OPSEU Diablogue in 2012

Diablogue is about to take a hiatus to finish out 2011. With more than 400 postings, you may want to check out some of the stories from the last 24 months. Or you may want take advantage of the festive atmosphere and take a break with us.

Next year promises to be a challenging one with the potential for major change in health care:

  • Don Drummond will release his Commission’s report on reform of the public sector. He has already said that 40 per cent of his work has been on health care.
  • An all-party legislative committee will review and make recommendations for changes to the Local Health Integration Networks. The pundits are predicting fewer but more powerful LHINs. Some are suggesting we should watch for a merger between the LHINs and the Community Care Access Centres (CCAC).
  • The negotiations for a new Federal-Provincial health accord will pick up steam. Will the provinces continue to receive a 6 per cent funding escalator from Stephen Harper now that he has a majority in Parliament? Or will he renege on his promise of a two-year extension given his own budget pressures?
  • Will the government be as focused on ALC? Alternate level of care or “ALC” patients are those who have completed their hospital acute care but are not well enough to go home. To what extent will the government follow the Walker Report from June and build community supports for these patients? Or will it all fall apart as the McGuinty government pushes forward its austerity agenda?
  • The government is slowly realizing that primary care holds many of the keys when it comes to health care reform. Are we going to see doctors made more accountable for their performance? Are we going to see more primary care brought under the jurisdiction of the LHINs? And what about the new Ontario Medical Association contract to be negotiated in 2012?
  • And what about funding? Will the investments in the last decade be enough to carry health care through some lean years, or will we see a replay of the Harris years where ambulances cycled the streets looking for an open ER?

We’ll be here providing news, comment, analysis, and debate starting in January. We hope you’ll be here too!

 

 

 

 

CCACs not given sufficient resources to deal with “home first” initiative

The government speaks regularly about moving services out of hospitals and into community-based care, including nursing homes and home care.

They tell us that it is not only more cost-effective, but it is preferred by patients.

So what is the deal with holding the line on CCACs and nursing home beds at a time when the hospitals are being placed under extreme pressure to move alternate level of care patients into the community?

The latest conflict is in Windsor, where the LHIN has refused to give the Community Care Access Centre a waiver to run a $5.2 million deficit.

The CCAC is arguing demand is on the rise and patients will be stranded in hospital if they are unable to provide home care services. Just yesterday Windsor Regional Hospital CEO David Musyj was urging patients to go elsewhere in the anticipated post-Christmas rise in demand for ER services.

No home care. No hospital care. People in the Windsor area must be truly wondering about the direction of their health care.

The CCAC says the overall increase in home care patients is rising by 1,000 to 1,500 per year in Erie St. Clair, and coming out of hospital sooner, these patients are more costly to serve. The cost of the CCACs end-of-life program is rising by 11 per cent per year.

The CCAC is also facing more demand because of delay in the building of a planned 256 bed long-term care home at St. Clair College. They say that delay is costing them $3 million annually.

The LHIN is willing to help out with a one-time grant of $1.5 million while they “study” the needs of the CCAC. In an unusually frank retort, CCAC Executive Director Betty Kutcha told the Windsor Star that “in my view, they’ve got a $1.5 million solution, so they’re trying to fit our problem into that.”

We are hearing that the Home First program – an initiative where hospitals are supposed to discharge patients home to wait for long-term care placement – is increasing overall community referrals to the CCACs by 10 per cent or more. This is a significant strain on their budgets.

Even the Auditor General of Ontario was skeptical in his summer report of the government’s plans to reduce the rate of growth in hospital spending based on service from home care and long-term care where the level of restraint is expected to be even more severe.

When the Health Restructuring Commission of the late 1990s made its recommendations around the transfer of mental health services to community-based agencies, they were adamant that no beds should close until community-based resources were established. The government cut the beds, didn’t provide anywhere near adequate service in the community, and left us with a system that has been the subject of one report after another calling for better.

Are we to repeat the experience as the government pushes hospitals to discharge patients before adequate community resources are put in place?

Seems we never learn.

Walker misses point on why for-profit nursing homes cherry-pick residents

Dr. David Walker is accusing long-term care homes of cherry-picking patients who are easy to care for, leaving more complex ones to hospitals.

As the province’s point person on the alternate level of care issue, did he just discover this?

