Common use of Service Coverage Clause in Contracts

Service Coverage. Government submits that service coverage is a critical issue. It is necessary to develop new mechanisms to ensure that the current range of services will be continued. An attempt was made to address the issue in the MOU, but there was no means to enforce it. The Arbitration Board has jurisdiction and the NLMA has the legislative authority to bargain on this issue, as discussed above. Government proposes that physicians who do not accept the service coverage commitment proposed by Government, would not receive the increase in FFS payments set by the Arbitration Board. As a result there would be a two tier system, with those physicians committing to service coverage receiving the new rates and those physicians not committing to service coverage receiving the old rates. Government provided several examples of lack of adequate service coverage, including coverage for admissions to hospitals, escort duties and emergency departments. Government provided a detailed proposal that would apply to all physicians and with details under headings including factors to consider, physician resource plan, operational schedules for the comprehensive range of services, dispute resolution, period of notification for decreases in existing service levels, non-conformance to service agreement, general practice, and specialty services. The NLMA submits that the Board does not have jurisdiction to address the issue of service coverage, as discussed above. With respect to the merits of the proposal, the NLMA submits that Government’s proposal should be rejected because it contains too many uncertainties. Government has an obligation to meet the conditions under the Canada Health Act for federal funding. It seeks a service commitment in writing from physicians that may be enforced by establishing a two tier payment system, with the effect that the new rates will not be paid to physicians who do not provide the service coverage required. Government has not established the necessity for this approach. However, the principle of service coverage is important and needs to be promoted. The NLMA has the authority to negotiate service commitments and to enforce such terms as a condition of membership in the NLMA. The Board finds it appropriate to order continuation of the statement of principle as set out in the MOU, as follows: Physicians commit to provide, in accordance with the negotiated fee schedule/salary rates, the insured services which have been traditionally funded through MCP and which the public might reasonably expect to be available, subject to resource and skill limitations. The Board orders that the parties establish a Service Coverage Committee to be chaired by a representative of Government and with two members appointed by each of the parties, with a mandate to review and report to the parties any service coverage issues and to recommend the terms of any physician service commitments, which may be implemented subject to the approval of both parties.

Service Coverage. The issue of “service coverage” was included on the Government submits that service coverage is a critical issue. It is necessary list of items referred to develop new mechanisms to ensure that the current range of services will be continued. An attempt was made to address the issue in the MOU, arbitration but there was no means to enforce it. The Arbitration Board has jurisdiction and not included on the NLMA has the legislative authority to bargain on this issue, as discussed abovelist. Government proposes that physicians who do not accept the requiring a commitment to service coverage commitment proposed by Government, would not as a condition for physicians to receive the increase in FFS payments set the fee for service rates established by the Arbitration Board. As a result consequence, there would be a two tier systemsystem consisting of the new FFS rates for physicians who agreed to the service commitment and the old FFS rates for physicians who did not agree to the service commitment. Government submits that, with those pursuant to the MOU, physicians committing committed to providing services, including on call services. The issue of service coverage receiving was discussed during the new rates negotiations and those physicians not committing the parties exchanged proposals on the issue. The NLMA sought arbitration on all outstanding issues and this was one of the issues outstanding from negotiations. The NLMA bargains on other issues in addition to service coverage receiving compensation issues, such as the old ratesissue of the defined work week. Prior agreements with the NLMA were enforceable, in particular, the JMCA and the MOU. Government provided several examples is accountable to ensure that an adequate level of lack of adequate service coverage, including coverage is provided. Regional Health Boards have the obligation to provide access to health services which requires physician services. General practitioners who are paid on a fee for admissions service basis have a relationship with their individual patients and not with the population at large. General practitioners do not have a requirement to hospitals, escort duties affiliate with a regional health board and emergency departments. Government provided as a detailed proposal consequence that they would apply not have an obligation to all physicians and with details under headings including factors do on call or to consider, physician resource plan, operational schedules for admit patients to hospitals without the comprehensive range of services, dispute resolution, period of notification for decreases in existing proposed service levels, non-conformance to service agreement, general practice, and specialty servicescommitment. The NLMA submits that the Arbitration Board does not have authority to impose any order binding physicians to service coverage. The NLMA does not have authority to bargain on behalf of its members in the same manner as a union acting as bargaining agent under the Labour Relations Act. The authority of the NLMA to bargain is limited to the authority set out in Section 5 of the Medical Act. The NLMA submits it cannot impose any obligations on physicians who may opt out of the medicare system and collect fees directly from patients. The NLMA cannot bind its members to provide services. The NLMA has the right to negotiate only on issues of compensation. The NLMA cannot bind salaried physicians who have the right to negotiate individual contracts of employment. Under the Canada Health Act physician fees are considered to be reasonable if they are negotiated between the Government and the Association representing physicians. The agreement made under the Canada Health Act is for the purpose of compensation and not for the purpose of service commitments. The effect of the two tier system proposed by Government would be that physicians would leave the Province. Government regards fee for service physicians as independent business operators. The MOU did not contain a service commitment. It contained an agreement that physicians would be bound by their professional code of conduct. Past agreements between Government and the NLMA should not be considered by the Arbitration Board. There was no evidence of any withdrawal of service prior to October 1, 2002, while the MOU was in effect. There are service coverage problems caused by an inadequate supply of physicians. These problems could be addressed by having the incentive of adequate compensation. The Arbitration Board finds that it has jurisdiction to address the issue of service coverage. This was an issue outstanding from the negotiations . The NLMA advised its members by newsletters in 2002 when describing the negotiations, that it would negotiate service commitments if appropriate conditions were in place. Service commitments were addressed in general terms as discussed abovea statement of principle in the MOU. With respect The NLMA has authority pursuant to the merits Medical Act to negotiate on behalf of physicians. The Medical Act does not limit the proposal, issues for which the NLMA submits that Government’s proposal should be rejected because it contains too many uncertainties. Government has an obligation to meet the conditions under the Canada Health Act for federal funding. It seeks a service commitment in writing from physicians that may be enforced by establishing a two tier payment system, with the effect that the new rates will not be paid to physicians who do not provide the service coverage required. Government has not established the necessity for this approach. However, the principle of service coverage is important and needs to be promotednegotiate. The NLMA has the authority to negotiate commit its members to service commitments coverage by making compliance with the agreement between the NLMA and to enforce such terms as the Government a condition of membership in the NLMA. The Board finds it appropriate to order continuation of the statement of principle as set out in the MOU, as follows: Physicians commit to provide, in accordance with the negotiated fee schedule/salary rates, the insured services which have been traditionally funded through MCP and which the public might reasonably expect to be available, subject to resource and skill limitations. The Board orders that the parties establish a Service Coverage Committee to be chaired by a representative of Government and with two members appointed by each of the parties, with a mandate to review and report to the parties any service coverage issues and to recommend the terms of any physician service commitments, which may be implemented subject to the approval of both parties.