Northern Health Medical Staff Recruitment to Practice Summary for NH Medical Staff Leaders Series C Booklet

Northern Health Medical Staff Recruitment to Practice Summary for NH Medical Staff Leaders Series C Booklet August 2014 Prepared by: Northern Health, Medical Affairs

Series C NH Medical Staff Recruitment to Practice Process: Summaries for Medical Staff Leaders TABLE OF CONTENTS MEDICAL STAFF RECRUITMENT PROCESS... 3 What are the trigger events for recruiting a practitioner?... 3 How to recruit to a vacant position on the Physician Human Resource Master Plan?... 3 Where are the vacant positions posted and who can apply?... 4 What is the role of Medical staff leaders in recruitment?... 4 What steps are taken when recruitment to a position is urgent?... 4 What are the next steps after a qualified applicant has been identified?... 4 What incentives are available to successful candidates?... 5 Contacts... 6 References... 6 MEDICAL STAFF RECRUITMENT SITE VISIT... 7 What are the steps involved in initiating a site visit?... 7 Who plans the site visit?... 7 What are allowable expenses incurred in a site visit?... 7 What is the process for reimbursement of a site visit?... 8 Who does the candidate meet with on the site visit?... 8 Who do you contact if you aren t sure about the process, need advice, or more information?... 8 MEDICAL STAFF APPOINTMENT AND REAPPOINTMENT PROCESS... 9 What is the difference between Credentialing and Privileging?... 9 When is an application issued to a practitioner?... 9 What are the criteria for appointment to the medical staff?... 9 What information is requested within an application for appointment?... 9 What is the procedure for appointment and a practitioner receiving privileges?... 10 What is the role of Medical Leaders in the appointment process?... 11 How do the facility privileging committees operate?... 11 How does a practitioner receive clinical system access?... 11 How does a practitioner maintain their privileges on an annual basis?... 11 What is the process for the annual renewal of privileges?... 11 What is the process for a practitioner applying for additional privileges?... 12 When should a practitioner apply for a Change of Status?... 12 How does a practitioner apply for privileges at an additional facility?... 12 References... 13 Page 1 of 24

Series C NH Medical Staff Recruitment to Practice Process: Summaries for Medical Staff Leaders PHYSICIAN COMPENSATION PROCESS AND CONTRACT TYPES... 14 What is Physician Compensation and what is their role regarding physician contracts?... 14 As a Medical Staff Leader, what is my role in physician compensation and contracts?... 14 How do I know whether or not I need a physician contract to be established?... 14 Are there different types of contracts?... 14 What is fee for service?... 14 What is an Income Guarantee Contract?... 14 What is the Alternative Payment Program (APP)?... 15 How are APP funds and contracts administered?... 15 What are APP Sessional payments? How are they administered?... 15 What is the Medical On-Call Availability Program (MOCAP)?... 15 What are MOCAP contracts and MOCAP Sign On Agreements?... 16 What is a Physician Administrative Contract?... 16 References... 16 Contacts... 16 RURAL PROGRAMS... 21 What are Rural Programs?... 21 What is the Rural Practice Subsidiary Agreement (RSA)? What is the Joint Standing Committee (JSC)?... 21 How are RSAs identified and how are communities rated?... 21 What programs are included in the Guide for Rural Programs of British Columbia?... 21 What is the Rural Retention Program (RRP)?... 21 What is the Rural Continuing Medical Education (RCME)?... 21 What is the Recruitment Incentive Fund (RIF)?... 21 What is the Recruitment Contingency Fund (RCF)?... 22 What is the Isolation Allowance Fund (IAF)?... 22 What is the Rural Emergency Enhancement Fund (REEF)?... 22 What is the Rural Education Action Plan (REAP)?... 22 What is the Northern & Isolation Travel Assistance Outreach Program?... 22 What is The Rural GP Locum Program (RGPLP)?... 23 What is the Rural Specialist Locum Program (RSLP)?... 23 Who do you contact if you aren t sure about the process, need advice, or are looking for more information?.. 23 References... 24 Page 2 of 24

