Regulatory changes suggests hospitals soon to divest outpatient procedures

In the dead of summer the province gave notice that it intends to bring the independent health facilities (IHFs) under the Local Health Integration Networks.

The change in regulation states their intention to shift “low-risk ambulatory services from a hospital to a community-based setting.” Oddly, that “setting” could simply be a satellite facility run by an existing hospital.

Previously the LHINs were not able to formally transition services from hospital to the IHFs because there was no way to transfer funding outside the LHIN’s jurisdiction. Funding for the IHFs had previously been handled directly by the Ministry.

This change could, for example, give the Champlain LHIN the opportunity to formally transfer funding from The Ottawa Hospital to private clinics to perform the endoscopies hospital CEO Jack Kitz no longer wanted. That will likely not help the hospital’s bottom line.

Launching such a major change in the middle of summer suggests that the new regulation may not be entirely welcome by many in the community. It will likely be seen as an aggressive move to take services out of Ontario hospitals.

Clearly the government has anticipated this, suggesting such clinics be non-profit and that services not be shifted if “changes to capacity will impact their (hospital) stability.”

How the government intends to determine the latter and restrict it to the former is unknown. Most IHFs in the province are thought to be for-profit.

Clearly the intent is to bring down costs, although we have to question whether there will be a fair and public assessment of those costs before such transfers are made. We never got such a comparison in the Ottawa endoscopy example.

Many diagnostic services – including lab services – have been proven to be more cost-effective delivered in hospital. A 2008 government-commissioned study showed that the smallest and least equipped public hospitals were able to perform lab services for about two-thirds the cost of the private lab system. The additional volumes also helped keep the hospital labs more efficient.

MacKenzie Health (formerly York Central Hospital) had formerly tendered out such minor procedures, but we were told the evidence suggested it was more cost-effective to keep them in-house.

When Perram House closed last year, we were also told placing palliative care patients in hospital was in fact less expensive than the hospice.

Yet just about every politician assumes that moving any service out of hospital is going to be more cost-effective. This is simply not true nor supported by evidence.

The government believes we really want to drive around our communities for care rather than access it all in one place – the public hospital. We’re expected to believe that simply moving hospital outpatient clinics away from a main campus will somehow translate into a better patient experience. This is absurd. It also calls into question why we have one of the biggest infrastructure renewal programs taking place in Ontario hospitals when the plan is to siphon out services within these buildings so we can build additional new smaller clinics.

The hospitals have inadvertently aided this process by charging the highest parking rates in their community. Some patients may be willing to burn some gas to save $15-$20 on hospital parking rates even if it takes a GPS to find the new service provider. That is, of course, if they have a car. Most city bus routes go by the hospital, not necessarily past every IHF.

Maybe the Ministry can provide us with an APP to tell us where all these transferred services will eventually be. And the punch line for all this driving around? It’s all in the name of system “integration.”

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