What does Dalton McGuinty have against physiotherapists?

In 2005 the Ontario government partially delisted physiotherapy, limiting public coverage to Ontarians who are age 19 and younger or 65 and older, to those receiving Ontario Disability Support or Family works, or to anyone who has spent at least a night in a hospital for a condition that will require physiotherapy.

Preservation of even this limited public coverage followed an outcry from the community over a proposal to completely delist these services.

Even if you do qualify, finding publicly funded physiotherapy is likely to mean a lengthy wait and often travel. The number of independent physiotherapy clinics licensed to conduct OHIP work has been frozen since 1964 – that’s almost 50 years. According to the Ontario Physiotherapy Association, there are 91 authorized licenses to bill OHIP for both clinic based and home based services for the entire province. With no new licenses in nearly half a century, geographic distribution has become unbalanced. The city of Mississauga, for example, has a population of more than 713,000 people but has no independent OHIP licensed physiotherapy clinic.

Having lost the battle to totally delist physiotherapy, the McGuinty government’s new strategy appears to be about labelling it a “fringe” service and to shut down access to publicly funded care wherever they can.

The simplistic view that making access difficult will result in savings may be misguided.

People who cannot gain access will end up in more costly venues, including hospital ERs.

Recently Quinte Health Care failed to replace a vacationing physiotherapist in their chronic obstructive pulmonary disease (COPD) program.

During the clinician’s two week absence, patients enrolled in the program became sick resulting in three ER visits. The goal of the program is to keep these patients healthy, avoid an infection, and ultimately reduce emergency and ICU admissions. The nearest hospital with a similar COPD program is Kingston.

Like elsewhere, cuts to outpatient physiotherapy are slowly choking off public access at the four-hospital Quinte Health Care. In Picton, for example, outpatient physiotherapy is now limited to half a day per week, down from two and a half days. The physiotherapists there estimate half a day gives capacity to provide care to 37 patients a year in a county of more than 25,000 people.

The story is similar in Belleville, where a single full-time physiotherapist remains in place of two. In Trenton outpatient physiotherapy has been slashed to two days a week from five. In Bancroft outpatient physiotherapy has been reduced to 3.75 hours per week.

In smaller hospitals, the physiotherapists who provide outpatient therapy are also the same individuals who provide inpatient services. When the outpatient hours are scaled back, it often means so are the days available for inpatient services and there are fewer opportunities to provide coverage for vacations, sick time and when workloads become overwhelming.

While Quinte is slowly withdrawing from outpatient physiotherapy, many other hospitals have completed the job.

This week the Toronto Star reported that the Centre for Addiction and Mental Health had eliminated its outpatient physiotherapy services. NDP Health critic France Gelinas told the Star that “if you have a mental illness, chances are you live in poverty. At the end of the day, that means the service is no longer available to them anymore.”

CAMH maintains the service provided care for 100 people a year, a number OPSEU disputes given the most recent year was atypical due to a professional absence for part of the calendar.

CAMH insists that ending physiotherapy will save the centre $100,000 a year on a budget of more than $300 million. Even using CAMH’s estimate, that means it is costing $1,000 per patient for physiotherapy – or less than what it would cost if the same patient were hospitalized for a single day.

The closure also flies in the face of the province’s efforts to make services more patient-centered. Instead of being treated at the same location that is providing care for mental illness, CAMH is instead insisting these same individuals go find alternate and difficult-to-find services in the community.

Taking physiotherapy services out of hospitals also reduces the likelihood that rehabilitation will include support from other professionals. For example, most stand-alone rehab clinics do not have a geriatrician on staff. Rehabilitation for stroke, for example, often involves a team of health professionals, not just a physiotherapist.

Given the government’s interest in moving “alternate level of care” patients out of inpatient beds, it is surprising to see so many public providers close down access to publicly funded physiotherapy.

Dr. David Walker, the government’s lead on ALC, recognized the connection between patients languishing in hospital beds and the lack of publicly funded physiotherapy available in the community. He specifically recommended in his June 2011 report that “The Ministry of Health and Long Term Care review OHIP funded community rehabilitation services (particularly Designated Physiotherapy Clinics) to ensure that these investments are aligned with the higher care needs of the elderly, particularly stroke and fracture patients.”

Community Care Access Centres often run out of funding long before the end of the fiscal year, making the community-based support for physiotherapy often very difficult to access. Last year the Erie St. Clair LHIN denied its CCAC the ability to run a deficit to meet local need.

Of course the Ministry of Health will inevitably deny that there is any plan to cut physiotherapy, but instead blame the cuts on the hospitals. Hospitals this year are cutting services and running deficits in response to a zero increase in base funding. But the continual cuts to physiotherapy suggest there is more to this than just hospitals reacting to a budget straightjacket.

Even before 2012, the province’s hospitals were cutting outpatient physiotherapy programs in significant numbers. In April 2010 the Ontario Physiotherapy Association issued a press release noting 20 hospital outpatient physiotherapy programs had closed within the previous two years, calling the situation in Ontario “one of the most serious in the country.”

More on this in the weeks to come.

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