RVHS CEO Rik Ganderton with TSH CEO Robert Biron looking on during Wednesday’s Central East LHIN Board meeting.
The two CEOs representing the Scarborough and Rouge Valley hospitals appeared before the Central East LHIN this morning following news last week that their proposed merger was off – at least for now.
Both Rik Ganderton and Robert Biron looked nervous knowing at least in this venue the decision to pull back from the brink would be regarded as a disappointment. Had the two merged, they would have formed the seventh largest hospital corporation in the province.
The outcome of the meeting was predictable – the LHIN would work with the two hospitals to further an integration agenda and develop next steps. Both CEOs agreed to come back in April after meeting with the LHIN senior staff.
LHIN CEO Deborah Hammons tried to put the best face on the situation noting that the $3.8 million already invested in the merger was not entirely lost –getting the public to understand the position of the hospitals was “money well spent.”
In a perfect world hospitals would be publicly funded to meet the health needs of their communities. That would be it.
When the government started talking about funding reform, the thinking was that at last we would be moving closer to a rational system of allocation.
What we got instead was a hybrid of global funding, competition, and a funding formula that was supposed to take into consideration both existing usage and local demographics. Layered on top is a base funding freeze to at least 2018. Money has always been a driver in the health system, but suddenly it appears to be driving everything.
The evidence suggests that the complex and confusing system of funding allocation is creating new inequities that may be even worse than the ad hoc system of the past.
The South Bruce Grey Health Centre, for example, has argued to the South West LHIN that they are being penalized for efficiently combining the resources of four small rural hospitals. The Scarborough Hospital and the Rouge Valley Health System have made it clear that the complex demographic needs of their two communities are not being recognized in their base funding allocation.
What the new funding system appears to be doing is driving a new wave of costly and disruptive hospital mergers. You can’t blame the hospitals for seeking such mergers because they are simply acknowledging the new rules of the game set by the province. In this new world bigger gets more clout gets more funding.
In the past few weeks we have been challenging the Champlain Local Health Integration Network (LHIN) to step up to the plate around cuts and transfers of services from The Ottawa Hospital.
Champlain LHIN CEO Chantale LeClerc has dug herself in for the fight, insisting that considerable changes to health service delivery in her region do not warrant an integration decision nor any additional public consultation.
Curiously, in her most recent letters to both OPSEU and the Ontario Health Coalition, she has suggested that regional volumes of endoscopies have not yet been decided and that the LHIN has no mechanism to transfer them outside of a hospital environment (LHINs have no jurisdiction over private clinics performing public OHIP work).
The Ottawa Hospital CEO Jack Kitts is publicly stating the hospital will perform 4,000 fewer endoscopies per year (initially it was 5,000 fewer) and that it was his expectation that these volumes would be picked up by independent community-based clinics and other regional hospitals.
Clearly the hospital CEO and the LHIN CEO are not on the same page even though the LHIN is telling us the hospital is merely following its accountability agreement.
Endoscopies will be coming under what are called “Quality Based Procedures” for the coming year. These QBP get funded separately from hospital global budgets. That means if The Ottawa Hospital decides to stop doing 4,000 endoscopies, it also stops getting funding for them. Unless TOH is losing money on these procedures, it doesn’t suggest that such cuts will do anything to aid their bottom line – the whole point of this “restructuring.” Until we know where these procedures are migrating to (if anywhere), we have no idea whether the region will be saving any money or whether the public will be maintaining access.