The last time the government granted a license to operate a OHIP designated physiotherapy clinic was 1964. This is the alternative government now wants patients to turn to after hospital-based outpatient physiotherapy is eliminated – an almost forgotten system leftover from 50 years ago.
The Designated Physiotherapy Clinics Association (DPCA) gives us a glimpse into the significant number of Ontario hospitals that are reducing access to outpatient physiotherapy services. The DPCA received back 120 surveys of Ontario hospitals in October 2011 and found 50 per cent had reduced outpatient physiotherapy services within the last two years. Further, another 16 per cent indicated that they had planned to do so before the end of that year. This is a significant policy shift with little to no public discussion.
The survey information was part of a DPCA press release this week. Faced with significant cuts to hospital physiotherapy, the DPCA proposes to pick up some of the slack, offering to soldier on at $12.20 per visit for another two years and even help out the CCACs with home care at $60 per visit – half of what they say the present costs are by contract home care agencies.
There are 94 of these designated OHIP clinics in Ontario and distribution reflects the population as it existed in 1964, not 2012. The City of Mississauga, for example, had a population of 156,070 in 1971 (it didn’t become incorporated until 1968). It has no OHIP designated physiotherapy clinics today despite a 2011 census population of more than 700,000 residents. On the other side of Toronto, Oshawa has three such clinics with a population of about 150,000.
OHIP pays these designated clinics $24.40 for an initial visit, $12.20 for each subsequent treatment. The $12.20 has not changed since 1996. These clinics are allowed to charge assessment and reassessment fees over and above the OHIP reimbursement, which means the patient partially pays out-of-pocket. Some sample assessment and reassessment fees we have seen on-line can be as much as $75 for the initial “assessment” and as much as $10 per follow-up visit, or what the clinics would describe as the “reassessment.”
Not everyone is eligible to receive coverage at a designated OHIP physiotherapy clinic and there are limits on the total number of visits. To receive OHIP coverage, you must have a doctor’s referral and be:
• 19 years old or younger, or;
• 65 years old or older, or;
• receive benefits under the Ontario Disability Support Program or Ontario Works, or;
• have been overnight in a hospital for a condition that now requires physiotherapy treatment.
By contrast, treatment received in a hospital is free, protected under the Canada Health Act. Physiotherapy services delivered in the home by the CCAC or by a long term care facility are also fully covered.
When Dr. David Walker issued his report on alternative level of care last year, he made a specific recommendation 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.”
Cuts to hospital outpatient physiotherapy services will leave Ontarians with little choice but to pay out-of-pocket for essential care. Not only is this an erosion of our public Medicare system, but it makes little financial sense either. Those that cannot afford to pay will likely end up back at our emergency departments at a much higher cost to the province.