In some ways the injunction filed by the Designated Physiotherapy Clinics Association of Ontario may have been a blessing in disguise.
As of August 1st OHIP funding for these private clinics was to cease, their clients transferred to the Community Care Access Centres. Now that decision awaits the outcome of an application for judicial review this week — August 21.
Last year OHIP received $200 million in billings from these designated private clinics even though the government had only budgeted $146 million. Chantale LeClerc, CEO of the Champlain Local Health Integration Network, told the media that the province had already increased funding for physiotherapy by 70 per cent three years ago, and that expenditures were anticipated to double by 2014.
Now the government has determined the funding will be $156 million by placing the responsibility in the hands of organizations with fixed budgets and LHIN accountability agreements. The private clinics argue that represents a cut of $44 million.
Health Minister Deb Matthews has been reassuring patients of these clinics that they will continue to receive service as long as it is medically necessary. They are also quelling rumours that service will be capped – noting patients will receive as many sessions as is determined to be necessary.
That may be a tall task, especially given Matthews herself has recognized the existing and unacceptable wait times at the Community Care Access Centres for physiotherapy. Reallocating $33 million to address that backlog will help, but the transfer also means many more patients looking for service – an anticipated 60,000 more added to the home care lists. This also comes at a time when hospitals are making significant cuts to outpatient physiotherapy services and adding to the CCAC’s woes.
The plan also transfers another $68.5 million in funding to provide physiotherapy in the province’s long term care homes, $10 million for falls prevention programs organized by the LHINs, and $44.5 million for community clinics that may very well be run by the same private operators seeking the court injunction. Physiotherapists are also promised for the Family Health Teams.
It also represents a massive transfer of service in a very short period of time. Given the surprise announcement April 18, it had given both the private clinics and CCACs less than four months to effectively transfer services that were being delivered to 150,000 Ontario seniors, children, social assistance recipients and the disabled.
That’s not much time for the CCACs to pull this together, nor time for the clinics to rebuild their businesses or as many as 3,000 professionals and support staff to change jobs. That’s where the delay may actually help.
The designated clinics should be upset that this was done without any open consultation. When the health minister made this announcement in April, not even the LHINs had any detail as to how this would roll out.
The transfer of work may be particularly difficult given remuneration rates for public physiotherapy has been very low. The designated OHIP clinics had not received an increase on the $12.20 per visit since 1996. Existing CCAC contract providers may balk at these kinds of rates.
While clinics can work with more than one client at a time, it will still be challenging to break even on this work given what experienced licensed physiotherapists are paid. For example, the top rate for OPSEU’s hospital physiotherapists is $42.69 per hour.
Physiotherapists working at the designated clinics have been told to prepare a physiotherapy summary report for each client to facilitate the transfer to the CCAC. Clients are also being told that they can go private should they choose to remain with their existing physiotherapists. In these cases, no transfer would be required.
The last time a license was issued for a designated OHIP physiotherapy clinic was 1964. As a result, the distribution of these clinics does not represent Ontario’s current demographic profile. The clinics are located primarily in urban areas, most around the Greater Toronto Area. The Ontario Physiotherapy Association (OPA), which supports the government’s changes, has noted there are no designated OHIP clinics north of Sault Ste. Marie nor in all of Mississauga.
The redistribution of funds will therefore make service far more geographically equitable. The OPA also likes the strengthened accountability and transparency of having these services under the CCAC. They also believe it will make funding more sustainable.
For patients it will also have an upside – CCAC delivered service means no extra billing for assessments that weren’t previously covered by OHIP.
What the changes do not do is make physiotherapy any more accessible for those who were already excluded from eligibility for OHIP service. In 2009 the OPA noted that partial delisting of OHIP services represented a loss of more than a quarter billion dollars in funding for community-based care. There is nothing in this plan to bring that back.
Predictably the Tories are bending the truth by suggesting the Wynne government is simply delisting the physiotherapy services seniors are relying upon.
While the PCs tell seniors that they are on their side, we don’t hear any financial commitment from either leader Tim Hudak or health critic Christine Elliott to back that up. Given Hudak’s desire to cut corporate taxes and reduce the deficit even faster than the Liberal government, the involvement of the PCs is likely more opportunistic than helpful. What they are doing is creating a lot of confusion among a vulnerable population.
There is no question that the designated OHIP clinics were an antiquated system that had deep inequities in service delivery. Some clinics would turn away more complex clients because of the low rate of public remuneration. Their own association appeared to recognize these issues last year as it made fresh overtures to government about changing and expanding their role.
While they claim they can do the service for less, the dramatic rise in billings likely convinced the government that they had to find an alternate solution that would give them more ability to control and cap costs.
The real test could come soon if the private clinics are unsuccessful in the courts. The question is, will the CCACs be ready, and will existing funding be enough?
Given the CCACs are inheriting transfers from the designated clinics with little new funding beyond what was paid out for these services last year, we’re not sure how these changes are supposed to also bring down existing home care wait lists for physiotherapy. It could do so if large numbers of the existing patients at the designated clinics go totally private and pay out-of-pocket for their continuing care. There is also an assumption that many of these billings were for service that wasn’t medically necessary — raising the debate over preventative care. Both are very large “ifs” in the planning equation.
If the wait times for CCAC physiotherapy fail to drop, Matthews will be under considerable pressure to make good on her promises regardless of cost.