OMA President’s Update: OMA Board Unanimously Rejects Government Final Offer, Ministry to Impose Further Cuts to Medical Services
PRESIDENT’S UPDATE
Vol. 20, No. 1
January 15, 2015
OMA Board Unanimously Rejects Government Final Offer, Ministry to Impose Further Cuts to Medical Services
Today,
the OMA Board of Directors unanimously rejected a final offer from the
Ontario government that would cut an additional 4% in medical services,
and place an arbitrary ceiling on the physician services budget, which
would cap the number of services physicians are able to provide to our
patients.
The government’s final offer, submitted late Wednesday evening, included:
· $580 million in cuts over two years, including
- $259 million through 9 specific cuts in physician payments, the majority of which impact family practice;
- $50 million in system savings;
- Increasing the current 0.5% payment discount to 1% on all physician payments;
- Further additional increases to the payment discount by specialty of practice.
· A 1.4% one-time payment in year 3.
The
Ministry warned the OMA that if we did not accept this punitive offer,
it would pursue unilateral action against physicians immediately. We
have received details of this arbitrary action and are assessing its
potential impacts.
The
OMA and the physicians of Ontario have worked hard to build and
maintain a positive relationship with government. We have negotiated in
good faith to improve the health care system for our patients. In 2012,
Ontario’s doctors did our part and contributed more than $850 million in
fee concessions and health system savings. To impose a further $580
million in cuts to medical services and payments is unwarranted and
destabilizing.
The
government’s position will lock in system underfunding for future years
and subject physicians to open-ended liability for growth in the
utilization of medical services that is beyond our control. It will
limit training opportunities in primary care, mental health, and many
other specialties. Also, the government’s pattern of heavy-handedness
toward doctors, and unwillingness to negotiate reasonable agreements
with the profession, will make Ontario an undesirable place to practice.
The
OMA will be active in the media and other venues to ensure that the
public and our patients understand the truth and the real impacts of the
government’s final offer and its arbitrary measures.
We
anticipate the government will claim to have offered the profession a
modest raise based on the language in its proposal — this is
disingenuous and misleading. In fact, government plans to set an
arbitrary baseline for the physician services budget that is more than
$80 million below current levels, and fund growth of no more than 1.25%
per year, despite the current growth of 2.7%. This difference will be
funded through cuts to physician payments. Also, the government intends
to claw back from physicians through reconciliation any expenditure that
exceeds its arbitrary budget.
While
we have rejected the government’s final offer, and it has been
withdrawn by the Ministry, the OMA Board considers it vital that we
share the government’s proposal with all members. We know that members
will have many questions, and we will work to ensure that you get the
information and answers that you need in a timely and effective manner.
The
OMA will undertake an extensive member education campaign to provide
all details of the rejected government offer, as well as the Ministry’s
unilateral cuts. We are organizing a series of face-to-face meetings and
teleconferences across the province.
OMA
Council will meet in the near future to review these developments and
plan how we intend to move forward championing our patients and
supporting our members in the face of the government’s cutbacks.
The
OMA has been negotiating with government for more than a year. These
talks have been difficult. Since the outset, the government focused
exclusively on cutbacks and balancing its budget. We concluded the first
round of negotiations in August and were unable to reach an Agreement.
We then moved to facilitation, and subsequently conciliation with former
Chief Justice of Ontario Warren Winkler. Here too, we were unable to
reach a deal. Justice Winkler submitted his report to the parties on
December 11. In his report, he suggested the OMA should reconsider the
government’s offer, and we did.
The
OMA called a meeting of physician leaders, which was held December 20.
More than 150 physicians from across the province attended. The Board
outlined the negotiations timeline, the government position, and the
results of our facilitation and conciliation process. We detailed the
challenges at the negotiations table and the significant gap between
both sides. We circulated the offer on the table from government at that
time and we shared Justice Winkler’s then-confidential report, which
will be available on the OMA website. We set out the positives and
negatives of the government position, and reviewed the Winkler
recommendations and the critical elements not referenced in the final
conciliator’s report. Physician leaders provided valuable perspective to
inform the final stage of the negotiations process.
