What is the Practice Support Program (PSP)?
The Practice Support Program (PSP) is an initiative that provides training and support for family physicians (FPs), general practitioners (GPs), specialist physicians, and their medical office assistants (MOAs) to improve clinical and practice management and thereby:
- Increase practice efficiency and capacity.
- Improve patient care and professional satisfaction.
- Reduce costs to the health care system.
The PSP began as an initiative of the General Practice Services Committee (GPSC), a partnership of the BC Medical Association (BCMA) and the Ministry of Health, and now receives additional direction, support, and funding from the Shared Care Committee and the Specialist Services Committee (also partnerships between the BCMA and Ministry of Health).
Why did the GPSC develop the PSP?
In 2004 and 2005, the GPSC held province-wide consultations with about 1000 GPs to hear their perspectives on the decline of family practice and ideas about solutions to the mounting problems of low morale and decreasing professional satisfaction among BC’s full-service family practice physicians.
The committee learned that the declining interest in family practice might be curbed if GPs: • Felt valued. • Were appropriately compensated for their work. • Received adequate, ongoing training. • Were supported to provide high-quality care for an increasingly complex and aging patient population.
When was the PSP created?
The program was created in 2007. In April of that year, the PSP launched with four learning modules: Advanced Access, Chronic Disease Management, Group Medical Visits, and Patient Self-management.
What does the PSP do?
The PSP works to improve clinical and practice management for physicians by providing them with tools and resources that can be implemented into daily practice to increase efficiency and capacity, improve patient care and professional satisfaction, and reduce costs to the health care system. The program offers focused training sessions (learning modules) for physicians and their MOAs in three domains: • Clinical improvement. • Practice management. • Information technology.
How are the PSP learning modules structured?
Each PSP learning module involves three half-day group learning sessions offered locally in communities throughout the province. Each group session is followed by an action period of 6 to 8 weeks during which PSP participants try out what they’ve learned in their own practice. During action periods, participants receive in-practice support to ensure they get as much benefit as possible from the learning sessions and have the guidance they need when incorporating newly acquired tools and processes into their practices.
Why are the learning modules structured this way?
The process of interspersing training sessions with action periods is based on a quality-improvement model known as the Plan-Do-Study-Act (PDSA) cycle. Using PDSA cycles enables physicians and their staff to test out changes on a small scale before implementing them across the board. It also provides the opportunity to see if the proposed changes work.
Are physicians compensated for participating?
Yes, physicians are compensated for attending the learning sessions and testing changes during action periods.
Are MOAs compensated for participating?
Yes, MOAs are compensated for their participation.
Who presents the learning modules?
The PSP provincial coordinating office arranges and coordinates train-the-trainer sessions through which physician participants are taught to become physician practice leaders, who then work with their local PSP provincial coordinators to deliver the module to other physicians. Module learning sessions are then presented by these physician practice leaders and are organized in communities throughout the province by health authority PSP coordinators. Physicians and MOAs interested in participating in the program can contact the PSP coordinator in their health authority (HA). In-practice support for participants during action periods can be provided in different ways, including: • Visits from members of local HA regional support teams (each HA has its own support team), which consist of PSP provincial coordinators and physician practice leaders. • In-practice coaching that meets the needs of a particular physician community.
What learning modules are currently offered?
- Advanced Access/Office Efficiency.
- Group Medical Visits (includes Patient Self-management and Health Literacy).
- Chronic Disease Management.
- Adult Mental Health.
- End of Life. Are there any new ones being developed?
- Child and Youth Mental Health.
- Shared System of Care for Patients with COPD/Heart Failure.
- Quarterly learning sessions.
Who determines the learning module content and how is it developed?
Learning module content is determined by the GPSC and, in some cases (e.g., Shared System of Care for Patients with COPD/Heart Failure), the Shared Care Committee. The committee receives input from physicians and also looks at data to identify gaps in care and then determines what modules should be developed. The provincial PSP coordinating office then develops the content with the assistance of committees and working groups made up of physicians and, where appropriate, other health care professionals.
Is every learning module offered throughout the province?
In general, yes. Learning modules can be offered to physicians across the province by PSP provincial coordinators and physician practice leaders.
Is the work of the PSP making a difference to the professional lives of physicians?
In a recent external evaluation of the program, physicians reported that participating in PSP learning modules has had a positive impact on their practices (Advanced Access, 87.7%; Chronic Disease Management, 80.6%, Group Medical Visits, 86.3%).1
Is the work of the PSP making a difference for patients?
In a recent evaluation of the program, 70% of physicians who participated in the Advanced Access learning module said they had reduced patient wait times for regular appointments and 51% reduced wait times for urgent appointments.2 Thirty-seven percent said they were able to increase the number of patients they are able to treat.3
Do I have to be a physician to participate?
You need to be an FP, GP, or specialist physician to participate in the PSP. Locum FPs may participate if they have been at the same practice for more than 3 months. MOAs may attend learning sessions either with their physician employer or without, as long as they have his or her approval to do so.
Can I earn CME credits for participating in PSP learning modules?
