Under the 2023 Physician Agreement, physicians paid through an Alternative Payment Plan (APP) receive 10% across-the-board increases spread over four years (3% in years 1 and 2, 2% in years 3 and 4), retroactive to April 1, 2023.

A significant investment into longitudinal family medicine aims to support physicians who provide comprehensive longitudinal primary care services to Nova Scotians. The Longitudinal Family Medicine (LFM) payment model will replace alternative payment plans (APPs) for family physicians and provide higher earning potential for most APP physicians, as well as for fee-for-service family physicians who wish to transition to the new model.

APP family physicians are eligible to receive the overhead/attachment support payment for the first six months of 2023, at a rate of $10 per patient, to bridge the transition to the LFM payment model. Many other elements from the 2023 Physician Agreement apply to APP physicians.

Additional investments in APP family medicine

• The APP rate for family physicians with a Certificate of Added Competence (CAC) in geriatrics, palliative medicine or addictions medicine will increase to $310,000.
• The APP rate for family physicians practising in geriatrics, palliative, addictions, FP oncology or FP psychiatry (but without a CAC) will increase to align with the FP sessional rate.
• Inpatient work: Physicians working under the Community Hospital Inpatient Program (CHIP) and the regional hospitalist model will benefit from increased facility on call rates. Digby and Hants will remain eligible to convert to the CHIP program should the physicians delivering inpatient services wish to do so.
• Primary Maternity Care: Physicians working under the Primary Maternity Care (PMC) payment model will benefit from increased facility on call rates. The PMC model will also will be available to any regional hospital (Kentville, Cape Breton, Truro, New Glasgow) that wishes to convert to this alternative payment model, if all parties are agreed it is in the best interests of the system.

Competitive compensation for APP specialists
Ensuring that regional specialists are receiving competitive compensation is crucial to both retaining and recruiting the physician resources the province needs. The following increases and changes have been agreed on:

1. All APP specialists – APP specialists will now be able to earn more if they shadow bill over and above their APP contract value.
2. General surgery – APPs will now be available to any General Surgery service that wishes to transition from fee for service. The APP rate will be $421,425 annually, plus the ability to earn more if billings exceed contract value.
3. General internal medicine – A new payment model will be available for two areas of general internal medicine (GIM) work: a) “Internist of the day” – A daily minimum income guarantee of $1,600 will be available for the physician covering GIM inpatients and emergency department consults. Details and deliverables will be finalized and the new model implemented by Oct. 1, 2023. b) In-office cognitive services – A daily minimum income guarantee of $1,600 will also be available for core cognitive internal medicine in-office work. Details and deliverables will be finalized and the new model implemented by Feb. 1, 2024. Physicians eligible are only those IM specialties that are not procedure-based (such as endocrinology, rheumatology, infectious disease, GIM or IM covering a generalist practice). Physicians must participate equitably in the acute care coverage model to be eligible to participate in this model and should be billing a minimum of one patient per hour, on average.
4. Geriatric and palliative specialists – The Royal College certified specialist APP rate for geriatrics and palliative care will increase to $340,000 annually, while the APP rate for family physicians with a certificate of added competence (CAC) in these specialties will increase to $310,000 per year. Family physicians without additional training will see their rates move with the MSU increase, as with the family physician sessional rate
5. GP oncology – The APP rate for general practitioners providing oncology care will increase to align with the family physician sessional rate.
6. Addiction medicine – A new APP at a rate of $310,000 per year will be created for physicians with a CAC in addiction medicine. Family physician without additional training will see their rates move with the MSU increase, as with the family physician sessional rate.

Future work: The Fee Committee will also be asked to complete a full review of GIM visit and consult codes in the coming months to assess appropriateness of fee values and address issues. This review will include access to the MRP Complex Discharge code for GIM physicians, the rate for follow-up office visits, and the rate for subsequent hospital visits.

Alternative payment plan  contracts are implemented to:

• Provide physicians with a guaranteed minimum funding level and income stability
• Facilitate the delivery of efficient and effective medical care that may not be compatible with the fee-for-service funding model
• Support new models of care, including collaborative care models, to better meet community needs

An APP contract includes a deliverables agreement  agreed upon by the physician (or physicians), as well as representatives of the Department of Health and Wellness (DHW), the Nova Scotia Health Authority (NSHA) and Doctors Nova Scotia.

Physicians on APP contracts are expected to be accountable for the services they deliver. This requires consistent shadow billing and completion of an annual activity report.

Doctors Nova Scotia representatives are available to help physicians who are interested in converting to an APP, as well as new physicians who are considering or being offered an APP arrangement.

Contact your Physician Advisor for assistance with:

• Converting to an APP
• Negotiating deliverables
• Reviewing your contract before signing