1. PSP Compensation Policy Update
May 30th, 2019

2. UPDATE: Effective June 15th, 2019
New compensation policy is aligned to the Practice Facilitation Framework and is designed to support practices to build QI Capacity via flexible QI cycles (i.e. Facilitation Cycles)
Note: This is not retroactive to projects started prior to June 15th
This is also our first step toward aligning all PSP services under the Framework and, as we’ve mentioned, we’re working toward aligning the certification as well to streamline all PSP services.

3. Why? Greater flexibility Clear plan and expectations for the practice
Streamline and align with the Practice Facilitation Framework
Reduce administrative burden for regional and provincial office staff
The updated policy is in response to feedback from both RSTs and GPs and
Promotes the sustainability of at-the-elbow supports for physicians and team members
Honours/rewards the increase in physician and team time spent participating in individual and/or group learning opportunities AND the subsequent ‘actioning’ of practice improvements
Acknowledge the time in-practice to take a deeper dive into quality improvement activities
Create improvement projects that are manageable and attractive to practice teams
Provide flexibility in delivery of services provided under the newly implemented PSP practice facilitation approach
Align and streamline PSP’s compensation and accreditation policy (latter coming soon!) with the Practice Facilitation Framework
Reduce administrative burden for regional and provincial office staff

4. What does a Facilitation Cycle Include?
Time:
in practice to determine the needs/pain points/areas of interest
in session or to complete an Assessment
in practice to create AND implement an action plan
in practice to discuss sustainability plan
A facilitation cycle is the completion of the PSP Practice Facilitation Cycle. Although not all phases may be necessary the physician and team will have to complete at least one PDSA cycle implementing a change as defined in the Action Plan in practice, measurement of the outcome and reflection on the process and outcomes.

5. From this…
To this…

6. Learning Experiences included in the assessment phase
Module Session/Flexible Learning Units
SGLS (including EMR SGLS)
PMH  Assessment*
Patient Experience Tool
EMR Functionality Assessment
Panel Maintenance (Panel Management activities following Phase 3**)
Other physician-driven quality improvement activities  
*Compensation for one (1) hour is provided to family physicians to complete the PMH Assessment through the GPSC Evaluations portfolio.
**Action planning time will not be paid for activities related to Phases 1-3 of Panel Management as these are compensated via the Panel Development Incentive.

7. Facilitation Cycle Engagement Sustainment Implementation Assessment
Pre-visit with the physician and the RST.
During this time the RST can begin to build their coaching relationship with the physician and establish the benefits of PSP’s approach, manage expectations and secure commitment to the process.
Estimated time commitment for RST: 30 min - 1 hour
Estimated time commitment for physician/team: 1 hour
Sustainment
If necessary the physician/team may choose to create space and time for ongoing reviews for their project and develop a plan to spread the project impact.
Physician submits for compensation up to a maximum of 15 hours.
Engagement
Assessment
Action Plan
Test & Measure Impact
Implementation
Sustainment
Implementation
RSTs final check-in with physician to review data collected, measures/indicators, and facilitate ongoing implementation of improvements into workflow where applicable.
Estimated time commitment for RST:
1 – 2 hours
Estimated time commitment for physician/team: 1 – 2 hours
Assessment
With the support of the RST, the physician and team may opt to use one of PSP’s tools and resources (learning experience, assessment, etc.)
The RST works with the physician to gain a baseline and begin action planning.
Estimated time commitment for RST: hours
Estimated time commitment for physician/team: 1 – 4 hours
Estimated time commitment for each stage is flexible (PSV can only be 1 hour). It could be more or less than the hours recommended above – however the total cannot exceed 15 hours (maybe we need an example for a QI project with 0 hours for Assessment?)
Speaking Notes - Detail for each section:
Engagement –
Assessment – PSP tools and resources – could be participation in a traditional module, evolved module content, SGLS, PMH Assessment, EMR Functionality Assessment, Patient Experience. This is also where we being thinking about what data they have and where they’re at right now.
Action Plan – see comment re: simple action plans before we add additional speaking notes here
Expected timeline – dependent on the engagement and capacity of the practice. If they’re keen this could be a month, maybe two or it could stretch to 6-12 or even longer depending on capacity and size of the project
Test & Measure Impact
The RST may support the physician to test action plan activities in practice; however, this stage may not include at-the-elbow interaction depending on action plan goal and activities
Estimated time commitment for RST: 0 – 1 hour
Estimated time commitment for physician/team: 1 – 4 hours
Action Plan
The RST attends ongoing follow-up visit(s) (anticipated 1-4 additional visits with the physician and team to develop their action plan.
The Practice Facilitation Action Plan should include a problem and aim statement, at least one measure built on baseline and one key step/ task.
Estimated time commitment for RST: hours
Estimated time commitment for physician/team: 1 – 4 hours

