To help increase patient access to physicians, there will no longer be a daily cap on the number of visits a physician can fully bill.

During the negotiations with the Alberta Medical Association (AMA), Alberta’s government heard that Alberta’s doctors could safely see more patients than the current cap allowed.

Albertans want to know that they can see a doctor when they need one, and physicians want to be able to provide Albertans with the health-care services they need. By changing the daily cap policy, some of the immediate pressures for services provided by general practitioners and specialists, including pediatricians and ophthalmologists, will be addressed. By lifting the cap, physicians will be fully compensated for every visit rather than receiving a discounted rate if they provide more than 50 visit services in one day, which is the current practice.

“We’re moving forward to implement the new agreement, starting with ending the daily visit services cap policy and working to put rate increases in place. We’ve heard from some physicians that the daily visit cap was having a negative impact on patient access, so this change addresses those concerns. It is also part of the new agreement with the AMA where we are listening to physicians and working with them as partners moving forward.”

“The AMA agreement allows physicians and government to work together on challenges facing patients and physicians in the health-care system. This early step to remove the services cap is an important example that will allow more physicians to care for more patients while helping to stabilize physician practices.”

Lump sum payment

The agreement between the AMA and the province also includes a one per cent rate increase in each of the next three years and a one per cent recognition lump sum payment in 2022-23.

Alberta physicians were at the forefront of the pandemic and the one-time payment for eligible practising physicians is in recognition of that work during the 2021-22 fiscal year. This lump sum payment is approximately $45 million and will go to the AMA to distribute to their members by the end of 2022.

In addition to the lump sum payment, the government is working with the AMA to implement the one per cent rate increase for 2022-23. The increase applies to fee-for-service and alternative relationship plan rates, providing an additional $46 million to physicians.

As outlined in the AMA agreement, the rate increase is heavily weighted to specialties facing the greatest pressures, such as family medicine. Alberta’s government and the AMA are working together to distribute these increases across and within specialties. Increases will be effective April 1, 2022, and are expected to be finalized by March 31, 2023.

Quick facts

• The daily visit services cap policy was introduced as part of the Physician Funding Framework in 2020.
• The intent of the policy was to support quality patient care by reducing physician burnout while addressing fiscal constraint for the province.
• It applies to all physician services that are defined in the Schedule of Medical Benefits (SOMB) as “visits” with a “V” category code that physicians provide to patients in person, including physician office visits, consultations and counselling services. Procedures and tests that physicians provide are not billed as visits.
• Under the current policy, physicians are compensated 100 per cent for up to 50 visit services billings in a day, 50 per cent for between 51 and 65 visit services, and there is no compensation for visit services billings greater than 66.
• Physicians working in rural and remote areas, hospital visits and virtual care are exempt from the current policy.
• The policy change (to lift the cap) aligns Alberta with most other jurisdictions.
• Alberta Health is working on updating the SOMB and billing system to operationalize this change. A Medical Bulletin and a new SOMB will be posted when information technology changes are complete.
• The daily visit services cap policy change will be reviewed and its impacts assessed before determining the future policy beyond the current fiscal year.