C1 Medical Staff Recruitment Process: Summary for Medical Staff Leaders MEDICAL STAFF RECRUITMENT PROCESS: SUMMARY FOR NH MEDICAL STAFF LEADERS This summary is one of a series developed for NH Medical Staff Leaders and should be used in conjunction with the following information provided: ü C1 Medical Staff Recruitment Process ü C2 Recruitment Site Visit ü C3 Medical Staff Appointment and Reappointment Process ü C4 Physician Compensation Process and Contract Types ü C5 Rural Programs Information Sheet What are the trigger events for recruiting a practitioner? Ø A vacancy is identified due to a practitioner leaving the community or retiring. Ø In the event that there is a need for an increase to the complement of medical staff. How to recruit to a vacant position on the Physician Human Resource Master Plan? 1. When the Medical Director determines an increase to the medical staff is appropriate for a community or department, the first step is to determine if there is room on the Master Plan. 2. If there is room, the vacancy is presented to the Northern Health (NH) Medical Advisory Committee for a recommendation to the NH Board of Directors for inclusion on the Urgent Priority List. 3. The vacancy is then posted, and a recruitment strategy is developed in consultation with the Medical Director. 4. If there is not room on the Master Plan, this indicates that NH has recruited to the maximum number of physicians specified for that community or department. 5. To increase the number of positions on the Master Plan, a Preliminary Impact Assessment must be submitted to the NH Medical Advisory Committee for recommendation to the NH Board of Directors. The Impact Assessment is a comprehensive report outlining evidence of need and requires the following considerations: Data on local and regional roles this position may fulfill. Clinical and academic mandates must be considered. The implications of the position not being approved must be identified. Deliverables and consequences are required and will include items such as reduced wait times, changes in standard of care, etc. The patient care consequence if the position is not added should also be indicated. Staffing and operational resources required to support this additional position must be specified. Operational resources will include bed capacity, sterile processing, housekeeping, etc. Capital equipment requirements are important elements of this submission as well. Space requirements and overall costs must also be included. 6. If an internal Northern Health Impact Assessment receives approval by the Board of Directors, the Physician Human Resource Master Plan is updated. The position is then added to the Urgent Priority List*, the vacancy is posted, and a recruitment strategy is developed in consultation with the Medical Director. * The vacancies on the Urgent Priority List guide recruitment efforts. In order to access funding for site visits, a vacancy must be placed on the urgent priority list. Page 3 of 24

C1 Medical Staff Recruitment Process: Summary for Medical Staff Leaders Where are the vacant positions posted and who can apply? Ø Service Canada requires that a vacant position must be advertised on two national and one regional site. o The postings must be advertised for a minimum of four weeks. o Canadian and permanent residents must be considered for the position prior to foreign candidates. o Health Match BC is a resource which assesses the training and experience of eligible candidates to determine if they qualify to practice medicine in BC and assists candidates in the licensure process. Ø Current practice opportunities are posted to the Northern Health physician website with information regarding the community, benefits, compensation type, facility etc. Ø Health Match BC s mandate is to report all difficult to fill vacancies for the province to the Ministry of Health. Therefore, it is important to avoid double counting vacancies. What is the role of Medical staff leaders in recruitment? Ø The applicable Medical Staff Leader (Department Head, Medical Director, etc) is responsible for notifying the Physician Recruitment Coordinator of an upcoming vacancy or the need for an increase to the complement of medical staff. Ø Medical Staff Leaders are responsible for reviewing the CV s of suitable candidates and advising the Physician Recruitment Coordinator of potential candidates. Ø Depending on the circumstance, the Medical Staff Leader or Physician Recruitment Coordinator will make the initial contact with prospective candidates. Ø The Medical Staff Leader is also responsible for conducting an informal reference check for each prospective candidate. What steps are taken when recruitment to a position is urgent? Ø A Targeted Recruitment Initiative is initiated where a Medical Director has isolated an urgent need for focused recruitment services to be provided to a community or facility. Ø The Recruitment Team will work closely to monitor the vacant position and will act as a source of contact for interested applicants and guide them through the recruitment to practice process. What are the next steps after a qualified applicant has been identified? 1. References are checked. 2. A site visit may be hosted to introduce a candidate to the community. A site visit is also an opportunity for Medical Staff Leaders and physicians practicing within a community to meet the eligible candidate. 3. The NI Medical Staff Relocation & Staffing Assistant or the Medical Director s Assistant for the Northeast and Northwest will send out a Letter of Offer to the selected applicant. 4. Once the Letter of Offer has been signed and returned, an application for privileges will be issued. Page 4 of 24

C1 Medical Staff Recruitment Process: Summary for Medical Staff Leaders What incentives are available to successful candidates? Recruitment Contingency Fund (RCF) Payments: Ø The Recruitment Contingency Fund is intended to provide additional assistance to eligible communities/physicians covered by the Rural Practice Subsidiary Agreement (RSA) where there is a difficult to fill position. Ø Payments under this program include: 1. Relocation Physicians relocating from outside of Northern Health to a RSA community are eligible for up to $15,000.00 in relocation expense reimbursement. The Ministry of Health provides $5,000.00 for relocation and Northern Health provides an additional$10,000.00 to successful candidates. Those relocating within Northern Health may be eligible for relocation of up to $5,000.00 as per the Medical Affairs Relocation Policy. Exceptions for relocation funding are up to the discretion of the Medical Director depending on the recruitment circumstances and available budget. For a list of acceptable and unacceptable receipts please click here. 2. Interview Visit Reimbursed upon receipt of an approved Recruitment Contingency Fund Payment form. Interview visit reimbursement is only offered if the position is on the Urgent Priority List (UPL). Maximum of $3,500.00 reimbursement per visit. 3. Advertising These will be paid upon receipt of an approved Recruitment Contingency Fund payment form received from the Recruitment Coordinator of the office of the VP Medicine. $5,000.00 maximum advertising per vacancy. Ø If a physician leaves the community within two years of receiving the reimbursement they must pay a prorated portion back. Ø Applications for this funding are administered by Rural Practice Programs, Physician Compensation, and the Ministry of Health. Ø Physician Compensation issues payment to the appropriate physicians. Recruitment Incentive Fund (RIF) Payments: Ø Communities under the Rural Practice Subsidiary Agreement (RSA) are eligible for RIF provided that there is a vacant position in the Physician Supply Plan A communities- $20,000 B communities- $15,000 C communities- $10,000 D communities- $5,000 Note: All communities within Northern Health are classified as A communities except for Prince George which is a B community. Ø In order to receive RIF funding, physicians must be recruited outside of eligible RSA communities. Ø If a physician leaves the community, prior to completing one year of service, they are obligated to repay a prorated portion of the amount they have received. Ø If a physician has already received an incentive for working in a RSA community they may be eligible for another incentive after two years of leaving the community. Page 5 of 24

