Dr. Ed Brown asked how many people in the audience were able to e-mail their family doctor? A small handful in the Mount Sinai hospital auditorium raised their hand. When asked who would like the ability to e-mail their doctor, everyone in the room raised their hands.
The situation is likely to change much sooner than we think. The question is, are health care providers ready, will the public participate, and will quality be more than an “acceptable second best?”
Brown, CEO of the non-profit Ontario Telemedicine Network, says Ontario is already one of the most advanced telemedicine environments in the world. Last year there were 204,058 telemedicine “events” in the province – a staggering 52 per cent growth over the previous year. There are slightly over a thousand regular users – this in a doctor population of 25,000.
Brown and Will Falk, a health care “leader” with PwC Canada, spoke at Longwood’s Breakfast With The Chiefs this morning on the growing virtualization of health care.
By conducting health care consultations virtually, Brown says that Ontarians have been spared travelling the equivalent of 275 trips to the moon and back. In Northern Ontario it has saved 108 million miles of travel. Given northern travel grants are available for citizens to access health care mostly in the south, that represents about $45 million in savings had all those trips actually taken place (likely not all would have).
It’s a sign of our times when a simple labour agreement can be framed as a political triumph.
The latest is news the Ontario Medical Association reached a deal with the provincial government this week on behalf of 25,000 doctors.
Here’s the shocker: there was some give and take. This wasn’t supposed to be possible in this new austerity landscape.
The government took two years of zeros. The docs got the government to reverse some of the unilateral fee cuts from earlier this year.
Don’t we all feel better now?
Medical office assistants and their supporters picket outside the Oshawa Health Centre August 29. The workers were told they were losing their jobs at the medical clinic upon the retirement of chiropractor Dr. Adrian Pettyan.
Picketing OPSEU members got a partial result for their efforts outside the Oshawa Health Centre on August 27.
Medical office assistants at the Oshawa Health Centre were calling for the medical clinic’s owner to reveal his plans for the future of services offered at the clinic after it formally closes at the end of September.
Dr. Adrian Pettyan, who says he owns the clinic, had been adamant patients were not being “abandoned,” but could not say earlier in the week where the clinic’s health practitioners would move their practices.
Pettyan told the news media yesterday that he expects most of the doctors will make lease arrangements to continue working out of the facility at the corner of Adelaide and Simcoe Streets.
Ontario’s doctors are fighting back after the government unilaterally cut $340 million in fees last month.
The Ontario Medical Association is applying to the Ontario Supreme Court of Justice for a review of the government’s negotiations tactics and the imposition of fee cuts.
The doctors are arguing the landmark BC case in which the Supreme Court of Canada recognized the right to collective bargaining should be extended to the OMA, which has negotiated the fee schedule with government since the beginning of Medicare.
Much has been made of potential doctor shortages resulting from the no-holds barred death match between the Ontario Medical Association and Health Minister Deb Matthews.
It is notable that last year Dr. Sacha Bhatia, the former health advisor to Premier Dalton McGuinty, wrote an essay published on longwoods.com last year that discussed the problems young physicians will soon have finding work.
Bhatia notes a Royal College of Physicians and Surgeons of Canada study that reports graduates in 13 specialities in Canada were having difficulty finding jobs, and another study published in the Annals of Thoracic Surgery that found 34 per cent of cardiac surgery graduates were underemployed.
“There are several factors affecting demand for physicians,” writes Bhatia. “Hospital budget constraints mean less capacity for physicians to operate in. Technology changes, expanded scopes of practice of non-physician specialties, and improvements in efficiency also mean fewer physicians are required to do the same volume of work.”
Bhatia states that these efficiencies should be offset by increased demand resulting from an aging medically complex population.
Well that didn’t take long.
After a few weeks of bluster, the Ontario government has walked away from bargaining with the province’s doctors and imposed a retroactive fee schedule that rolls back fees affecting 4,500 different OHIP services.
That includes a four-year 11 per cent rollback on fees paid for 250 diagnostic radiology tests that the government claims are justified by improved technological efficiency.
Fees paid for cataracts are being similarly rolled back from $441 to $397.75.
Fees paid for eye injections for retinal disease will be more than halved over four years, from $189 to $90.
Ann Cavoukian, Ontario’s Information and Privacy Commissioner has called upon the province to regulate the amount doctors and other health care providers can charge to provide patients with copies of their health records.
Cavoukian writes that “access to one’s own records of personal information is a cornerstone of fair information practices and privacy legislation. In the context of health care, the right of access enables individuals to determine what shall or shall not be done with their own bodies, to exercise control over the collection, use or disclosure of their own personal health information, and to require the correction or amendment of that information.”
While the McGuinty government did draft a regulation around such fees in 2006, it was never passed.
A patient complained to the Commission about a $125 fee charged by her physician for access to 34 pages of her records. They found $125 to exceed “reasonable cost recovery” and ordered the physician to reduce the fee to $33.50. The Commission arrived at the fee by suggesting $30 be charged for the first 20 pages to cover time for the doctor to review the information, and 25 cents per page be charged beyond that.
Health Minister Deb Matthews said she didn’t believe the problem to be widespread, but said she would talk to the Ontario Medical Association about it.
Creeping charges related to access to health care is becoming a growing issue.
A few years ago Vector conducted a poll in which the majority agreed that the high cost of parking at hospitals constituted a health care user fee.
If you want to find the most expensive place to park in any town or city, it’s usually the hospital. We have seen ridiculous attempts by hospitals to protect that revenue such as erecting fences to prevent people from walking from nearby free parking lots. Municipalities have been forced to limit parking in nearby neighborhoods as patients and their families try and avoid the high fees.
The high parking fees have also been used as an argument by some hospitals for divesting services elsewhere in the community.
The latest amendment to Ontario’s Budget Bill 173 fails to address concerns raised around a change to freedom of information legislation that will permit greater hospital secrecy.
Schedule 15 of Bill 173 enables a hospital CEO to shield from public scrutiny any information about quality of care produced for or by a hospital committee. More than a dozen groups appeared before the legislature’s Standing Committee on Financial and Economic Affairs in April asking the offending schedule be removed.
Instead the McGuinty government has amended the proposed Bill to exempt “information provided in confidence to, or records prepared with the expectation of confidentiality by, a hospital committee to assess or evaluate the quality of healthcare and directly related programs and services provided by a hospital, if the assessment or evaluation is for the purpose of improving that care and the programs and services.”
Ontario hospitals are the last in Canada to come under Freedom of Information legislation. After introducing a public sector accountability bill last fall that would open up hospitals to freedom of information requests beginning January 2012, the McGuinty government recently caved-in to a lobby by the Ontario Hospital Association, the Ontario Medical Association and a private insurance company to narrow what would be accessible.
“The government’s amendment allows hospital executives to make some documents secret by simply stamping ‘confidential’ on them or retroactively suggesting that the records were intended to be private,” says Cybele Sack of Impatient for Change, a patient advocacy group. “Our freedom of information laws are meant to increase transparency and this amendment undermines that spirit.”
The final act is expected to be passed by the majority Liberal government this Thursday (May 5).