In the coming weeks ahead, we can look forward to autumn’s spectacular colours, pumpkins, hot apple cider, warm sweaters and scarves.
Please take a few minutes to catch up on the latest OMA news. Please read on to find out more about our retroactive one-time payments for 2017-2020 and allocations for year four (2020-21). Also, read through carefully the CPSO’s four NEW approved and published Continuity of Care Policies (and one Advice to the Profession companion document). Physicians are expected to align with the new CPSO expectations by October 20, 2019.
- Retroactive Compensation
The OMA and government reached an agreement for the distribution of normative increases for years 1-3 (2017/18-2019/20) of the Physician Services Agreement (PSA).
September 27, 2019, the Ministry posted the following timelines for issuing the first year and second year one-time payments:
- 2017/18 payments – December 2019
- 2018/19 payments – April 2020
- 2019/20 payments – Not yet confirmed
For year one, rheumatologists will receive a lump-sum payment of 0.8% of their personal/individual billings for that year.
Due to rheumatology’s relativity score being slightly below the average for the profession, rheumatology’s year-one normative one-time payment allocation (0.80%) is slightly better than the average for the profession (0.75%).
The estimated year one (2017/2018) allocation by specialty can be found by clicking on this link: Table
The OMA President, OMA Board, the Negotiations Committee, and our CEO Mr. O’Dette have been pressing the Ministry to expedite the process of calculating and making these one-time payments.
The Ministry attributes the delay to the “complexity of accounting, technical issues and manual processing of payments, where required”.
Members are encouraged to ensure that the Ministry of Health has your up to date banking information (see InfoBulletin for details).
- Results of Rheumatology Undervalued Fee Code Evaluation Survey
On August 23, 2019, all primary members of the Section on Rheumatology were emailed an Intra-Sectional Undervalued Fee Code Evaluation Survey. The purpose of the survey was for primary members to evaluate the list of rheumatology codes in terms of time and intensity, which would determine whether those rheumatology billing codes were considered “undervalued.” You were advised prior to filling in the survey that the outcome of the survey was expected to have important consequences for allocation of payment increases within our section.
Just under 20% of rheumatologists completed the survey and it was overwhelmingly evident that all billing codes evaluated were considered undervalued.
3. AWG Clarification – Consultation Intervals: On August 22, 2019, the OMA and Ministry of Health (MOH) released the Phase 1 recommendations of the Appropriateness Working Group (AWG). The formation of the AWG was ordered by the Arbitrator and is binding on both the OMA and the MOH.
As you know, the AWG is tasked with making recommendations to improve the quality of patient care by reducing the provision of medically unnecessary or inappropriate care, without compromising patient access to medically necessary services. Under the terms of the AWG imposed by the Arbitrator, fees can be delisted, and the required elements for billing them can be changed, but the fees themselves cannot be altered.
Effective October 1, 2019, the only Schedule of Benefits change relevant to rheumatology is:
Consultation services will be limited to one per 24-month period when the same patient is seen by the same consultant for the same problem as the initial consultation.
The following exceptions to the above payment rule apply:
- When the additional consultation service(s) is a repeat consultation;
- When a consultant has rendered a consultation service to a patient in any location and the same consultant is referred to the same patient a second time with the same diagnosis, then the number of consultations eligible for payment is a total of two services per two consecutive 12 month periods only when: i. the second consultation is rendered for a hospital inpatient or a patient in an Emergency Department; and ii. the consultation is rendered > 12 months but < 24 months following the first consultation.
OHIP computer rules will be updated to identify emergency department and inpatient services. However, in the unlikely event these services are not paid as consults, members are advised to seek a manual review.
If you have any questions about the AWG, or require further information, please email negotiations@oma.org.
4. CPSO Continuity of Care Policies: Over the past few years, the CPSO has been developing Continuity of Care Policies. The intent of the policies is to ensure that patients don’t “fall through the cracks” or have lab work and diagnostic results not followed up. Many physicians expressed concerns about the initial draft policy. Concerns were expressed about the increasing administrative burden and that the requirements were onerous! The OMA’s Economics, Policy and Research department, in collaboration with the OMA’s Health Policy Committee worked to advocate for changes to the drafts. Many of the changes recommended by the OMA were accepted by the CPSO.
