Transitional Payment Model (TPM) Information

To be eligible for the program, fee-for-service family physicians must:

• Be licensed to practice and currently reside in Saskatchewan.
• Provide longitudinal family medicine as the majority of their practice in a Saskatchewan community.
• Hold SHA appointment/privileges.
• Commit to being the “Most Responsible Provider” (MRP) to a panel of patients and document patient understanding of the relationship.
• Commit to providing chronic disease management including submitting CDM-QIP flow sheets.
• Provide comprehensive care and on-call services.
• Participate as part of a group (a clinic group or multiple clinic groups for solo physicians) to ensure adequate service and call coverage; and
• Assign a family physician as the physician group lead.

Registration is open on April 19, 2024, and there is no deadline to apply. To qualify for payment for any given quarter you must register within 60 days from the start of each quarter (i.e., May 30 for Q1 or July 30 for Q2).

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Eligible physicians will receive a payment of up to $144,000 based on the following formula:

Patient Contact Ratio

A patient contact represents each time a physician provides primary care (in-person or via virtual care) to a patient. The visit is considered one contact based on date regardless of the number of services provided during the visit (contact count is limited to one contact per patient per day).

Physician billing data is used to determine the number of patient contacts.  The contact ratio is calculated using a threshold of 6,500 contacts.  

Patient Panel Ratio

A patient panel is a group of patients assigned to one specific physician. 

Patient panel size is calculated using a four-cut methodology that matches patients to one physician. The four-cut matching methodology uses a three-year data analysis period to match Saskatchewan patients to a Family Physician or Nurse Practitioner where most of their primary care services were billed to the Medical Services Branch (MSB).

The Patient Panel Ratio is calculated using a threshold panel size of 1,600.

NOTE: An individual physician must have a minimum of 250 patients matched to be eligible for the program.
NOTE: Although the calculations of the ratios use thresholds (6,500 contacts and 1,600 patients), there is no limit on the number of contacts or matched patients a physician may have.

Establishing A Patient Panel 

Family physicians are expected to engage in a conversation with their patients about physician-patient empanelment and what a "Most Responsible Physician" (MRP) relationship between physician and patient entails. An empanelment process will be developed by Ministry of Health and the Saskatchewan Medical Association.

• The empanelment process represents a physician’s commitment to delivering patient-centred care by communicating and collaborating with patients regarding the management of their condition(s) and care plan(s) on an on-going basis.  
• The empanelment process means the patient commits to seeking all their primary care from that physician, or that physician’s colleague(s) whenever possible.

Physicians will be required to maintain an up-to-date list of empaneled patients as well as to retain copies of all physician-patient documentation. The empaneled patient list will inform the next phases of the Saskatchewan made blended capitation model.

NOTE: For the purposes of calculating TPM payments, the four-cut methodology described in the payment section is used to determine patient panel size, not the number of patients the physician empanels through an established empanelment process.   

Physicians participating in TPM are expected to provide the following four deliverables:

1. Establish a longitudinal relationship with patients, by providing ongoing community-based family medicine services to a dedicated patient panel, which includes screening, prevention activities, chronic disease management, and comprehensive care.

• When the empanelment process is developed, physicians will be expected to document patient understanding and consent to the Most Responsible Physician (MRP) relationship with each empaneled patient.
• Physicians are expected to adhere to best practices in Chronic Disease Management.
• Physicians are expected to provide comprehensive care to their empaneled patients shared by a TPM clinic/group, including hospital and supportive care, nursing home care, pre- and post-natal and infant care, complete physicals including PAP smears, and phone calls from Allied Health Care Providers (AHCP), where applicable.
• Physicians are expected to adhere to a set of Primary Care Quality Indicators once jointly developed by the SMA and Ministry.
• Physicians are expected to adhere to common work standards for EMR/eHR patient- centered information exchange.

2. Commitment to transition towards the Patient’s Medical Home (PMH) framework:

• Physicians are expected to be part of a group with more than one Most Responsible Physician (MRP) participating in TPM.
• For solo clinics, joining a group of physicians (minimum of two family physicians) in the same community or catchment area is encouraged, with all physicians willing to share patient information for coverage and comprehensive care.
• Appointment of at least one family physician lead from the clinic or group to be a point of contact, attend learning events, and liaison with SHA. This role is paid.
• Providing on-call coverage for the group’s patients.

3. Commitment to address multiple relevant patient issues/concerns during one visit.

4. Commitment to any necessary data tracking, sharing, and reporting that demonstrates improvements to primary care delivery and patient outcomes as jointly developed by the SMA and Ministry.

Further details on each deliverable are available.

1. Enrolment and Changes to Enrolment

Who can enrol in TPM?

Licensed fee-for-service physicians providing longitudinal community-based family medicine in Saskatchewan.

How do I enrol in TPM?

Eligible physicians must register to participate in TPM.

How do I make changes, updates or withdraw from TPM registration?

Changes to your registration can be made by sending an email to: tpm@health.gov.sk.ca.

Is TPM mandatory? If I join, can I leave it?

