What do hospitals really receive in funding increases?
This is often a difficult question to answer given funding flows in so many different ways.
One of them is pay-for-results (P4R) funding.
In year four of the scheme, the P4R program was intended to reward hospitals that succeeded in reducing emergency room wait times. Payments would be determined each quarter.
The results have been hardly stellar.
The Central East Local Health Integration Network recently indicated that of the nine general hospital sites eligible for P4R funding, only $755,150 out of a possible $5.1 million would be given out for the most recent fiscal quarter (Q3).
Most notable is the struggling Peterborough Regional Health Centre, which will only receive $23,100. Had they met their targets, they would have been eligible for a bonus of as much as $758,250. Ouch.
Smaller hospitals, like Northumberland Hills in Cobourg, will receive no bonus money at all for the quarter. This won’t be the first time Cobourg came up empty-handed in the past year.
As hospitals get squeezed even further under the coming austerity plan, it will make it harder for them to reach their targets, creating a ripple effect in funding.
Many of the factors affecting these times may be out of the hospital’s control, such as the effectiveness of nearby Urgent Care Centres or whether a counterproductive stampede effect takes place when news of the shorter waits become public. Then there are flu epidemics, bad winters, sweltering summers and other omens of a hectic day in the ER.
And let us dare suggest that the squeeze on staffing may be having some effect on these outcomes?
Four years on, this scheme is clearly not working. Perhaps its time to look at other ways to improve ER performance.
It seems to me there is a very simple solution here. Quit cutting staff. The staff process the patients, care, assess, treat, and ultimately transfer, admit or discharge the patients. When you decrease the staff everything slows down, almost grinding to a halt. Every department within the chain is affected causing back-ups throughout the institution.
Rather than punishing the hospitals for perceived poor performance, why not look at the wait time within each department in the chain. Nothing can be done if there is no one there to do it.
Always the same, cut staff, close beds, decrease budgets all in the name of saving money. How can you justify the outcomes when the only way money comes into the system is through patients being admitted? Bed closures means less patients being admitted, means less money coming in and around we go again.
People are becoming more aware of the necessity to not abuse the health care system. Their reward is to punish the ER departments which is the first line. Look at Cobourg for an example. This institution is directly beside the 401. Their ER is essential and has dealt with multiple horrific accident victims. They are rewarded for their work with the P4R punishment.
Take a good look at the history within each institution. My experience has been that with bed closures etc to save money, another layer of management appears. With amalgamation of hospitals there was supposed to be costs savings. Look at the outcomes. CEO’s salaries through the roof, heads of departments plus their assistants in each of the institutions, salaries again through the roof. Layering of management does not save money.
The final outcome is an institution in place to preserve a management kingdom. The reason for the institution, patient care, has long gone out the window.
Don’t blame the hospitals for long ER waittimes. Blame provincial policy for encouraging LHINs to order the hospitals to cut beds and frontline staff.