8. How?: Example 1 – EMR Functionality Assessment
Sustainment
Final in-practice visit to ensure capacity to sustain the change and decides their next area of focus of the framework will be Dementia SGLS because they have realized they aren’t managing their dementia patients as well as they could be.
Physician/ team submits for credits and compensation.
TOTAL COMPENSATION SUBMISSION: 2 hours 15 minutes
Engagement
Assessment
Action Plan
Test & Measure Impact
Implementation
Sustainment
Engagement
How PSP will support physician through this process.
Decision to start with an assessment because the physician was unsure which PSP learning experience to start with.
Estimated time commitment for RST: 15 minutes
Estimated time commitment for physician/team: 15 minutes
Implementation
Physician to document in action plan how this change will be implemented into practice
Estimated time commitment for RST: 15 minutes Estimated time commitment for physician/team: 15 minutes
Assessment
Physician completes assessment with the RST and MOA.
Estimated time commitment for RST: 30 minutes
Estimated time commitment for physician/team: 30 minutes
Other examples of how the EMR Functionality Assessment can be incorporated:
- As part of the AA/ OE SGLS
As a EMR SGLS
Before Phase 3 of Panel Management
Action Plan Example - EMR Functionality Assessment (Desktop, Web, Mobile)
Action Plan
Complete action plan with small change in their EMR
Estimated time commitment for RST: 30 minutes
Estimated time commitment for physician/team: 30 minutes
Test & Measure Impact
With support from the RST the physician makes the change and documents the impact in the action plan
Estimated time commitment for RST: 45 minutes
Estimated time commitment for physician/team: 45 minutes

9. Engagement
Assessment
Action Plan
Test & Measure Impact
Implementation
Sustainment
How?: Example 3 – Adult Mental Health Learning Series (traditional module format)
Engagement
Assessment
Action Plan
Test & Measure Impact
Implementation
Sustainment
Based on the physician’s learning needs and availability 3 x 3.5 hour learning sessions are held over the 6 months on AMH
A facilitation cycle is completed for each of the 3 sessions.
The practice improvement project following each session is short and simple – building capacity and appetite for future application of QI approach.
Sessional is submitted after each individual cycle
The number of sessions held in a series can be flexible to the physician’s needs and volume of content
NOTE – payment for session 3 is now linked to action planning following the session.
Action Plan Example - Pain SGLS (Desktop, Web, Mobile)
Engagement
Assessment
Action Plan
Test & Measure Impact
Implementation
Sustainment

10. Facilitation Cycle Engagement Sustainment Implementation Assessment
Actions:
Time:
Sustainment
Actions:
Total Time:
Engagement
Assessment
Action Plan
Test & Measure Impact
Implementation
Sustainment
Implementation
Actions:
Time:
Assessment
Actions:
Time:
Let’s build one together!
Who has an example of a project that would fit here?
Test & Measure Impact
Actions:
Time:
Action Plan
Actions:
Time:

11. Compensation Policy: Dollars & Sense
Compensation enabling time for additional team members to participate in action planning activities with the GP will be provided as follows:
Item
Time (up to)
Pre-visit
1 hour
Learning Experience/Assessment
4 hours
In-practice visit to facilitate action planning
10 hours
Billing Rate (per hour) GP
$144.88
AHP in Private Practice
$70
AHP employed by GP Practice
$50
MOA
$20
MOA Peer Mentor
$30
AHP employed by HA NA
Additional team members (including Medical Office Assistants, Clinic Managers, and clinic/practice employed clinical team members. NOTE: This does not include HA-employed AHP. What we encourage is for the action to happen during the regular work day to ensure that all team members are appropriately compensated for their time. PSP and GPSC cannot get in the middle of an employer-employee relationship and with HA-AHP there is the additional complexity added by working with unionized team members.
***An Allied Health Professional is considered one who has a private, stand-alone practice which insures overhead costs. Those AHP that currently qualify are: Pharmacists, Occupational Therapists, Dietitians, Psychologists, Registered Nurses, registered Psychiatric Nurses, Nurse Practitioners, Social Workers, Midwives and Mental Health Counselors
Walk-in Clinic – GPs practicing in a walk-in clinic may participate and be reimbursed if they are providing longitudinal care for patients
Locums – Locum physicians may participate and be reimbursed if they have been at a practice for at least 3 months
de Health Authority employed staff)
GPs will be compensated at the current sessional for each Facilitation Cycle.
Compensation will not be provided for only completing a learning experience. An attempt to implement a change based on the learning experience must be made.

12. Documenting, documenting, documenting : Where & When?
Final number of hours will be shown on the sessional form submitted at the end of the Facilitation Cycle
Time spent during activities of a Facilitation Cycle should be documented in COMET as part of the Action Plan (Practice Facilitation AP)
Fields to facilitate logging of hours related to a Practice Facilitation Cycle are under development, in the meantime, please capture in the Notes field on the Action Plan to help you track the number of hours over time

13. Sessional submission
There will no longer by multiple sessional forms to keep track of!
A single participant sessional form (with dropdown menus for each PSP service and hours spent by each practice team time in each of the facilitation cycle stages)
Sessional Forms will be submitted to at the completion of a Facilitation Cycle
PSP Sessional Form - In-Practice Visits (Desktop, Web, Mobile)

14. Always an iterative process … flags? Suggestions?