The
OMA and Ministry reconvened for a brief final round of negotiating that
concluded January 9, with the government tabling its final offer on
January 14. Today, the OMA Board met to review that offer. After careful
consideration of the potential impacts of the proposal, threatened
unilateral action, and the valuable input from more than 150 physician
leaders who attended the December 20 meeting, the Board voted
unanimously to reject it.
This
offer will not improve quality of care, nor will it improve public
access to medical services. In fact, we know the opposite will result.
In the face of this arbitrary action, the OMA and Ontario’s doctors, on
behalf of our patients and our partners in the health care system,
intend to candidly and aggressively inform the public and all
stakeholders about the truth of the government’s offer and the real
implications for health care.
I
urge all members to stay focused on our patients and avoid divisive
actions or any actions that will compromise patient care. We need to
monitor the impacts of the government’s measures on the system and our
ability to practice. We need to work together as a profession and with
our partners in the system to assess our relationship with government,
and establish our collective strategy going forward.
I
want to thank all members for your tremendous patience during the past
year. The Board recognizes that these developments will be frustrating
for physicians and have significant implications for your practice and
your patients. We have made every effort to convince government that
heavy-handedness is not the solution, however, it is clear the government is entirely focused on fiscal targets and not patient care.
The
OMA will be communicating regularly with you in the coming days.
Documents will be posted on the OMA website and the site will be updated
on a continuing basis (www.oma.org).
Once
again, I encourage all members to maintain focus on patient care and
professional unity as we assess the current circumstance, and let’s work
together to address this challenge collectively on behalf of our
patients and our colleagues.
Dr. Ved Tandan MD(Tor.1989) FRCS(C)
OMA President
(Hamilton General Surgeon)
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15 Jan 2015
Past Ont.Chief Justice Hon.Warren K. WINKLER BA(Manitoba) LLM(York) QC CONCILIATOR'S REPORT
Physician Services: Ten-Point Plan For Saving And Improving Service
Backgrounder
Physician Services: Ten-Point Plan For Saving And Improving Service
"During the Conciliation, much progress was made towards achieving a three-year PSA. A three-year PSA would be a significant win for the public, health system and the Parties... In the circumstances, I would urge the OMA to reconsider its rejection of the Ministry's Proposal."
-- Conciliator's Report, The Hon. Warren K. Winkler, Q.C., December 11, 2014
The Ministry of Health and Long-Term Care will implement 10 changes to physician services payments. These include changes to fees and payments wherever possible so that Ontarians are paying the right amount for the right services. Other specific initiatives included will enhance the quality of care offered, improving how the health care system works, and making sure every dollar spent on health care gets the best results.
Specific Changes Planned to Physician Services Payments
Getting the best results:
When a patient goes to a walk-in clinic instead of his/her own doctor, there isn't as much continuity of care. Currently a visit to a walk-in clinic on a weekend or holiday costs more than a visit to your own doctor. The fee for a walk-in visit on these occasions will become comparable to the fee for a visit to your doctor.
Updating payments to specialists:
Internal Medicine, Nephrology, Gastroenterology and Cardiology are specialists that currently benefit from a 50 per cent premium payment on fees for assessing patients for certain diagnoses. These higher payments are no longer relevant, as these particular specialities are closer to the higher end on the physician income scale.
Removing obsolete programs:
All professionals, including doctors, have an obligation to remain current in the knowledge of their area of practice. No profession gets government funding to meet their obligation. That is why we will eliminate funding for doctors to attend courses and events that are considered part of their continuing medical education. This was funding the government established in the 1990s when Ontario had a doctor shortage. Doctors are still obligated to remain current in their medical knowledge.
Doctors who treat a roster of patients are paid a premium for accepting patients with complex health care needs. Doctors have also been paid a premium for accepting healthy patients on their roster - patients who they would have likely accepted anyway. This premium for accepting healthy patients is being eliminated.
Prioritising underserviced areas:
Doctors who work in underserviced areas will benefit from income stabilization payments and doctors who work in over-serviced areas will no longer benefit from these payments.
Only areas with a high need for physician services will get new Family Health Organisations and Family Health Teams.
Improving payment models to better reflect current needs:
The Hospital On Call Coverage program provides funding to ensure timely access to physician services for hospital patients 24/7. A new funding model will be developed that better recognizes local patient and hospital needs. Until then,
- Hospital On-Call Coverage funding will be frozen at the current level; and
- Planned funding increases, which were not directly linked to improving patient care, will be eliminated.
