OMA Update

Some of the key priorities for the OMA going forward: strengthening physicians’ roles as leaders in health transformation, unifying the profession, advocating for all members and furthering work on relativity to improve income fairness across specialties (Sections).

1. UPDATE ON OMA LEADERSHIP/ELECTIONS: PRESIDENT AND PRESIDENT-ELECT

Our new OMA President, Dr. Sohail Gandhi was sworn in at OMA Spring Council in Ottawa on May 5, 2019 to begin his 1-year term.  He is a University of Toronto graduate (1990) and a GP and coroner in Stayner for 26 yrs. Our President-elect, Dr. Samantha Hill, was elected at Spring Council. She is a cardiac surgeon in Toronto and a McGill graduate (2003).

2. PHASE 1 ARBITRATION AWARD REVISITED

As you probably know, the Kaplan Arbitration Board released its Phase I decision Feb. 19, 2019. This was summarized in the Spring Newsletter, 2019; however, I will recap the 4-year contract, effective April 1, 2017-March 31, 2021, below.

• Physician Services Budget (PSB): NO cap

Government, and NOT doctors, will be responsible to fund physician services and to cover the yearly increase in utilization

• REDRESS: Monthly “discounts” on RAs or the across-the-board ceased April 1, 2019 (visible on the May remittance advice).

This means that all payment discounts (4.45% Fee for Service & 3.15% Non-Fee for Service) ceased effective April 1, 2019

• Normative Compensation INCREASES:

Compensation increase in each of the 4 years

Effective April 1, 2017 – 0.75% global payment increase

Effective April 1, 2018 – 1.25% global payment increase

Effective April 1, 2019 – 1% global payment increase*

*Effective April 1, 2019 – 0.5% used to remove the 0.5% payment discount from the 2012 PSA

Effective April 1, 2020 – 1.0% global payment increase

3. PHASE 2 ARBITARTION AWARD

• After careful deliberation and debate, the OMA Board decided against redistribution
• The OMA will instead pursue an allocation-only relativity approach in Phase II: All new monies will be used to address “relativity”, and none will be allocated to the top 5 specialties (Ophthalmology, Gastroenterology, Diagnostic Radiology, Cardiology, Radiation Oncology
• Years 1 to 3 will be a series of one-time payments based on a physician’s billings in that year & the normative increase that specialty receives, adjusted using the CANDI (Comparison of Average Net Daily Income) score

• Year 4 (2020/21), permanent allocation of the cumulative compounded amount of 3.54%, using the hybrid CANDI-RAANI (Relativity Adjusted Annual Net Income) Relativity Score
• 2017/18 à normative increase 0.75% à rheumatology increase 0.8% (based on physician billings for that year)
• 2018/19 à normative increase 2.01% à rheumatology increase 2.1% (based on physician billings for that year)
• 2019/20 ànormative increase 2.52% à rheumatology increase 2.6% (based on physician billings for that year)

• It is not yet known when these payments will occur.
• In summary, we are getting retroactive payments for income generated in 2017-18, 2018-19 and 2019-20. Since the Rheumatology Section is underpaid compared to other Sections, our retroactive payments are slightly higher than average. For each $100,000 you billed in each of 2017-18, 2018-19 and 2019-20, here is the breakdown of lump sum payments:

4. APPROPRIATENESS WORKING GROUP (AWG)

• In his ruling, Kaplan wrote:” There is evidence that <4% Ontario’s family doctors are responsible for ordering nearly 40 % of tests considered to be low value, that is worth investigating.”
• Phase 1 Arbitration Board ordered an Appropriateness Working Group (AWG) which is a bilateral committee (comprised of the OMA & MOH) to tackle “appropriateness” to eliminate and restrict inappropriate or overused physician services by very specific deadlines without compromising patient access to medically necessary services:

• Identify $100M in changes by May 1, 2019 for the 2019/20 fiscal year
• Identify $360M in changes by September 30, 2019 for the 2020/21 fiscal year
• Fees CANNOT be set, changed or reduced to address appropriateness
• If parties cannot agree on whether a service is appropriate or the total value of the inappropriate services, the board of arbitration will decide.

5. ONTARIO APRIL 2019 BUDGET HIGHLIGHTS

• There is ongoing concern over the provincial debt level and current deficit. Ontario has the largest subnational debt in the world.
• The government expects a balanced budget by 2023-24.
• Six existing Provincial Health Agencies and 14 LHINs will be amalgamated into one agency: Ontario Health.