C1 Medical Staff Recruitment Process: Summary for Medical Staff Leaders Ø Any medical student resident who transitions to full time practice, filling a vacancy on the master plan in an eligible RSA community, may receive the recruitment incentive. Ø Once a successful applicant is found, NH will submit a Recruitment Incentive Application to the Ministry of Health. Ø Funds for recruitment incentives are submitted to the Health Authorities by the MoH for distribution. Contacts: Ø Physician Recruitment Coordinator Ø NI Medical Staff Relocation & Staffing Assistant Ø HSDA Medical Director References: Ø DST: Recruitment Contingency Fund (RCF) Payments Ø Ministry of Health: Recruitment Contingency Fund Policy Ø DST: Recruitment Incentive Fund (RIF) Payments Ø Ministry of Health: Recruitment Incentive Fund (RIF) Policy Page 6 of 24

C2 Medical Staff Recruitment Site Visit: Summary for NH Medical Staff Leaders MEDICAL STAFF RECRUITMENT SITE VISIT: SUMMARY FOR NH MEDICAL STAFF LEADERS This summary is one of a series developed for NH Medical Staff Leaders and should be used in conjunction with the following information provided: ü C1 Medical Staff Recruitment Process ü C2 Recruitment Site Visit ü C3 Medical Staff Appointment and Reappointment Process ü C4 Physician Compensation Process and Contract Types ü C5 Rural Programs Information Sheet What are the steps involved in initiating a site visit? 1. An interested candidate has applied for a position on the urgent priority list. 2. A copy of their CV and 3 informal references must be obtained. 3. A candidate must express an interest in working for a particular community. 4. The candidate must be formally assessed by the College of Physicians and Surgeons for eligibility of licensure. 5. A visit must be viewed as a last step prior to a letter of offer being made; The candidate must be serious about moving to the North and not to view it as a paid holiday. 6. A site visit must be approved by the Medical Director. 7. A formal invitation is sent to the candidate to visit the area of interest in the North. This invitation outlines the reimbursement information and initiates the planning of the site visit. Who plans the site visit? Ø In collaboration with other HSDA and local administration, the site visit and itinerary are planned by the NI Medical Staff Relocation & Staffing Assistant or the Medical Director s Assistant for the Northwest and Northeast. Ø Details involved in the itinerary are discussed with the visiting physician along with the opportunity to have tours of the community, schools and real estate, as well as to look at other areas of particular interest in the community. What are allowable expenses incurred in a site visit? Ø Whenever possible, NH should pay for the expense and not have the candidate pay out-ofpocket and NH reimburse them after the visit. Ø Meal expenses must be within Northern Health guidelines ($55/day). Ø When travelling within the community, a physician must use the least expensive travel possible. Ø Where expenses are paid on Northern Health purchasing cards, reconciliations must include the physician name in the on behalf of field and the description field must contain the urgent vacancy site & speciality as well as the interview date. Ø During a site visit, one meal with the Department or Faculty Staff is permitted. The Ministry states that Northern Health will be reimbursed for $50 per person to a maximum of $750.00. Bar bills must be kept separate as these are not reimbursed through Northern Health. Ø Flights are covered for the candidate and their spouse. Ø Hotel Ø Car rental Exception: The HSDA Medical Director can approve other visit costs that they feel would be necessary to enable the recruitment of a physician. A letter explaining the details of this expense must accompany the cheque requisition. Page 7 of 24

C2 Medical Staff Recruitment Site Visit: Summary for NH Medical Staff Leaders What is the process for reimbursement of a site visit? 1. The Medical Director s Assistant or the NI Medical Staff Relocation & Staffing Assistant will collate all original receipts. 2. The reimbursement package is forwarded to Medical Director for approval. 3. The HSDA Medical Director approves and sends the package back to the NI Medical Staff Relocation & Staffing Assistant or Medical Director Assistant who then forwards the approved cheque requisition to Physician Compensation. Who does the candidate meet with on the site visit? Ø Chief Medical Officer Ø HSDA Medical Director Ø Department Head/Chief of Staff Ø Community Representatives and Other Stakeholders Who do you contact if you aren t sure about the process, need advice, or more information? Ø NI Medical Staff Relocation & Staffing Assistant Ø Coordinator, Physician Recruitment Ø Regional Medical Director Page 8 of 24