On September 20, 2019, The CPSO approved and published four new policies and one Advice to the Profession companion document that set out expectations related to continuity of care. The OMA has developed resources to help you understand and implement the new policies regarding the following themes:
- AVAILABILITY AND COVERAGE
- MANAGING TESTS
- TRANSITIONS IN CARE
- WALK-IN CLINICS
Within policies, the terms ‘must’ and ‘advised’ are used to articulate the College’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.
The CPSO has implemented a 30-day transition period to allow physicians to align with any new expectations that were not previously set out in policy or where there has been substantial change in expectations. This transition period will end on Sunday October 20, 2019.
The OMA has developed a series of checklists to help physicians understand and implement the new policies.
Please read through the CPSO documents and OMA CPSO checklists carefully. Consider printing out the checklists for you and your staff for easy reference.
The OMA checklists organize expectations from across all four policies into common themes so that you can easily apply them to your everyday tasks and practice contexts.
Each checklist lists key action items followed by the exact wording from the CPSO’s policies. They also include optional guidance from the CPSO’s Continuity of Care: Advice to the Profession document. The links for the OMA checklists are provided below.
Includes:
- Making referrals
- Receiving referrals
- Special considerations:
- When preparing for temporary absences from practice
- For physicians practicing in walk-in clinics
Includes:
- Ordering tests
- Tracking tests and results
- Receiving test results
- Communicating test results
- Following-up on test results
- Special considerations:
- When preparing for temporary absences from practice
- For physicians practicing in walk-in clinics and Emergency Departments
Includes:
- Doing consults
- Preparing and distributing consultation reports
- Receiving and reviewing consultation reports: special considerations:
- When preparing for temporary absences from practice
- For physicians practicing in walk-in clinic
Handover and Discharge Checklist
Includes:
- Handing over responsibility for patient care
- Having discharge discussions with patients
- Completing discharge summaries
- Distributing discharge summaries
Availability and Coverage Checklist
Includes:
- During office hours
- Outside of office hours
- When preparing for temporary absences from practice
Includes:
- Supporting the relationship between episodic care and primary care
- Maintaining standards of practice
For questions about the expectations set out in the Continuity of Care policies contact the CPSO Physician Advisory Service Phone: 416-967-2606 / Toll Free: 1-800-268-7096 x 606
5. Update on MAID/Conscience Rights
Members continue to express concerns about the CPSO’s “Effective Referral” policy, with respect to Medical Assistance in Dying (MAID).
Some members feel that forcing a referral against a physician’s conscience is a violation of their individual rights and freedoms.
ANY patient or family member can request an assessment for MAID and call the Care Co-Ordination Service Number for MAID (1-866-286-4023)
ANY patient who requests an assessment for MAID via that number will get an assessment without a formal referral from their physician.
It is not necessary for physicians to do a formal referral (sending a written referral note, with billing number, etc.) for patients to access a MAID assessment, and not doing a formal referral will not impede patients who want this service.
6. Ontario Health Teams (OHTs)
The Ontario government is proceeding with health system transformation called Ontario Health Teams (OHTs). OHTs are teams of health care providers working together to design a system that aspires to deliver seamless and integrated care. To date, no OHTs have been approved – teams are still in the application mode.
You may have recently received an email from the OMA about Ontario Health Teams. The OMA is strongly advocating the fundamental importance of physician leadership in Ontario Health Teams, with primary care at the core. Participation for rheumatologists and all physicians in OHTs is voluntary. OHTs will have no effect on your practice or compensation.
Please send any questions to oma@oht@oma.org
We will continue to represent our Section at Medical Assembly teleconferences and Assembly meetings, as well as all regular and special OMA Council Meetings. Upcoming meeting, OMA Fall Council, is November 23-24,2019.
You may also keep up to date on OMA issues by reading the Ontario Medical Review (OMR), the OMA monthly magazine available in print and on the OMA website: www.oma.org
Online educational modules on billing, patient care, practice management and retirement planning are available through the OMA Education Network at:
As well, an online Privacy and Security Training Module is available from OntarioMD:
https://www.ontariomd.ca/products-and-services/privacy-and-training-resources