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.

7 responses to “Patient-based nonsense

  1. Thanks so much for stating what we all know and most don’t have the courage to say: the Emperor has no clothes. Please, let us all DEMAND an end to this costly and time-consuming pretence.

  2. Why are we surprised when they keep doing the same things and they keep on getting the same results….their past performance predicts their future response …. the PEOPLE SUFFER as usual ….

  3. Julia Greenbaum

    180 days?? I just got a letter responding to my GP’s referral request to an orthopedic surgeon that the wait time would be one year. Bring on patient based!

  4. Julia — The Ministry estimates the wait time will be the same. Given they are implementing this now, you can see for yourself how effective patient-based funding is.

  5. wilbur treestand

    Hear that sound?That is the H.M.O. that will be coming to your neighbourhood and the PRIVATE slob licking their chops at the thought of sucking the last penny out of your pocket.Wake up people unless you want ROMNEY WORLD here in Canada.

  6. Congratulations Ontario you’re systematically destroying our health care system. Let me tell you about our system. Family member gravely ill. Had to call ambulance. Begged ambulance to take family member to LHO where Treatment Team awaited. No, ambulance not allowed. Apologetic and somewhat embarrassed, ambulance had no choice but to go to Northumberland. Several hours later NHH wanted to transfer to LHO because of complex care needs and needing established Tx Team. Ooops, no ambulance available to transfer, instead moved into ICU from emerg.
    3 days in ICU later, still awaiting ambulance transfer, pt called home begging to be picked up and driven to LHO… discharged from ICU to front seat of spouse’s car with direction to get pt to LHO (hoping he did not code on the journey) with advisement that Tx Team were expecting him.
    Wonder if this is the same black hole Alice In Wonderland fell into?

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