C3 Medical Staff Appointment and Reappointment Process: Summary for NH Medical Staff Leaders MEDICAL STAFF APPOINTMENT AND REAPPOINTMENT PROCESS: SUMMARY FOR MEDICAL STAFF LEADERS This summary is one of a series developed for Northern Health (NH) Medical Staff Leaders and should be used in conjunction with the following information provided: ü C1 Medical Staff Recruitment Process ü C2 Recruitment Site Visit ü C3 Medical Staff Appointment and Reappointment Process ü C4 Physician Compensation Process and Contract Types ü C5 Rural Programs Information Sheet The Appointment and Reappointment process is subject to change with the implementation of the Provincial Credentialing Program. What is the difference between Credentialing and Privileging? Ø Credentialing is the process used by an organization to review and verify a practitioner s license, experience, training, declarations, certification, education, and clinical competency. Ø Privileging is the process of granting a defined scope of practice and assigning the clinical services that a practitioner may provide. Privileging also assigns a practitioner to a site and department to which they may provide these services. When is an application issued to a practitioner? Ø An application is issued once a Letter of Offer (LOO) has been signed and returned by the candidate selected to fill a position on the Physician Human Resources (HR) Master Plan. Ø Applications are also issued to practitioners who are providing coverage for another physician or those who provide specialty services to a facility or program. What are the criteria for appointment to the medical staff? Ø A practitioner applying for membership must: o Hold a valid BC license; o Be a member of Good Standing with the College of Physician and Surgeons of B.C., College of Dental Surgeons of B.C. or College of Midwives of B.C.; o Have adequate training and experience; o Provide evidence of professional liability insurance coverage; o Demonstrate the ability to communicate and work cooperatively with colleagues and staff in a professional manner; o Produce documentation of experience; o Agree to be governed by the requirements set out in the NH Medical Staff Bylaws and Rules; o Disclose any physical or mental impairment that may affect the ability to deliver appropriate patient care. What information is requested within an application for appointment? Ø A statement that the applicant has read the Hospital Act and the Regulations, and the NH Medical Staff Bylaws and Rules; Ø An undertaking that, if appointed, the applicant will be governed in accordance with the requirements of the NH Medical Staff Bylaws and Rules; Ø An undertaking that the applicant will participate in the discharge of medical staff obligations applicable to the membership category to which they are assigned; Ø An agreement to accept committee assignments and responsibilities; Ø Valid professional liability coverage; Ø An up-to-date curriculum vitae; Ø 3 reference evaluations; Page 9 of 24

C3 Medical Staff Appointment and Reappointment Process: Summary for NH Medical Staff Leaders Ø Information on any civil suit relating to an applicant s professional practice and any physical or mental impairments; Ø Signed consent authorizing the Health Authority to obtain a Certificate of Professional Conduct from the appropriate College; Ø Reports on any action taken by a College disciplinary committee, or privileges that have been revoked by any hospital or facility. What is the procedure for appointment and a practitioner receiving privileges? Ø A practitioner sends a completed application with supporting documentation to the Medical Staff Appointment Office. Ø The Medical Staff Appointment Office reviews the application for completeness and ensures that the following criteria are met: o The applicant holds a valid BC license. o Practitioners that do not hold a full BC license will need to have a NH supervisor indicated on the license. o Practitioners who hold a temporary or provisional license may be restricted to a certain community. The correct community must be indicated on the license. o Fair or poor references evaluations are sent to the Medical Staff Leader for review and follow up. o A practitioner has correct liability coverage. o Declarations are flagged for the Medical Staff Leader. Ø Completed applications are sent to the Medical Staff Leader for review. Ø If the Medical Staff Leader is satisfied that the applicant meets the qualifications for the position, temporary privileges may be approved by the Medical Director and CEO pending Board of Directors approval. o Temporary privileges may be granted to an applicant if there is a need for the applicant to begin providing clinical services in advance of a Board of Directors meeting. Ø Once temporary privileges are approved, the practitioner is notified. Ø Medical Affairs also notifies the appropriate Medical Directors office once privileges are approved. The Medical Directors office should then notify those that require this information, including the appropriate Chief of Staff, Department Head, Hospital Administrators, etc. Ø If the applicant possesses sufficient experience and credentials, the Medical Staff Leader will sign a Recommendation to the Credentials Committee (RCC). o The Department Head or Chief of Staff may also make recommendations that the applicant be supervised for a certain period of time or that further documentation is submitted etc. Ø All applications for appointment to the medical staff are reviewed by the Credentials Committee. o o The Credentials Committee in conjunction with the recommendation of the relevant Medical Staff Leader, and/or facility privileges committee, will recommend to NH Medical Advisory Committee (MAC) the procedural privileges for which the applicant has demonstrated competency. The Credentials Committee will also recommend the assignment of an applicant to a primary department. Ø The NH MAC reviews the recommendations from the Credentials Committee concerning the appointment of medical staff members and the recommended clinical and procedural privileges. Ø The NH MAC will make recommendations to the Board of Directors. Ø The Board of Directors reviews the recommendations of the NH MAC and makes a decision regarding the appointment of an applicant to the medical staff. Ø The applicant is then notified of the Board of Directors decision. Page 10 of 24

