Friday 17 February 2012

Systemic Health Care Reform and Physician Salary Freeze

The long awaited report from the Commission on the Reform of Ontario's Public Services has finally been released.  There are many issues addressed and many recommendations put forth, but basically the underlying recommendation is that Ontario should undertake major changes in the way health care is approached and delivered, while immediately imposing a physician wage freeze (based on statistics that Ontario physicians are now the highest paid in Canada).  Ballooning health care costs, despite sub-obtimal patient care and outcomes, are placing further strain on our already strained health care model.  One of the issues addressed in the report is disjointed delivery of care.

"Throughout this chapter, we have been referring to Ontario's collection of health care providers as a "system".  In reality, the province has a series of disjointed services working in many different silos.  The Ministry of Health and Long-Term Care (MOHLTC) must work with its health care providers, administrators and stakeholders to co-ordinate roles, simplify the pathways of care and improve the overall patient experience". 

"Simplifying the pathways of care" will ultimately mean that family physicians will be evermore undertaking the bulk of patient co-ordination".  Currently, one of the major factors driving up the costs of the health care system is chronic ER visits despite the level of acuity.  Those of us in the primary health care field understand that a significant amount of these "unnecessary" ER visits are often triggered by the inability to access care primary with the family physician.
 
"The system should be centered on the patient, not on the institutions and practitioners in the health care system."

In the last few years we have seen a big change in the handling of preventative care and health records, they will increasingly become major factors in health care reform movement.  Family Health Teams will also likely become the new wave of care in Ontario, due to the multi-disciplinary nature which also supports financial savings. 

"There should be a heightened focus on preventing health problems...". 

If you are a primary care provider and you haven't yet made it a habit to use the government preventative care tracking codes, you should.  Going forward, preventative/chronic care is only going to become more integrated, which also means more tracking will become necessary. 

"The primary goal for physician performance should be prevention and keeping people out of hospitals."

The recommendation, noted above, to tether physician performance (and ultimately income) to prevention and keeping people out of hospitals will mean further tracking systems will be rolled out in order to support OHIP billing.  At this point, using most tracking codes (Q codes) is not mandatory, however, to ensure you are maximizing your income --particularly in light of the coming changes -- you should be using this period of time to become as efficient as possible with using the tracking codes. 

While there are a few different salary/FFS models currently in operation, the reports recommends that the mix should ultimately land somewhere around 70 percent salary/30 percent FFS.  With the report strongly stating that the government should impose an immediate wage freeze, preventative care and chronic care service incentives will be what make a significant difference to your income. 

Are you utlizing tracking codes to your benefit?  If you aren't sure, then it's likely you're not.  Take the time now to better understand and utilize the tracking systems while it's still optional.  If you wait until it's mandatory you will lose income because your incentive income will depend on your efficient use of the tracking systems.

Whatever the changes will be, one thing is for sure, we know that there will be a decrease in funding and a rise in the level of care expected.  The next round of OMA negotiations should be interesting.  Get ready for sweeping changes...

To view the report in its entirely follow this link http://www.fin.gov.on.ca/en/reformcommission/chapters/ch5.html

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