Payment reduction:
The ministry will apply a 2.65 per cent discount to all fee for service physician payments, effective February 1, 2015 and apply the reduction to non-fee-for-service payment contracts after the respective requirements for providing notice are met.
Under this element of the plan, the ministry will work with the OMA on a savings methodology that results in a higher proportion of savings from higher paid specialties.
The ministry will also be prepared to adjust the across-the-board rate reduction based on any agreed to savings initiatives with the OMA that result in comparable savings, as necessary.
Doctors will still be able to provide any and all services for their patients that they feel are required.
Payment to doctors - by the numbers:
The physician services budget is 25 per cent of the total health budget and 10 per cent of government spending.
The average payments have been reduced since 2011/12 to an estimated $354,000 in 2013/14.
Spending on physician compensation will continue to increase;
| Fiscal Year | 2013/14 | 2014/15 | 2015/16 | 2016/17 |
| Spending Target | $11.379B (actual) | $11.437B | $11.578B | $11.720B |
On average, gross payments to doctors are now 61 per cent more than in 2003.
| 2003/04 (ICES) | 2013/14 (MOH) | $ Increase (03/04 to 13/14) | % Increase (03/04 to 13/14) | |
| Family Medicine | $189,000 | $317,800 | $128,800 | 68% |
| Specialists | $246,000 | $381,500 | $135,500 | 55% |
| Diagnostic Radiology | $398,527 | $613,900 | $215,373 | 54% |
| Ophthalmology | $413,232 | $641,200 | $227,968 | 55% |
| Nephrology | $446,981 | $563,650 | $116,669 | 26% |
| Cardiology | $371,874 | $509,300 | $137,426 | 37% |
| All Physicians | $220,000 | $354,000 | $134,000 | 61% |
ONTARIO:Value of a worker's life. $150,000.
9 of 79,977
Future Mobility Healthcare Fined $150,000 After Worker Killed
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16:40 (33 minutes ago)
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Court Bulletin
Future Mobility Healthcare Fined $150,000 After Worker Killed
January 15, 2015
MISSISSAUGA,
ON - Future Mobility Healthcare Inc., a Mississauga company that specializes in
the assembly of wheelchairs, has pleaded guilty and has been fined $150,000
after a worker was killed while removing a 3,500-pound machine from a tractor
trailer.On May 26, 2013, a crew of workers at the company's premises at 3209 Orlando Drive was assigned the task of emptying the contents of trailers. The machine was being moved with a forklift and two workers were standing in the trailer attempting to guide and stabilize the machine. The distance between the two forks of the forklift was too wide and the machine was lifted on just one fork. As the forklift operator began to lift the machine, the load began to tip toward the one side of the trailer. One worker was able to jump out of the way and the other stayed beside the machine and tried to stop it from tipping. The machine continued to tip off the fork and pinned the worker against side of the trailer. Emergency services were called to the scene but the worker succumbed to injuries sustained in the incident. A Ministry of Labour investigation found that the company failed to ensure that materials were lifted or moved in such a way that they did not endanger the safety of any worker, as required by law. Future Mobility Healthcare Inc. pleaded guilty to failing, as an employer, to ensure that materials or equipment were lifted or moved safely and to failing to ensure that the material was transported so that it did not tip or fall, as required by Ontario Regulation 851/90 (the Industrial Establishments Regulation) and the Occupational Health and Safety Act. The company was fined $150,000 by Justice of the Peace Jeannie Anand in Provincial Offences Court in Mississauga on January 13, 2015. In addition to the fine, the court imposed a 25-per-cent victim fine surcharge as required by the Provincial Offences Act. The surcharge is credited to a special provincial government fund to assist victims of crime. Court Information at a Glance Location: Provincial Offences Court/Ontario Court of Justice 950 Burnhamthorpe Road West Mississauga, Ontario Judge: Justice of the Peace Jeannie Anand Date of Sentencing: January 13, 2015 Defendant: Future Mobility Healthcare Inc. 3223 Orlando Drive Mississauga, Ontario Matter: Occupational health and safety Conviction: Occupational Health and Safety Act Section 25(1)(c) Ontario Regulation 851/90 (Industrial Establishments Regulation) Section 45 Crown Counsel: Line Forestier |
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