The TPM is voluntary. Family physicians are free to join or withdraw from the program. If you wish to withdraw from the program, please send an email detailing the following information to tpm@health.gov.sk.ca:

• Physician Number
• Physician Name
• Date of Withdrawal

Please note that payment will not occur if your request for withdrawal takes place within the first quarter of the program.

2. Patient Contact

What type of primary care services count towards patient contacts?

Services associated with the delivery of longitudinal community-based family medicine count as patient contacts including GP visit services, prenatal and infant services, some minor procedures (e.g., suturing, other minor treatments not billed with a visit code), and some in-office diagnostics (e.g., ECG, spirometry).

If I see the same patient more than once in a day, does it count as more than one contact?

No, contacts counts are limited to one per day per patient.

3. Patient Panel

Where can I get my Health Quality Council (HQC) patient panel report?

Your panel report is available at Physicians Practice Report.

Why does my panel noted in the HQC patient panel report differ from the panel used to determine my TPM payment?

The panel methodology used the determine the TPM payment includes Nurse Practitioners and excludes clinics that do not primarily practice longitudinal family medicine. Information specific to payment drivers, deliverables and clinic activities will be available through your TPM report (currently in development).

How often is my patient panel calculated?

Patient panels are calculated semi-annually in April and October of each year.

Is there a limit on the number of empaneled patients a physician may have?

There is no limit on the number of empaneled patients a physician may have; however, to be eligible for TPM, a physician must have a minimum panel size of 250.

How will panel sizes be determined for family physicians new to practice and/or new to Saskatchewan? 

As an incentive for new family physicians choosing to practice in Saskatchewan, the below panel sizes will be used to inform payment for family physicians in the first two years of practice. 

The panel size used is directly correlated with the physician’s activity level (as measured by patient contacts). 

4. Payment

When will I receive my first payment?

TPM payment calculations occur quarterly; payments will be provided to participating physicians within 30 days of the end of the quarter.

How often will payments occur?

Payments will occur quarterly beginning in July 2024.

Is there a maximum amount paid in each quarter?

The maximum annual payment a family physician can receive through TPM is $144,000 per fiscal year. To support the administrative process and provide timely payments to physicians, the maximum annual eligible amount will be divided into four quarters ($36K each quarter). 

To account for fluctuations in the volume of services between quarters and to ensure all billing services are included, a reconciliation process will occur six months after the end of each fiscal year. An additional payment not to exceed $144,000 may result from the reconciliation process.  

Will the TPM calculation include patient complexity modifiers?

Patient complexity modifiers are not used to calculate payments in the current methodology. However, the Ministry and SMA intend to jointly review and develop patient complexity modifiers for future payment calculations.

5. Patient Matching

How are Saskatchewan residents matched to a family physician using a four-cut method?

Residents are matched to one provider using a four-cut method:

• Cut 1: Saw only you. If an individual only saw you during the three years, they are matched to you. Otherwise, go to cut 2.
• Cut 2: Saw you the majority of the time. If an individual saw you and other providers, but visited you the majority of the time, they are matched to you. Otherwise, go to cut 3.
• Cut 3: Had their last physical examination with you. If an individual saw you and other providers the same number of times, they are matched to you if you did the last physical exam (fee codes: 3B, 4B, 52B, 64B). Otherwise, go to cut 4.
• Cut 4: Saw you last. If an individual saw you and other providers the same number of times and has not had a physical, they are matched to you if they saw you last.

Note: Providers in the four-cut method include family physicians and nurse practitioners. Patients who match to an NP will not be matched to a FP.

What are the other inclusion and exclusion criteria for the patient matching?

Every Saskatchewan beneficiary with a billed service to an in-province Family Physician or a Nurse Practitioner (NP) practicing at a Family Medicine or Primary Health Clinic (PHC) is matched to one provider. Patients matched to providers are added to create the total panel size.

Inclusion Criteria

i) Patients are matched to a provider working at a clinic that was determined to offer full-service primary care services by an FP or NP.
ii) A full-service family medicine or primary care clinic is defined as a clinic that offers routine care, care for urgent but minor or common health problems, minor mental health care, maternity and childcare, liaison with home care, health promotion and disease prevention, nutrition counselling and end-of-life care.
iii) Patients are defined as Saskatchewan beneficiaries for which a billable service was submitted to MSB by a Family Physician (FP) or Nurse Practitioner (NP) at a primary care clinic during the three-year analysis period.

6. Other

I currently receive CDM-QIP and FPCCP payments. Will these payments continue?

Physicians enrolled in the TPM will no longer receive payments for FPCCP, Metro On-Call, and the CDM-QIP payment (specifically, the $75 payment for all indicators met per patient and per chronic condition in a 12-month period flow sheet). Fee for services payments for these services will continue.

Why do I have to consent to share my data?

Participation in TPM requires that a physician commits to necessary data tracking, sharing and reporting that demonstrates improvements to longitudinal community-based family medicine delivery and patient outcomes as jointly developed by the MoH and the SMA.

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