When Ontario decided to put the more than half of its nursing home beds in the hands of profit-seeking companies, what did they expect?

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Musyj “very concerned” even though “nothing dramatic changing” – huh?

If you regularly read these pages, you’ll notice that we have been sounding the alarm for some time now about the surge capacity of hospitals.

If you have an average occupancy of 98 per cent, what happens when you have a bad flu season or there is a significant pandemic in the community? You can’t, as Spinal Tap’s Nigel Tufnel recommends, turn it up to 11.

One of our favourite targets here at the Diablogue is Windsor Regional Hospital CEO David Musyj, who has a habit of blaming everyone but himself for his hospital’s ongoing woes.

Musyj is back in the media this week telling Windsor residents to think about going elsewhere after the holidays given his already clogged emergency room at the Metropolitan Campus is going to get worse.

The fact that the ER is clogged during a traditionally quieter time is “making us very concerned about what we’re going to see after the holidays,” Musyj told the Windsor Star.

Less you worry about your ability to get treated after that somewhat uncooked turkey, Musyj also says “there is nothing dramatic changing one way or another.” Huh?

Musyj says he will have extra beds to fill with those emergency patients, but doesn’t say where they are coming from.

Maybe it’s a slow news day in Windsor. Then again, it could be yet another early warning that cutting all those hospital beds over the last decade may have gone a little too far.

Docs get paid $123 million for patients they never saw in a year

The Ministry of Health says they conducted an in-depth analysis on the anticipated costs of new funding arrangements for doctors. When asked by the Auditor General of Ontario, they couldn’t quite find it.

They may have similarly just overlooked the fact that a significant number of doctors in family health groups (13%) and family health organizations (18%) had actually not signed their contracts or declaration forms, leading the auditor to question whether these doctors fully understood their obligations under these new arrangements. Whoops!

The auditor’s report gives a clear indication why the docs suddenly had an overriding interest in group practice – much higher compensation levels.

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Some hospital CEOs get bonuses for “unambitious” and declining targets — report

The threshold for CEOs receiving pay-for-performance bonuses in Ontario hospitals can be very low. Today’s panel report commissioned by the Ontario Hospital Association suggests some hospital CEOs receive bonuses on targets that are set below existing performance levels.

In other words, a hospital’s performance can decline and the CEO can still get his or her bonus.

The report – put together by executives from the public and private sector – calls Ontario hospital CEO compensation reasonable at a median of $266,000 annually, but suggests there are inconsistencies particularly among mid-size hospitals.

During the last election the NDP had called for a cap on hospital CEO salaries at twice the salary of the Premier: $418,000 per year. The report indicates 25 per cent of Ontario hospital CEOs make more than twice the compensation of the Premier.

The report says hospital CEO salaries are slightly less than university presidents – its nearest comparator. They do not compare hospital CEOs to provincial deputy ministers, who have a compensation guideline of about $220,000 a year.

This spring the provincial budget called upon hospital CEOs to reduce their executive office budgets by 10 per cent over two years. However, as reported in this BLOG, the Ministry later clarified that this did not necessarily mean a reduction in executive salaries, that clerical and support staff could be laid off instead.

Did this occur? The report is coy in stating that “to date there have been no legislative provisions to support this action.”

The report puts hospital CEO salaries in the bottom 25 per cent of private sector executive salaries. They recommend private sector compensation be used as a future benchmark even though there is broad consensus that corporate executive salaries have been rising at an unsustainable rate. Last year average CEO compensation in Canada’s top 100 corporations rose an average of 13 per cent. Does that mean hospital CEOs should have a similar raise as long as they remain in the bottom 25 per cent?

The report also indicates that what we are seeing in the sunshine reports may not entirely reflect the whole story. For example, some CEOs receive a SERP – a supplemental employee retirement pension plan. Four Ontario hospital CEOs receive SERPs that are over and above contributions to HOOP – the Hospitals of Ontario Pension Plan. Others receive a SERP in lieu of HOOP. Public contributions to a SERP – which is fixed benefit plan – can range from below $50,000 to above $200,000 a year. Hospitals are not required to report SERPs as benefits in the sunshine list.

The report says total individual CEO compensation should be made public. The sunshine list can often distort the real story given CEOs can start or leave midway through a year, the reported compensation can contain retroactive or severance pay, and not all benefits are included (such as the SERPs).

