (relative to Family Medicine) 3 Emergency Medicine 6% 4.2 Pediatrics Internal Medicine 13% 5.1-5.3 All Other 19-20% 6.2 – 6.4 Cardiac Surgery Neurosurgery Cardiology 26-28%

Overall training premium  6.4% per year

14

Adjusted Net Daily Income and CANDI Scores

Additional Resources:

https://www.oma.org/sections/billings-and-agreement/research-analytics/relativity

15

Questions?

relativity@oma.org