Red dots

In the age of accountability, being careful about your spending gets interesting when you don’t know much you will have to spend.

Each provincial budget usually gives some indication of what to expect in the coming years, so while this year’s offering is not expected until May 2nd, it is likely that hospital administrators are already planning (and worrying) none-the-less.

Prognostication is not always an exact science. When the Drummond Commission recommended restraining health care to 2.5 per cent, few expected the government to exceed that in last year’s budget. Instead Finance Minister Dwight Duncan delivered a 2012-13 budget that gave health care 2.45 per cent with promises of an average of 2.1 per cent over three years. If hospital administrators started doing back of the envelope calculations with those disappointing numbers, they may have been rudely surprised to find hospital base budgets were singled out for no increase from that money – not even a modest crumb to cover inflation, aging or population growth.

April 1st marks the beginning of a new fiscal year. Usually hospitals have a good idea what they are to receive by this point, even if much of the community sector ends up waiting months more to get their dollars confirmed.

There likely isn’t a hospital administrator who is counting on more than zero, so how much the LHINs have available for separately funded surgical volumes really starts to matter.

The Ministry of Health has yet to determine how much it is going to spend on quality-based procedures (QBP), another of Deb Matthews’ Orwellian terms for what is effectively fee-for-service for select procedures.

With scheduling usually done 5-6 weeks in advance, hospitals are now conducting specific procedures without being one hundred per cent certain that there will be money for them.

The Ministry has repeatedly delayed telling the LHINs what the funded volumes will be for this year – likely waiting on the big budget to be passed at Queen’s Park.

That means the LHINs cannot tell the hospitals.

The Central East LHIN entertained a motion today that would give hospitals the green light to 25 per cent of the QPB procedures they did last year.

We can only guess that the calculation was the province wouldn’t scale back funding further than that, although they did slash 10 per cent of the funding for cataracts last year.

Given the Ministry hadn’t actually transferred any money for the LHINs to do this, the board balked at the idea of sending out letters confirming these modest volumes and instead asked for another month to think about it.

That means the risk really is back on the hospitals.

However, even having the discussion at the LHIN would suggest that maybe counting on a quarter of what you got last year should be safe. Maybe. Possibly.

Let’s not forget that while this is all taking place, the Federal government continues to pass on 6 per cent increases to the provinces. That was supposed to be money to fix health care for a generation.

Meanwhile the tracking of wait times for the same funded (or not) procedures continues. If hospitals get nervous and reduce the number of funded surgeries, their waits may increase, creating little red dots on their performance scorecards. If they continue on business as usual, they could also have little red dots reflecting their negative fiscal performance on the same scorecard.

May 2nd likely can’t come soon enough.

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