Master Agreement

Doctor in his office

Master Agreement

The Master Agreement is the formal funding contract between physicians and the government of Nova Scotia for most physician services. The contract covers the period from April 1, 2019, to March 31, 2023.

Through consultation with physicians, the Board of Directors identified five priority areas for targeted investments to help stabilize some of the province’s most critical services. The goal was to make these physicians the highest paid among their peers in Atlantic Canada by the end of the contract, thus making Nova Scotia competitive with other provinces. By the end of the contract, family physicians, anesthetists and emergency physicians will be the top paid in Atlantic Canada. Psychiatry and obstetrics/gynecology will come very close to the top.


Increases

In total, Doctors Nova Scotia secured $135 million in new funding over four years for Nova Scotia’s doctors.

Each physician will receive a 2% rate increase in each year of the contract.

These annual increases are effective April 1 of each year and apply to the medical service unit (MSU), alternate payment plan (APP) rates, Collaborative Emergency Centre funding, anesthesia unit (AU), Clinical Assessment for Practice Program (CAPP) rates, Regional Hospitalist and Community Hospital Inpatient Program (CHIP) daily rates, the Primary Maternity Care Program hourly rates, Pathology List B payments, sessional rates and hourly rates (ICU, ED and psychiatry).

Repair funding

The contract includes $42 million in repair funding, also known as targeted investments. This will increase compensation for physicians to the top or nearer to the top in Atlantic Canada. The five priority areas are:.

  • Primary Care
    • Increased ME=CARE comprehensive care visit, inpatient and obstetrical delivery fee codes
    • Increased emergency department hourly rates
    • New community hospital in-patient program for larger community hospitals
    • New Primary Maternity Care model (IWK, Bridgewater, Amherst, Yarmouth, Antigonish, Sydney)
    • New blended capitation payment model
  • Anesthesia APP and AU rate increases
  • Emergency medicine hourly rate increases
  • Psychiatry hourly rate and fee code increases
  • Obstetrics/gynecology APP rate and fee code increases

Learn more about Master Agreement programs and funding.

Additional investments

Some additional investments will support recruitment and retention of doctors in other ways.

  • The rural specialist retention program will double to $16,000 by the end of the contract
  • NewMD funding of $9.05 million for new physicians
  • APP specialists now are able to bill fee-for-service while on-call
  • Fee Committee will have a budget of $1.5 million in year three of the contract
  • Funding for preceptors will increase to $450/week for students and $250/week for residents
  • Parental leave benefit improvements
  • Health and dental plan wait time will reduce from six months to three months

First-time audit focused on education

The first instance that a physician is audited on a particular fee code, the audit will be for education purposes unless in the rare event of intentional abuse.

Administrative burden review

The Office of Regulatory Affairs and Service Effectiveness, working with partners and physicians, launched a two-year pilot project designed to identify and implement measures to reduce administrative burden on physicians and their patients.

Physician engagement

In a new Memorandum of Agreement, the DHW, NSHA and IWK commit to engage physicians in any decisions that may impact physicians and their delivery of services. The DHW, NSHA and IWK will meaningfully consult with DNS, ensuring that the concerns and input of physicians as represented by DNS are considered in health-system decision-making.

Role of DNS restored

Doctors Nova Scotia has secured physicians’ right to representation in all aspects of contract negotiations, including not only compensation but also the services that can be required of physicians in exchange for that compensation, through a Memorandum of Agreement between DNS, the Department of Health and Wellness, the Nova Scotia Health Authority and the IWK.

Programs continued from previous agreements

Technology Stipend - Virtual Care

The 2019 Master Agreement secured the continuation of the virtual care stipend, which was announced on March 19, 2018. The stipend allows family physicians to better leverage technology by repositioning telephone services along with eVisits in a reconstituted pilot consisting of a block payment structure for physicians who are prepared to leverage MyHealthNS and telephone visits to provide care to their patients.

A stipend of up to $12,000 per physician is available to all family physicians (APP, AFP, and FFS) who enroll their patients in MyHealthNS, enable patient access to laboratory results and other key platform features as well as agree to participate in the pilot evaluation process. 

This investment aims to improve access to care for patients and compensate physician participants for the time telephone and eVisits take. Compensation will be pro-rated for physicians working part-time or who have small patient panels.

Current non-face-to-face fees continue for specialists. Family physicians who choose not to participate in the MyHealthNS pilot are eligible to bill the non-face-to-face fees.

On Aug. 7, 2019, the Department of Health and Wellness (DHW) announced that McKesson Canada, the software vendor behind MyHealthNS, will not be renewing its contract in Nova Scotia.  The Department of Health and Wellness (DHW), with input from Doctors Nova Scotia, is in the process of selecting the new solution and working closely with McKesson to develop transition plans.  In the meantime, all current functionality of MyHealthNS and the funding associated continues.

Master Agreement management

The Master Agreement is managed jointly by DNS and the Department of Health and Wellness (DHW). See more information under the Fee Committee and the Master Agreement Management Group (MAMG).

Next steps