C3 Medical Staff Appointment and Reappointment Process: Summary for NH Medical Staff Leaders What is the role of Medical Leaders in the appointment process? Ø The applicable Medical Staff Leader (Medical Director, Department Heads, and/or Chief of Staff) will evaluate an applicant for their ability to provide effective medical service for the privileges that have been requested. Ø It is the responsibility of the Medical Staff Leader to make a recommendation to the Credentials Committee of their support of the applicant with any suggestions for supervision, further training, or restrictions to privileges. Ø The Medical Staff Leader is responsible for contacting and reviewing the reference evaluations submitted by the applicant s chosen referees. How do the facility privileging committees operate? Ø Work in collaboration with the NH Credentials Committee to review applications for membership to the medical staff. Ø Review applications for additional privileges, status changes, or additional facility requests of current medical staff members. Ø Provide recommendations to NH MAC for applicants to exercise some or all of the procedural privileges. Ø Responsible for advising on the appropriate combination of training and experience required to practice effectively and safety in a facility. Ø Responsible for determining that the recommended candidates are providing a needed service. How does a practitioner receive clinical system access? Ø Once Temporary Privileges are granted to a practitioner by the Medical Director and CEO, their demographics, credentials, and temporary privileges are entered into the data repository system. Ø The Medical Director s Administrative Assistant (AA) will notify the applicable facility of a practitioner s temporary privileges. Ø The Medical Director s AA or facility contact will send a request to the IT system access team of the accounts needed for the practitioner to practice. How does a practitioner maintain their privileges on an annual basis? Ø Each fiscal year, a practitioner must submit a reappointment application to apply to maintain privileges. Ø Privileges are valid until March 31 st of each fiscal year. Reappointment applications must be completed, returned and brought through the approval process before this date to ensure privileges are in place for the upcoming fiscal. What is the process for the annual renewal of privileges? Ø In October of each year, reappointment applications are mailed to practitioners. Ø January 31 st is the deadline for the submission of reappointment applications. Ø Physicians who hold a Provisional or Active category within a facility must complete an annual meeting with their Medical Staff Leader (Dentists and Midwives are exempt from having the annual meeting at this time). o All Active and Provisional physicians must bring their reappointment to their annual meeting for review. This meeting gives practitioners an opportunity to review current privileges and/or request additional privileges with their Medical Staff Leader. The annual meeting also focuses on professional development and career plans. Ø Returned reappointments are reviewed for the following: o Accuracy; o Completeness; o Declarations stated; o Additional privileges requested. Page 11 of 24

C3 Medical Staff Appointment and Reappointment Process: Summary for NH Medical Staff Leaders Ø The Medical Staff Appointment Office provides follow up on any discrepancies or additional privileges requested by practitioners. Ø Reappointment information is reviewed by the Credentials Committee who reports their recommendations for practitioner reappointment to NH MAC. Ø NH MAC reviews the recommendations of the Credentials Committee and makes a further recommendation to the Board of Directors regarding the maintenance, restriction, non-renewal or cancellation of privileges for each medical staff member. Ø The Board of Directors has the ultimate decision regarding the annual renewal of privileges. Ø Once the Board of Directors has reviewed the reappointment recommendations, a letter is sent to each practitioner regarding the continuation of membership and privileges for the next fiscal year. What is the process for a practitioner applying for additional privileges? Ø A current member of the medical staff, who would like to apply for additional procedural privileges, must submit an Addition of Advanced Procedural Privileges application to the Medical Staff Appointment Office. Ø The Addition of Advanced Procedural Privileges application is sent to the Medical Staff Leader for review. Ø The same procedure is followed as outlined in the appointment process, where if temporary privileges are required, they must be approved by the Medical Director and CEO. An RCC must also be endorsed by the applicable Medical Leader. Ø A practitioner may be asked to supply documentation of qualifications or letters of support from a supervisor to support their applications. Ø The application will then follow the same process as the appointment processes where it is reviewed by the Credentials Committee, NH MAC, and the Board of Directors. Ø A letter is issued to a practitioner upon approval of privileges. When should a practitioner apply for a Change of Status? Ø A permanent member of the medical staff is one who has signed a Letter of Offer and has accepted a full time position on the Physician HR Master Plan. These members of the medical staff start out with a Provisional category and can apply for an Active category after 6 months. (Please review the NH Bylaws for further information on each medical staff category) Ø Practitioners applying for a status change must submit a Change of Status application to the Medical Staff Appointment Office. Ø The application must be endorsed by the applicable Medical Staff Leader and must have an RCC accompany it. Ø The application moves through the Credentials Committee, NH MAC, and Board of Directors process as previously outlined. How does a practitioner apply for privileges at an additional facility? Ø Current NH medical staff members who would like to provide service at an additional facility must submit an Addition of Facility application. Ø Members who do not hold a full license with the College of Physician and Surgeons of BC must have their license amended to demonstrate a valid supervisor for the community they are providing service to. The Medical Director s Administrative Assistant will work to find a suitable supervisor and will contact the College to declare the name of the selected supervisor and community that the practitioner will be providing service. Ø The Addition of Facility application is endorsed by the applicable Medical Staff Leader at the facility where the practitioner is applying for privileges. The Medical Staff Leader will also provide a RCC which supports the need for the service at their facility. Ø The application moves through the Credentials Committee, NH MAC, and Board of Directors process as previously outlined. Page 12 of 24

