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 the majority of physician services. The contract was signed in September 2016 and runs from April 1, 2015, to March 31, 2019.

Note: On Dec. 4, 2017, Doctors Nova Scotia (DNS) filed Notices of Application with the Nova Scotia Supreme Court to settle two contract issues with the provincial government. Under dispute are the government’s use of unapproved contracts for Alternative Payment Plan (APP) physicians and monies owed to DNS for the physicians’ health and dental plan and other benefits. Read more 


Increases

The contract has $28 million invested in the Master Agreement, including annual across-the-board increases that total approximately $14 million:

Year 1 (2015–16): 0%
Year 2 (2016–17): 0% 
Year 3 (2017–18): 1% 
Year 4 (2018–19): 1.5% 

These annual increases 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, sessional rates and hourly rates (ICU, ED and psychiatry).

New investments

In addition to these across-the-board increases, the contract includes $14 million to support new services and new positions.

  • $6.3 million for new fees
  • $3 million for non-face-to-face patient care (care by telephone)
  • $2.1 million in rate increases for APP physicians
  • $1 million to support methadone maintenance in family practice, intended to take pressure off provincial programs to improve access to treatment and to provide good continuity of care
  • $1 million to support increased care for complex and chronic illness
  • $500,000 for surgical emergency premium – provides a premium to physicians whose surgeries are bumped to evenings or weekends

Learn more about Master Agreement programs and funding.

Member benefits funding

The Master Agreement funds the member benefit programs offered by Doctors Nova Scotia (DNS). The government pays for 65% of the actual costs of the health and dental program and 100% of the professional support and parental leave programs.

CMPA rebates 

Physicians pay the first $1,750 of the physician liability premiums (CMPA fees) applicable to their specialty and 10% of the balance; government pays 90% of the cost of the remaining CMPA fees.

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).

Improved audit and appeal

This Master Agreement includes a new and improved audit appeal process (Schedule E). The new process allows physicians to challenge both post-payment audit results and pre-payment assessment of claims that have been rejected or adjusted. In the past, physicians had no right to appeal pre-payment assessment decisions. When a physician disagrees with an audit or pre-payment assessment result, they may initiate a review. If the issue cannot be resolved by DNS and DHW representatives, a two-tiered appeal process is initiated: first through facilitated resolution and then through arbitration. See more information under MSI Audit and Appeals.

Completion of Physician Manual Modernization Project

The Master Agreement secures funding from government to complete phase five of the Physician Manual Modernization Project

Right to arbitration

This contract secures physicians’ right to arbitration.

Funding for practice supports

Funding to support DNS to provide practice support for physicians – such as EMR advisors – continues.

Master Agreement evaluation

Eight funding programs from the 2008 - 15 Master Agreement contract were evaluated by Deloitte, as requested by the Department of Health and Wellness (DHW) and Doctors Nova Scotia (DNS), to inform 2015 Master Agreement negotiations.

Key recommendations

The key recommendations included:

  • Simplify programs to improve understanding
  • Improve communications to increase program awareness and transparency
  • Set clearer objectives and measures
  • Align payments with outcomes and workload

Outcome of evaluation

As part of the 2015 contract, four programs will convert to fees while others remain largely unchanged. See more information on the Funding Program Changes page.