Quebec wants to link doctors’ remuneration to their performance

The Quebec government tabled its proposal to family doctors in the context of negotiations for the renewal of the 2015-2023 Framework Agreement. Quebec wants to modify the remuneration model for family doctors, notably by introducing colour codes per patient.

The offer published on the Quebec Treasury Board’s website states that the government wishes to introduce “a performance-based principle, linked to relevant clinical performance indicators determined” by the Ministry of Health.

Quebec wants 25 per cent of the current global budget to be dedicated to performance. In other words, the fee-for-service remuneration model for family doctors would be completely transformed by integrating performance objectives that would be set by the government, for example with regard to the care of vulnerable patients.

“If the objectives are not met, the sums earmarked for performance in the overall budget envelope will not be owed to the Fédération des médecins omnipraticiens du Québec,” reads the document.

Quebec clearly indicates its desire to change the way primary care is done. The government’s proposal includes the colour codes established by INESSS according to the patient’s health condition, which will be used to determine the family doctor’s remuneration.

The government wants half the doctor’s salary to be based on the capitation payment model, meaning that instead of being paid for each service rendered, doctors would receive a fixed annual amount for each patient on their list.

Annual flat rates by colour would go as follows: $12 for a green patient (patients with episodic problems); $74 for a yellow patient (minor chronic health problems with no functional impact); $124 for an orange patient (moderate health problems requiring regular follow-up, such as cancer); and $223 for a red patient (major health problems with complex conditions).

In the model proposed by Québec, 30 per cent of a physician’s remuneration would continue to be on a fee-for-service basis, plus an additional hourly rate of 20 per cent of the physician’s salary.

Fee-for-service rates vary according to the type of consultation. A fee of $16.50 would be assigned for a virtual consultation; $18 for an in-person interaction; $25 for a group, in-person or video interaction; $33.50 for a clinic visit of at least 30 minutes; $79 for an interaction in the patient’s home; $25 for consultation with another professional.

Health Minister Christian Dubé did not comment on the content of the new proposals. Asked why he had decided to make them public, Dubé replied that it was to be transparent with the public, so that they know what the government is asking doctors to do. “To make sure that the information is clear for all parties, all doctors, for the population, what is being asked and what is the state of negotiations,” he said in a press scrum.

–This report by La Presse Canadienne was translated by CityNews