C3 Medical Staff Appointment and Reappointment Process: Summary for NH Medical Staff Leaders References Ø Northern Health. (December 2012). Northern Health Medical Staff Rules. Northern Health: Prince George, BC. Ø Northern Health. (2004) Medical Staff Bylaws. Northern Health: Prince George, BC. Page 13 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine PHYSICIAN COMPENSATION PROCESS AND CONTRACT TYPES: SUMMARY FOR NH MEDICAL DIRECTORS & VP MEDICINE This summary is one of a series developed for NH Medical Staff Leaders and should be used in conjunction with the following information provided: ü C1 Medical Staff Recruitment Process ü C2 Recruitment Site Visit ü C3 Medical Staff Appointment and Reappointment Process ü C4 Physician Compensation Process and Contract Types ü C5 Rural Programs Information Sheet What is Physician Compensation and what is their role regarding physician contracts? Ø Physician Compensation is a department of Northern Health that works closely with Medical Affairs to ensure NH physicians are paid. Ø Working with Medical Affairs, they oversee key budget allocations from the Ministry of Health and are responsible for administering different types of contracts. As a Medical Director or VP Medicine, what is my role in physician compensation and contracts? Ø In conjunction with Medical Affairs and Physician Compensation, you are responsible for working with other Medical Staff Leaders, Medical Affairs and Physician Compensation to: o Oversee physician contracts and related budgets o Develop, sign and oversee new contracts o To ensure existing contracts are up-to-date and renewed How do I know whether or not I need a physician contract to be established? Ø During the recruitment process the Chief of Staff meets with the Medical Director to determine if the physician will be on a contract. Ø Once determined, the Medical Director will consult with Physician Compensation to determine if the contract funds are accessible and can be allocated to the potential recruit. Ø See Figure 1.0 for more details and potential contract types. Are there different types of contracts? Ø Yes, there are several different types of contracts from different funding sources. We outline the details in the rest of this summary. Ø Physician compensation and contracts is complex; which is why it is important to work with Medical Affairs and Physician Compensation. Key contact information is provided at the end of this summary. What is fee for service? Ø Fee-for-service (FFS) is when physicians bill through the Medical Services Plan (MSP) when they provide services to individual patients. Ø As a Medical Staff Leaders, you generally will not be involved in physicians FFS billings as they are administered through MSP. INCOME GUARANTEE What is an Income Guarantee Contract? Ø A contract whereby the physician bills fee for service (FFS) and NH guarantees a minimum income. If the physician s FFS billings do not reach an agreed upon number NH will pay the difference. Ø Income Guarantee contracts are unique and are tailored to the physician and situation. Consultation with the Regional Director of Medical Affairs and the Coordinator of Physician Compensation is needed in order to facilitate these contracts. Page 14 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine ALTERNATIVE PAYMENT PROGRAM What is the Alternative Payment Program (APP)? Ø The APP funds physician services through means other than (i.e. an alternative to) the fee-forservice method of payment. Ø Alternative payments secure sufficient access to care in situations where fee-for-service arrangements may not guarantee the necessary financial support. Ø APP service planning is done by NH Physician Compensation and Medical Affairs in conjunction with the Ministry of Health Ø APP Contracts are standard contracts as per the Physician Master Agreement (PMA a joint agreement between the Ministry of Health and the British Columbia Medical Association (now Doctors of BC). The service deliverables are specific to the contract defined by the Medical Staff Leader. Ø All APP planning of physician services are to be aligned with the NH Physician Human Resource Plan that outlines the physician resources required within communities of Northern Health. Ø See Figure 2.0 for information on the steps involved in securing and administering an APP contract. How are APP funds and contracts administered? Ø A contract funding plan is developed by Physician Compensation in partnership with Medical Affairs. In November a request is sent from Physician Compensation to the Medical Staff Leaders initiating the APP planning process for the fiscal year. Ø When new required resources are identified, Physician Compensation and Medical Affairs work collaboratively to submit an application to the Ministry for additional funding. Ø Physician Compensation submits the contract funding plan to the Ministry for the annual APP budget. Medical Affairs establishes physician contracts for the delivery of clinical services. Ø Physician Compensation holds the contracts in a database. Ø Medical Affairs manages and evaluates the delivery of health services and contracts with individual or groups of physicians to deliver APP-funded services. Ø APP service planning must be aligned with the Physician Human Resource Plan. What are APP Sessional payments? How are they administered? Ø APP Sessional contracts make funding available for Northern Health to pay physicians for their services within a defined program of clinical care (for example, UHNBC- Renal Program Specialists). Ø Dates and times when these services are going to be provided are recorded in the appropriate electronic session application and signed by the physician. Ø Sessional services entered are validated by the appropriate Program Manager. Ø The signing authority (Medical Director) will review validated sessions and approve for payment by Physician Compensation. Ø Sessions are approved based on signed sessions contracts and the Ministry of health policy. Ø For new physicians, the Medical Director and Program Manager sign a contract with the physician. Ø Payments are approved and processed on a weekly basis. Ø See Figure 3.0 for the budgeting, contract and administration steps regarding APP Sessional contracts. MEDICAL ON-CALL AVAILABILITY PROGRAM What is the Medical On-Call Availability Program (MOCAP)? Ø MOCAP contract are group contracts used to purchase physician on-call availability. Ø The steps involved in creating and renewing a MOCAP contract are outlined in Figure 4.0. Page 15 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine What are MOCAP contracts and MOCAP Sign On Agreements? Ø MOCAP contracts ensure that physicians providing coverage as part of an established call rotation/physician group are compensated for being available to provide service. Ø As members of an on-call group, physicians must sign the MOCAP contract that is then approved by the appropriate HSDA Medical Director before receiving remuneration. Ø MOCAP contracts are managed and developed by Medical Affairs and monitored by Physician Compensation based on the MOCAP distribution plan. Ø Contracts are renewed every fiscal year. MOCAP sign on agreements are used when a physician joins an on-call group after the fiscal year has started. Ø MOCAP contract templates are mandated by the Physician Master Agreement (PMA) - a joint agreement between the Ministry of Health and the British Columbia Medical Association (BCMA). PHYSICIAN ADMINISTRATIVE CONTRACT What is a Physician Administrative Contract? Ø An administrative contract is used for a Medical Director, Chief of Staff, Department Head, and Medical Lead. They encompass all contracts that do not fall under clinical services or MOCAP. Ø Service deliverables are determined by the Medical Director and are consistent with the Health Service Delivery Plan and NH Strategic Goals and Objectives. o Medical Directors contract service deliverables are determined by the VP Medicine. Ø Administrative contracts are funded from Northern Health s global operations budget and are not prescribed by the Ministry. Ø Prescribed contract templates are used for producing these contracts. References Ø Ministry of Health: Fee-For-Service Payment Statistics Ø DST: Alternative Payment Program (APP) Service Planning Ø DST: Alternative Payment Program (APP) Contracts Ø DST: Medical On-Call Availability Program (MOCAP) Contracts Ø Ministry of Health: Medical On-Call Availability Program (MOCAP) Ø DST: Physician Administrative & Other Contracts Contacts Ø Regional Manager, Physician Compensation Ø Regional Director, Medical Affairs Page 16 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine! Figure 1.0 Physician Compensation Process and Contract Types Overview!!! Page 17 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine Figure 2.0: Physician Compensation APP Contracts Page 18 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine Figure 3.0 Physician Compensation APP Sessional Contracts Page 19 of 24