Yes, each PSP module is CME-accredited for FPs, GPs, and specialist physicians.
Does the work of the PSP cross over into the work of other GPSC programs?
Yes, the GPSC has designed incentives and modules to be complementary, and many PSP modules help physicians to use incentive payments such as the Chronic Disease Management, Mental Health Planning, End-of-life Planning, and Community Conferencing fees.
1 Hollander M, Kadlec H. Evaluation of the Practice Support Program. Final report: End of module surveys – Report on the original four learning modules for the period March 1, 2008 to March 31, 2011. September 2011. p.27. 2 Ibid p.29. 3 Ibid. p.31.
Physician Participation FAQs
1. Can I participate in and be reimbursed for more than one PSP module? How many?
Yes, physicians can participate in more than one module, in addition to the practice self-assessment questionnaires. There is no limit on the number of modules a physician can take.
2. Can GPs practicing in a walk-in clinic participate and be reimbursed?
Yes, but only if the physician is providing longitudinal care for patients.
3. Can locum physicians participate and be reimbursed?
Yes, but only if long term at one practice (3 months or more)
4. Can specialist physicians attend and be reimbursed for participating in PSP modules?
5. Can hospitalist general practice physicians participate and be reimbursed?
No, only GPs practicing in the community can participate. If a hospitalist has a part-time practice in the community, they can participate and be reimbursed.
6. Do I have to attend every LS?
Yes. If a physician is unable to attend a scheduled LS, HA support staff may be able to assist with make-up sessions or materials.
7. Can I be reimbursed for a partial Action Period (AP)?
8. When can I get reimbursed for an AP?
Physicians are eligible to claim for an AP after implementing changes identified in the previous LS and reporting on experiences at the following LS, i.e. implement changes learned in LS2 and report at LS3.
9. When can I be reimbursed for travel and accommodation? Can my MOA be reimbursed as well?
Mileage is reimbursed if travel exceeds 50km one way (>100km travelled). Airfare and accommodation expenses require pre-approval from BCMA. This applies to MOAs as well as physicians.
10. Can I attend LS and AP in another Health Authority (HA) than where I practice?
As a general rule, no. In unique circumstances, and with the approval of both HAs, special arrangements can be made.
11. How long will it be before I receive payment?
If all necessary information is submitted with the claim and the attendance list has been received from the HA coordinator, payment is made via direct deposit within four weeks of the session.
12. Can I be reimbursed if I implement a PSP module from the website, without attending LSs and APs?
No, attendance at scheduled LSs and participation in APs are required for reimbursement.
13. Can physicians be reimbursed if they attend short CME sessions on PSP topics without enrolling in the full module?
MOA Participation FAQs
14. How many MOAs can attend each Learning Session (LS)?
Reimbursement is available for MOAs/staff persons who attend Learning Sessions with their physician. There is no longer a one MOA/Staff Person limit. All MOAs/Staff Persons who attend will be reimbursed via the Physician.
15. How will my MOA be reimbursed?
MOAs participation will be reimbursed at a rate of $20/hr (max. $80 per half-day LS). Physicians are paid for MOA attendance via direct deposit. Physicians will claim the payment as an expense and then reimburse the MOA (no taxes removed).
16. Can I bring a nurse or office manager instead and how much will they be reimbursed?
Nurses, office managers and other practice staff are welcome to attend and are reimbursed the MOA rate ($20/hr).
17. Can my MOA/practice staff attend learning sessions without me?
Yes, MOAs/practice staff may participate in PSP learning sessions without physician participation. Physicians will claim compensation for MOA participation using the same process as when the physician attends. Specifically, payment for MOA attendance goes to the physician via direct deposit. Claim the payment as an expense, and if the MOA attends outside office hours, please reimburse the MOA (no taxes removed). Compensation for MOA participation is $20/hour.
18. What is the policy for attending the Mental Health First Aid course?
MOAs/practice staff may not attend the Mental Health First Aid course unless their GP is a participant in the Mental Health module and attends the learning sessions. There is no longer a one MOA/Staff Person limit. All MOAs/Staff Persons who attend will be reimbursed via the Physician.
19. Can MOAs/staff be reimbursed separately for APs?
No, only physicians can claim for the AP payments, which include GP and MOA activities in the practice.
Chronic Disease Management Module FAQs
20. Which chronic conditions are eligible for participation in the CDM module?
Currently, the following conditions are eligible: Diabetes, Congestive Heart Failure, Hypertension, Chronic Kidney Disease and Chronic Obstructive Pulmonary Disease
21. What do I do if I have fewer than 20 patients with the condition I have chosen?
Add a second condition, and aim to add all of your patients with that condition as well.
22. If I have already developed a patient registry, can I still participate in the CDM module?
Yes, but you must choose a new chronic condition from the eligible list.
23. Is use of the CDM Toolkit mandatory for participation in the CDM module?
No, but the development of patient registries and tracking of QI measures are still mandatory.
24. Are the PSP modules CME accredited?
Yes. GPs are eligible for Mainppro-C or Mainpro-M1 credits. Specialists are eligible for Section 1 credits.