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% |
OMA Board rejected this proposal.. Earnings are GROSS ; not NET after overheads.
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