One of the last hospitals in Ontario to provide local outpatient medical laboratory testing is transferring the service to the private for-profit Lifelabs Medical Laboratory Services.
The move will save the Deep River and District Hospital money, but cost the province more and lengthen the wait for results. Its Ontario’s pay more and get less plan.
Patients will still come to the hospital to get their blood drawn and other specimens collected, but the testing will not stay in the Deep River community unless the referring doctor or nurse practitioner marks it urgent (STAT). All existing inpatient testing will remain at the hospital’s lab, which is part of the amalgamated Eastern Ontario Regional Laboratory Association (EORLA).
Coincidentally the move comes as the hospital is expanding to consolidate physician offices on site. As the physicians come closer into the central health hub for the community, the lab testing will be conducted further from Deep River.
EORLA and Deep River and District Hospital will still have to maintain staff and laboratory facilities that could easily handle these newly outsourced and privatized tests. Deep River must have staff present 24/7 to provide inpatient and emergency testing. Instead of turning around tests “super fast” at the hospital, professional laboratory technologists, technicians and phlebotomists will have much less to do. About 70 per cent of the hospital’s present lab work is conducted for outpatients.
Each outpatient test performed by Lifelabs is paid for publicly by OHIP. While the hospitals could perform these tests for much less using surplus capacity, they are prohibited from similarly billing OHIP. Instead they are expected to provide this service out of an annual budget that has been shrinking in relation to its overall costs.
The spend more and get less philosophy may make the pension fund which owns Lifelabs happy, but it is poor value for Ontarians — especially when the Wynne government is crying the austerity blues.
Lifelabs normally handles its own collections but the smaller volumes from Deep River would mean shorter hours and fewer days for the public to access outpatient lab services. Instead the hospital is providing the collections to maintain better hours of access and to save local jobs. However, this comes at an additional cost – a 30 per cent subsidy from the hospital to the private corporation.
Stripping work from the EORLA lab at Deep River comes at a time when publicly-provided lab costs are actually falling. EORLA reports in its 2013-14 annual report that the average price per test has fallen by about 60 cents since 2009-10. By maintaining a staff with so much less to do, the average cost per test at Deep River is expected to balloon.
About 40-50 outpatient collections per day take place at the hospital generating about 300-400 tests. The impact on patients will be difficult to assess given there has been no public input or disclosure on the details of the plan. The hospital indicates that some of these details have yet to be worked out, including the actual collections hours.
At present cancer patients routinely have their blood cell count done at the hospital in the morning, then proceed to Renfrew and other hospitals to receive chemotherapy treatment. A blood cell count is necessary for each round of chemotherapy to ensure that the number of white cells and platelets are at an acceptable level. Unless the lab tests are marked urgent, patients will have to wait at least until the next day for results before they can proceed on to Renfrew for treatment.
If the hospital receives a large number of outpatient STAT tests, it will also defeat the purpose of outsourcing this work to Lifelabs. When Mike Harris created two parallel public/private medical laboratory systems in the province during the 1990s, 12 small rural and northern hospitals entered into a pilot project in which the Ministry provided a lump sum payment based on existing outpatient volumes. These hospitals received funding based on 85 per cent of the OHIP payment to the private for-profit labs.
A decade later the McGuinty Liberals decided to evaluate the outcome of the pilot. Ten of these small hospitals were able to turnaround tests faster, doctors were able to speak directly with technologists in their community, and the additional money for the outpatient testing helped the hospitals to sustain shifts, staffing, equipment and in some cases provide a broader scope of testing than would otherwise be possible. By the end of the pilot the gap between the private and public costs widened. These small hospitals were performing outpatient testing at two-thirds of the cost of outsourcing it to the private sector. In other words, for every dollar it cost to perform a test at a public hospital, it was costing the Ontario government $1.50 to conduct the same test at the private commercial labs.
Rather than celebrate the success of the pilot and expand the model, the McGuinty government cynically began withdrawing funding for outpatient hospital testing. Today many small and rural hospitals would like to return to the pilot model.
That arrangement continues to exist at the nearby Pembroke Regional Hospital – one of three hospitals left on the initial Harris plan. In that version, the public hospital lab works with samples collected by Lifelabs.
When the government is crying poor it is unfathomable why they persist in continuing to privatize and outsource outpatient lab testing when they know it costs more and delivers less timely results.
At a time when hospitals are being deliberately starved of funding, these volumes could help maintain the quality of inpatient laboratory testing.
Next Wednesday members of OPSEU Local 475 who work at the EORLA lab in Deep River will be handing out leaflets in their community to draw attention to the changes in service.
Hospital CEO Gary Sims has done what he can to preserve his local EORLA laboratory. Now it’s time for the community to push this back on Queen’s Park and the Champlain Local Health Integration Network. All of us should demand answers. Further its time the Wynne government publicly release a Deloitte report on laboratory reform that it has kept secret from Ontarians. Ontarians need to shine a light on the dark corners of the Ministry of Health where these policies have been skewed in favour of private interest.
Want to help? Come to Deep River Wednesday, February 4 to help us get postcards signed in the community. Volunteers are being asked to meet at 1:45 pm at the downtown Valu-Mart, 75 Deep River Road. We’ll be talking to our community, handing out leaflets, and collecting signed postcards until 4 pm.