C4 - Physician Compensation Process and Contract Types: Summary for NH Medical Directors & VP Medicine Figure 4.0 Physician Compensation MOCAP Contracts Page 20 of 24

C5 Rural Programs: Information Sheet for NH Medical Staff Leaders RURAL PROGRAMS: INFORMATION SHEET FOR MEDICAL STAFF LEADERS This summary is one of a series developed for NH Medical Staff Leaders and should be used in conjunction with the following information provided: ü C1 Medical Staff Recruitment Process ü C2 Recruitment Site Visit ü C3 Medical Staff Appointment and Reappointment Process ü C4 Physician Compensation Process and Contract Types ü C5 Rural Programs Information Sheet What are Rural Programs? Ø In order to encourage physicians to practice in rural areas, various rural programs and incentives are offered by Northern Health and the Government of British Columbia. What is the Rural Practice Subsidiary Agreement (RSA)? What is the Joint Standing Committee (JSC)? Ø The RSA is a subsidiary agreement of the Physician Master Agreement between the BC government, the BCMA, and the Medical Services Commission. Ø The Joint Standing Committee (JSC), a result of the RSA, is comprised of members of the BCMA, Ministry of Health, and Health Authority representatives. The purpose of the JSC is to advise the BC Government and the BCMA on matters pertaining to rural medical practice. Ø The goal of the JSC is to establish the availability and try to maintain stability of physician services in rural and remote areas of BC through various funding incentives. How are RSAs identified and how are communities rated? Ø The JSC determines the number of points designated for each rural BC community within an RSA. What programs are included in the Guide for Rural Programs of British Columbia? ü Rural Retention Program (RRP) ü Recruitment Contingency Fund (RCF) ü Rural Continuing Medical Education (RCME) ü Isolation Allowance Fund (IAF) ü Recruitment Incentive Fund (RIF) ü Rural Emergency Enhancement Fund (REEF) ü ü Rural Education Action Plan (REAP) Rural Specialist Locum Program (RSLP) ü ü The Rural GP Locum Program (RGPLP) Northern & Isolation Travel Assistance Outreach Program (NITAOP) What is the Rural Retention Program (RRP)? Ø Retention payments and flat sum premiums paid to fee-for-service physicians working in eligible RSA communities. What is the Rural Continuing Medical Education (RCME)? Ø Funding opportunities for medical education in order to update medical skills and credentials for rural practice. What is the Recruitment Incentive Fund (RIF)? Ø Financial benefits available to physicians recruited to fill vacancies or pending vacancies that are part of a physician supply plan in RSA communities. o A Communities- $20,000 o B Communities- $15,000 o C Communities- $10,000 o D Communities- $5,000 Page 21 of 24