While Ontario legislated a pay-for-performance component to CEO compensation, some hospitals have made it an insignificant amount – as low as 2 per cent. The report states: “hospitals that introduced pay-for-performance in response to Bill 46 have struggled to identify performance expectations and to introduce performance-based compensation while at the same time complying with a two-year salary freeze for non-union employees.” The report says a number of hospitals have set “unambitious quality improvement targets” as part of this scheme.

While hospital CEOs have long told rank and file staff to suck it up with regards to austerity, the report indicates that changes in compensation practices appear to have “hurt morale” and made it more difficult to attract qualified senior managers.

Yet the background of existing CEOs suggests that only 40 per cent had previous experience as a CEO, most coming up the ranks. Only 47 per cent of hospital CEOs have clinical education credentials and just one has a PhD in management education. Slightly more than half – 55 per cent – have a master’s degree in management education.

Other recommendations from the panel include the use of a standard hospital executive compensation framework and template, pay-for-performance bonuses set at between 10-30 per cent of base compensation, standardized severance agreements, and enhanced training for boards in executive compensation issues.

The panel believes that CEO compensation should still rest with the hospital boards.

Want to solve the ALC problem? Stop designating patients as ALC.

In Dr. David Walker’s summer ALC (alternate level of care) report he gives the example of the Toronto Central LHIN’s efforts to reduce their ALC roster.

Alternate level of care patients are said to be indivdiuals who have completed their acute care but are unable to go home or secure a long term care bed. There used to be an ugly word for them — bed blockers — which appeared to put the blame on the patient for a failure of the system to provide a continuum of care.

The Toronto Central LHIN identified 148 long-stay ALC patients for review. While the LHIN was able to transition 28 of these ALC patients to alternate destinations, 22 were deemed medically unstable and not ALC at all. That’s nearly 15 per cent.

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Is McGuinty quietly adopting the Walker report?

August 31st the Ontario Ministry of Health did a curious thing. They posted on their website a report by Dr. David Walker, who had been appointed ALC lead back in January. There was no press release, no press conference, no op/eds were written supporting Walker’s 32 recommendations. Walker had submitted his report at the end of June, and for two months the government mulled it over before deciding to make it public on the eve of an election. During that election there was virtually no talk of Walker’s report.

ALC is the term for alternate level of care patients — those who have completed their acute care treatment in hospital but are not stable enough to return home.

Normally this kind of treatment of a report indicates a “thanks, but no thanks” attitude by government. However, at a meeting with public service reform commissioner Don Drummond, the Ontario Health Coalition was told that the government has actually accepted the recommendations of Walker.

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Free Music Download: They’re taking it away

By day Ian Robb works at the Children’s Hospital of Eastern Ontario (CHEO). However, Ottawa-area residents likely know him as part of a harmony trio called “Finest Kind.”

His song “They’re Taking It Away” has been sung at demonstrations against cuts to public services. Now that song is available for free for a limited time from the website of Fallen Angel Music.

“They’re Taking It Away” is about “the bully boys of Bay street” who are saying “to hell with paying taxes, pull the safety net away.” The song is certainly appropriate as the McGuinty government ramps up for what appears to be a decade of austerity.

If you like the song, you can also buy the full CD.

To go to the downloads page of Fallen Angel Music, click here.

 

 

Foundation calls for more powerful LHINs – but how accountable will they be?

Board members of the Local Health Integration Networks (LHINs) serve at the pleasure of the government of the day. They are appointed by Order in Council, and have a reporting relationship directly to the Minister of Health.

There isn’t much direct criticism from the LHINs of government health care policies, including organization of the LHINs.

Last week the Change Foundation issued a new report on integrated health care — Winning Conditions to improve patient experiences: integrated health care in Ontario. What’s significant is the Change Foundation report was reviewed by key players within the system, including Bill MacLeod, CEO of the Mississauga Halton LHIN.

While the Change Foundation suggests the final report wasn’t necessarily endorsed by the reviewers, this is an organization that has some high level participation from key stakeholders, including former deputy minister Ron Sapsford, who sits on the Foundation board alongside departing Ontario Hospital Association CEO Tom Closson.

The Change Foundation suggests that the LHINs function differently in reality than on paper, calling their “authority” a debatable point, the conditions on which they’ve had to operate “have been hardly winning.”

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