OMA Section on Rheumatology Report
With government underfunding, Ontario doctors sidelined by the government and unreasonable and growing patient wait times, it is no wonder healthcare is a forefront issue for all Ontarians. For the past 3 years, doctors have been disrespected and maligned by the government. The OMA has been especially active representing our interests during this election year. Ontarians wanted change, and on June 7, 2018, PC’s Doug Ford won a majority government. Progress is impossible without change and hopefully, this change will be for the better.
Since 2015, Ontario Liberals unilaterally cut more than $4 billion from the fees for patient services which physicians provide. Physicians have been without a contract since 2014 and the 4.45% clawback remains in effect since 2015.
The OMA’s first binding arbitration hearings were scheduled for May 24 and 25, 2018 with lead legal counsel Howard Goldblatt. The binding arbitration panel Chair is William Kaplan, with OMA representative Ron Pink and ministry representative Kevin Smith. The OMA and the government are extremely far apart on all substantive issues. The arbitration Board will address and determine issues with respect to the content of the Physician Services Agreement (PSA) for the period of April 1, 2017-March 30, 2021. Binding arbitration is planned to proceed in a 2-phase approach. Phase I covers redress (removal of payment discounts and targeted cuts) and normative compensation increases, and phase II, should there be a recovery of funds, covers the allocation and distribution of those funds (including relativity adjustments).
The OMA is proposing that effective April 1, 2017:
- Across-the-board payment discounts end.
- Physician fees and payments be increased by 4.26% (representing 1.4% per year from 2014-17) to compensate physicians for the lost normative increases for those 3 years.
- The OMA is also seeking fee and payment increases of 2.6% per year in each of the 4 years from April 2017-March 2021 of the current Physician Service Agreement (PSA), to compensate physicians who have faced and will continue to face increasing costs of practice.
- The OMA is fundamentally and irrevocably opposed to a predetermined cap on payments for physician services. In our publicly funded health care system, it is the government, and not physicians, that is responsible for funding the cost of physician services provided to Ontarians.
For a complete summary of the respective OMA and Ministry arbitration positions please refer to the OMA website link: https://www.oma.org/wp-content/wp-private.php?filename=ArbitrationStageOnePositions.pdf
In the week following the provincial election, our new Ontario premier reached out to OMA leadership, expressing its desire to reset the relationship between doctors and government. In fact, their negotiating team subsequently wrote to OMA negotiations counsel on June 17, with a formal request to replace the July arbitration dates with negotiation/mediation to explore the possibility of reaching a mutually acceptable settlement. After much discussion on June 20, the OMA Board accepted. An FAQ document concerning this can be found at: https://oma.us12.list-manage.com/track/click?u=f3031ca7cb6af54104b9de2cd&id=1d6204ba44&e=c3ce68c88b
The Ministry has developed a new relativity model called RAANI (Relativity Adjusted Annual Net Income). The government claims, that the OMA’s relativity tool, CANDI (Comparison of Average Net Daily Income) significantly overestimates physician overhead (on average, they claim overhead is closer to 20% than 30%). Relativity was hotly debated and discussed at Spring Council on April 28. The OMA Negotiating Committee has aggressively pushed back on the approach, validity and methodology used by the Ministry in the initial arbitration hearing. OMA Council asked that a Relativity Metric be developed and released to members prior to Phase II of arbitration. This is work that will be taken up by the Relativity Advisory Committee.
The Binding Arbitration Framework allows for the OMA to continue its Charter Challenge launched in October 2015 regarding the government’s course of misconduct towards physicians since 2014. The Charter Challenge seeks two main remedies from the court:
- To declare the OMA be entitled to a binding dispute resolution mechanism to resolve bargaining impasses with the government
- To declare unlawful some of the most egregious of the governments unilateral actions since 2015, including unilateral fee cuts, and to order compensation for physicians.
Dr. Philip Baer continues as an OMA representative on the Ministry of Health SADIE task force looking at modernizing the OPDP EAP program for drug access, using a web portal and eventually direct links to physicians’ EMRs. Dr. Jane Purvis and Dr. Chris McKibbon have also participated, and we are liaising with the ORA Executive and Informatics Committee as well.
Many workers struggle to support their families on part-time, contract or minimum-wage work. Bill 148, the Fair Workplaces, Better Job Acts was passed November 22, 2017 to modernize Ontario’s labour laws and create more opportunity and security for workers. Minimum wage increased to $14/hour on Jan. 1, 2018. Employees are entitled to 3 weeks of paid vacation after 5 years of service with the same employer and to 10 days of Personal Emergency Leave per year, including 2 paid days. Employers are prohibited from requiring an employee to provide a sick note from their health practitioner when taking personal emergency leave. For additional details on Bill 148: https://www.ontario.ca/page/plan-fair-workplaces-and-better-jobs-bill-148
A reminder that it is mandatory for employers to post the Employment Standards Poster, version 7 at the workplace and provide all their employees with a copy of the poster so that employers understand their obligations and employees know their rights. The following link will allow you to view and print the poster. https://www.labour.gov.on.ca/english/es/pdf/es_poster_2018_1.pdf
To continue with the theme of change, at Spring Council, Dr. Nadia Alam was sworn in as our new OMA President, taking over from Dr. Shawn Whatley. OMA Board members (25 people) no longer vote at Council (represented by 270 physicians). Board committees were reduced from 52 to 3 providing more opportunities for OMA grassroots members to be appointed to committees.
After a maximum 10-year term, Philip Baer stepped down as Section Chair. On behalf of the ORA, I would like to thank him for his incredible service and dedication. Dr. Baer will however, continue at the OMA in a new role, elected as delegate for District 11 Centenary Branch Society. Our new Rheumatology Section Executive: Chair and Delegate Julie Kovacs, Vice-Chair Nikhil Chopra and Secretary Jane Purvis. For three years I have represented Rheumatology at Medical Assembly teleconferences and was on the Rheumatology Executive as Secretary and Alternate Delegate. We will continue representation at Medical Assembly teleconferences and Assembly meetings as well as all regular and special OMA Council Meetings.
You can monitor the MOHLTC website under the Health Professionals tab for new developments: http://www.health.gov.on.ca/en/pro/. There are links to OHIP Physician Bulletins: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/ and to updates regarding the OPDP formulary, including new EAP listings:
http://www.health.gov.on.ca/en/pro/programs/drugs/eap_criteria.aspx
You may also keep up 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
Provided is a link to OHIP Billing Resources and OMA Quick Reference Guides at www.oma.org/sections/billings-and-agreement
Online educational modules on billing, patient care, practice management and retirement planning are available through the OMA Education Network at: https://learn.oma.org
As well, an online Privacy and Security Training Module is now available from OntarioMD: https://www.ontariomd.ca/products-and-services/privacy-and-training-resources
