Patient-based nonsense

Patient-based health care: Take away the phrase and the Minister of Health’s speeches would be little more than clean white sheets of paper.

There is an air of unreality when you see those trusted with stewardship of our health system using this phrase in new and unusual ways. It’s like somebody sent out a memo: this year is about patient-based care. Attach it to everything you do.

At last week’s Insight Conference on Continuous Quality Improvement in Health Care, Miin Alikhan, director of the Health Quality Branch of the Ministry of Health and Long Term Care, presented on the government funding “reforms,” including patient-based funding.

What is patient-based funding? It’s basically what they are moving the doctors away from — another version of fee for service although the exact mechanics are a bit unclear.

You don’t often associate funding reform with patient-based care. Evidently previous funding models didn’t apply to caring for patients.

In Alikhan’s presentation she showed a slide of what the patient journey looks like with the current funding model (a mix of global, pay for results and wait times funding)  and the future new shining “patient-based funding model.”

In the current state, a patient seeking a hip or knee replacement begins their “journey” with a visit to their primary care physician. It’s no surprise that they do the same in the new patient-based funding model.

In the current state they get referred to an orthopaedic surgeon and wait about 180 days. In the new model, they get referred to an orthopaedic surgeon and wait about 180 days. Are you with us still? Are you noting the differences?

In the current state the patient receives surgery, although the cost of that surgery could vary to the government. In the new model, the patient also receives surgery, although the government pays the same rate for that procedure no matter which hospital performs it. As a patient, are you excited yet? Are you seeing the difference to your care?

In the current state, you get discharged either to community based care for rehab, or you get referred to an inpatient rehab program run by the hospital. In the new and improved model, you get referred to community based care, or an inpatient rehab program. The funding source means the percentages will be a little bit different, likely because the government says it is giving larger funding increases to home care (they just haven’t seen it yet). Of course, if you want to be in long-term care instead, well, too bad.

As a patient, I’m sure you’re happy the government is remaking the system to be all about you, even if you can’t really tell what has changed to actually accommodate your specific needs.

But that doesn’t mean there aren’t some small differences.

In the current state there are no targets for rehab waits. In the new system, there are targets.

Hey, wait a minute – targets for rehab waits?

Coming out of a hip or knee replacement, it’s a really bad idea to have to wait for rehab. You have to keep on moving or those parts seize up. When the Ministry talks about target waits for rehab, we know what really happens. People either pay out-of-pocket or use private insurance to access private rehab until the public rehab is available — if it is ever available. This saves the government lots of money. It costs you lots of money.

Instead of addressing this problem, the government has decided a target for waits is appropriate. It also sounds like they are doing something about it.

The government figures hospitals will do more if they apply patient-based funding. They are also trying to figure out how to get hospitals to do less to save money. But let’s not get sidetracked.

Of course, you may say, hasn’t this been happening for some time now for priority wait times procedures ranging from cancer care to hip and knee replacements? Isn’t that what the federal government is transferring increases of six per cent a year for? The answer is yes!

The government presently sets aside so much money for procedures and diagnostics, like MRIs. If there is extra MRI money towards the end of the fiscal year, the LHIN asks the hospitals if anybody needs more MRI money. Next thing you know everybody and their poodle is getting an MRI before the money disappears.

That, in a nutshell, is patient-based funding. Just kidding about the poodle.