C5 Rural Programs: Information Sheet for NH Medical Staff Leaders What is the Recruitment Contingency Fund (RCF)? Ø An incentive to assist RSA communities with recruiting expenses where filling a vacancy is deemed to be very challenging and in cases where the community is in high need for medical care. Ø An RCF is used in cases where a vacancy would have a significant impact on the delivery of medical care in the community. What is the Isolation Allowance Fund (IAF)? Ø Available to physicians providing medical care in RSA eligible communities where there are only 4 physicians, no hospital, and the physicians do not receive MOCAP, Call-Back, or Doctor of the Day payments. What is the Rural Emergency Enhancement Fund (REEF)? Ø Program is utilized to encourage the access to emergency services in health authority service departments that are serviced by fee-for-service physicians. Qualifications o Eligible fee-for-service physicians supporting emergency departments (EDs) in qualifying RSA communities. o ED s and hours of public access must be supported by the health authority o Physicians must be on ER Call and have Active privileges in the rural community where they are providing service. o Maximum amount received by each physician under the plan is $65,000 per annum. What is the Rural Education Action Plan (REAP)? Ø Supports additional training for physicians, undergraduate medical students, and post-graduate medical students with rural practice experience. What is the Northern & Isolation Travel Assistance Outreach Program? Ø Provides funding to assist Health Authorities in the provision of outreach medical services in rural and isolated communities. NITAOP compensates visiting specialists and family medicine physicians for travel time and travel related costs that are incurred in the delivery of outreach services. General Practitioners (GP) o Meet funding requirements if they are providing care in eligible RSA communities where there is not an available GP within 105 km of the community. o Maximum of 48 visits per community per year Specialists o Eligible for funding if there is no specialist within 105 km of the community they wish to visit and provide care. o Maximum of 24 visits per community per year. Page 22 of 24

C5 Rural Programs: Information Sheet for NH Medical Staff Leaders What is The Rural GP Locum Program (RGPLP)? Ø Provides locum physicians with opportunities to practice rural medicine in BC and receive subsidized relief for Continuing Medical Education (CME), vacation, and health needs. Ø Locum days for physicians are established based on their community designation A, B, C, and D: The Program Host Physician Ø Requests must be a minimum of 5 days in order to be processed Ø Retains 40% of the MSP fee for service paid claims to recover overhead costs Ø Host GP physician must be living/practicing medicine in an eligible RSA community. Ø May request locum coverage when the health authority has a vacancy Locum Ø Ø Ø RGPLP locums are paid a guaranteed daily rate depending on the community designation. Additional stipends paid for enhanced skills to a maximum of $100/day May receive RRP fee-for-service premium and payment for on call. Responsibilities Host Physician Ø Provides the locum with a list of responsibilities they wish for them to fulfill. Ø Provides accommodation for locum Ø Submit claims within two weeks of the end of the locum assignment Ø Provides locum with a detailed reconciliation of claims Ø Ensure the locum receives on call and retention premium if needed Ø Reimbursement of services not covered by MSP should be covered by the host physician. Locum Ø Must contact the RGPLP to request a locum application form Ø Applicants must have their certificate in ACLS, CARE, or ATLS Ø Must be licensed to practice in BC Ø member in good standing of the Canadian Medical Protective Association Ø Must assign payment to the host physician s payment number Ø RGPLP arranges assignments and assists with privileges Ø Accommodation should be pre-arranged by the community or host physician. What is the Rural Specialist Locum Program (RSLP)? Ø The purpose is to secure periods of leave for specialists. With approval from the JSC, this funding may also be used to assist in gaps in specialist services vacancies. Ø Please check the RSLP policy for host physician and locum eligibility requirements, responsibilities and how to request a specialist locum. Ø RSLP Policy: http://www.health.gov.bc.ca/pcb/pdf/rslp_policy.pdf Who do you contact if you aren t sure about the process, need advice, or are looking for more information? Ø Local HSDA Medical Director s Office Ø Physician Compensation: Rural Practice Programs Ministry of Health Ø Ministry of Health Ø Northern Health Physician Compensation Page 23 of 24

C5 Rural Programs: Information Sheet for NH Medical Staff Leaders References Ø A Guide for the Rural Physician Programs in British Columbia (January 2012) Ø Ministry of Health: Physician Compensation Branch Ø RSA Communities Point Evaluation Ø Rural Retention Program Policy Framework Ø Rural Retention Program- Premiums and Flat Fee Sums Ø RCME Policy Ø Recruitment Incentive Fund Policy Ø Recruitment Contingency Fund Policy Ø Isolation Allowance Fund Policy Ø Rural Emergency Fund (REEF) Policy Ø Rural Emergency Enhancement Fund (REEF) Program Process Document Ø Overview of REAP and REAP Sponsored Programs Ø REAP Program Ø Rural Specialist Locum Program Ø Northern and Isolation Travel Assistance Outreach Program Policy Ø Application for Expenses Page 24 of 24