• There is $267 million in additional funding for home and community care.
• The government has committed to $17 billion over 10 years to modernize and increase capacity at hospitals.
• $394 million additional funding will be targeted to strategies to end hallway medicine.
• The government is rolling out a new dental program for low-income seniors.
• The changes to OHIP+ coverage for uninsured patients under 25 will generate annual savings of $250 million.
• The government has committed to 15,000 new long-term care beds over the next 5 years
• There will be an additional $3.8 billion over 10 years for mental health, addictions and housing supports.
• The government is interested in expanding the Scope of Practice for other health practitioners however, the details of this are still pending.

6. COURT OF APPEAL DECISION ON MAID (MEDICALLY ASSISTANCE IN DYING) REFERRALSThe Supreme Court of Canada in 2015 (Carter vs. Canada) ruled that it was legal to provide Medical Assistance in Dying (MAID).They directed that the process for MAID should be left to the provincial Colleges, and also recognized the need to balance a patient’s right to access health care with a physician’s right to freedom of conscience.

   After receiving input from multiple stakeholders, the CPSO implemented the current MAID policy, which included the requirement for an “effective referral.” Shortly after, several physicians and organizations (but NOT the OMA) instituted a constitutional challenge to the CPSO’s effective referral provision, citing unjustifiable infringement on the conscience and religious rights of physicians.

In January 2018, the Divisional Court ruled in favour of the CPSO. The court:

• AGREED that the CPSO policy infringes a physician’s right to freedom of religion (they simply felt the infringement was justified).
• Felt that if physicians were truly unhappy providing an effective referral, they could simply change their practice to insulate themselves from such a request.

The litigants (again, not the OMA) appealed this decision. The OMA did not take a position on the merits of the appeal but advised the court on: the difficulty of changing the scope of one’s practice; the fact that there are less restrictive methods to achieve the CPSO’s policy objectives; and the need for a complete freedom of conscience analysis.

In May, 2019, the Court of Appeal denied the appeal. The court affirmed that the CPSO policy justifiably infringed physicians’ right to freedom of religion. The court noted the compromise achieved by the CPSO policy is not optimal for patients or physicians but stated that it does strike a reasonable balance between patients’ interests and physicians’ Charter-protected rights. It is unclear whether the litigants will pursue this matter further.

For a legal summary of the decision click here.

For the OMA MAID resource page click here.

If patients wish to access information on MAID themselves, they can call 1-866-286-4023 for information on how to arrange a referral.

7. THE SUPREME COURT OF CANADA DENIES OMA’S APPEAL OF THE DECISION TO RELEASE THE NAMES OF THE TOP 100 OHIP-BILLING PHYSICIANS FROM 2008-2012

In April 11, 2019, The Supreme Court of Canada declined the OMA’s application to appeal the Ontario Court of Appeal’s decision to release physician names and billings due to Freedom of Information (FOI) requests. What that means is that the Toronto Star now has the names of the top 100 OHIP-billing physicians from 2008-2012 which opens the door to all physician billings being made public. The timing of when that information will be released is unclear.

• In 2014, the Toronto Star filed a Freedom of Information (FOI) request for the names and billing data of the top 100 OHIP billers from 2008-2012.
• The Star subsequently filed an FOI request for all physician billings and names; this second FOI request has been on hold, pending the April 11, 2019 outcome.
• The OMA learned on March 18 that the MOHLTC released data for an FOI request to a media source regarding specialty, gender, LHIN, total annual payments, days worked, daily breakdown of patients (anonymized), and fee codes for the top 100 billers from 2011 to 2017. The OMA does NOT know which media outlet filed this request.

8. RELATIVITY

The OMA’s Relativity Advisory Committee (RAC) established in 2018 is tasked to review the relativity model for Ontario doctors (ie. fee-based, income-based or hybrid models) and to propose an improved relativity model. The (RAC) will provide advice and ongoing input to the OMA Board, Council and the Negotiating Committee as to the most appropriate evidence-based approach to relativity. During the 2019 OMA Spring Council Meeting, the RAC provided a progress report and its next steps towards that mandate, which includes consultations with OMA Clinical Sections to obtain additional input into this process. Dr. Julie Kovacs and Dr. Philip Baer will meet with the RAC in August 2019.

We will continue representing the Section on Rheumatology 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