The Auditor General, The Minister of Health and The OMA

In the next week or so, there will be so much detailed analysis of the Auditor General’s Report on Physician Billing in Ontario that the small observation I am making here today here will be lost. As I reviewed the 57 pages, the details and references convinced me that the analysis had been seriously undertaken.

Some conclusions seemed quite inaccurate to me, e.g. “Our review of Ministry data noted that for the 2014/15 fiscal year, each physician in a Family Health Organization group worked an average of 3.4 days per week, and each Family Health Group physician worked an average of four days per week.” Most of my colleagues in these models work at least a five-day week.

Other conclusions really did reflect what I have heard from colleagues in all parts of the province, e.g. “A large number of the physicians who responded to our survey emphasized that patients’ demands are the driving force behind health-care costs. Many suggested that patient accountability is required to ensure that only necessary services or procedures are performed and costs are not duplicated.”

I want to focus, however, on one observation about the 14 recommendations, or specifically the Ministry’s response to them. Ten of the 14 recommendations require the Ministry to work with the Ontario Medical Association and, in each case, the Ministry confirms this. The recommendations are simple enough as statements but they are complex with respect to the knowledge and understanding of physicians’ practices that will be required to implement them.

Here is that common theme running through the Ministry’s responses:

“Adjustments to the capitation rate will require the Ministry to engage with the Ontario Medical Association (OMA) through the negotiations and consultation processes of the Ontario Medical Association Representation Rights and Joint Negotiation and Dispute Resolution Agreement (OMA Representation Rights Agreement).”

“Contract amendments, including minimum number of regular hours and consequences for not meeting contract requirements, will require the Ministry to engage with the OMA through the negotiations and consultation processes of the OMA Representation Rights Agreement.”

“Enabling these recommendations would require contract amendments and will require the Ministry to engage with the OMA through the negotiations and consultation processes of the OMA Representation Rights Agreement.”

The problem for the Minister of Health and Long-Term Care is that his preferred way of “engaging” with the Ontario Medical Association and Ontario physicians for the past two years has been through unilateral imposition of cuts and contract amendments. With Bill 41 as the last straw, doctors collectively and the OMA are informing the Minister and the public that working without a contract and being dictated to by legislation do not further a productive relationship.

So the Minister has a problem. By the Ministry’s own admission, 10 of the 14 recommendations in the Auditor General’s Report on Physician Billing will require him to work with his physician partners and the OMA. Over the years, only the Ontario Medical Association has provided realistic ideas about how to implement government recommendations. This is well illustrated in the various examples of real practice situations outlined in the Auditor General’s report. Developing payment models and incentives that improve access for patients is necessary for the health care system to work properly. These models of care promote both a healthy population and a stable, fairly remunerated physician workforce.

Ministers pay attention to the Auditor General’s Reports. I hope the Minister of Health and Long Term Care keeps this report in mind and that he reaches out to the OMA. I hope he does, but I’m not optimistic.

4 thoughts on “The Auditor General, The Minister of Health and The OMA

  1. I believe the auditor generals report is quite accurate. It may be that you colleagues are working 5 days a week but many family doctors in FHO arrangements are working a lot less. A colleague in the office next to me has the roughly the same number of patients as me and worked 10 days in November and will work 11 in December. Sees less pts per hour than I do as well. So this doctor makes same amount of money as I do but puts in a fraction of patient visits. In our large family health team it is quite common for docs to work 3 days a week many of those days being from 9 am to 2 or 3 pm. The problem with the FHO agreement is that the incentives to see pts are so low as to be non-existent. We get 10 percent of the OHIP fee schedule to see a patient for a visit. It should be something like half the capitation fees that we now get and 50 percent of the schedule fee to see the patient. FHG docs have to actually see patients to get paid so it makes sense that they spend more time seeing patients.

  2. Thank you for the wonderful in site you have on the importance of service and health care. I had the upper hand with my daughter. Although I was left alone to care I knew what was needed to make it work.Our lives would have been very different if Health care recognized that stress causes a delay in healing.Many doctors are frustrated because they know and understand the importance of eliminating stress for better care. Too many are sent away and told that they need to care better for themselves but Doctors know once they leave the room it is highly unlikely if they are left alone to care. There is only one way for that to happen. New regulations that require both parents to stay involved in care for their child regardless of age. Many parents are left to care alone. Home monitoring for mental illness patience that do not remember or understand the importance of their medications. Famsac and other food donations are great however a better diet for many is required. Although there is a small addition for diet allowance it does not come close to covering costs for special diets. Food vouchers are a much better way to control cost and bring in the food your loved one will eat. Transportation is another service that needs a serious look at. Many wait too long in the cold and are very ill or seniors with risk of wondering.. You must call Para Transpo early morning the day ahead or chances are you will be forced to cancel your appointment. So many services that could have made a difference but I was forced to figure out all the glitches myself. Services are a definite requirement for better care. Most importantly guidance and help to ensure all services they qualify for are in place before leaving a hospital. I speak out for those who cannot. A great and informative post. One more small request. Nurses and paramedics play a huge role in a caregiver and loved ones life and should never be left short staff. They know what is needed and I offer you all of what I gave them to help. Determined for better change Cathy. Open minded and willing to understand

  3. Another great post Dr. Beck. When I was reading the AG’s report I, too, felt that there were inaccuracies and that the report had a superficial quality to it as it did not accurately capture the important work Ontario’s Doctors do.

    I would ask that the OMA create a specific task force dedicated to correcting the inaccuracies in this report and providing realistic solutions that clarify the report. We know that Bill 41 was created from the 2015 Auditor General’s report where she identified the CCAC waste and mismanagement and we know that the MOHLTC has stated that they will make amendments to primary care contracts based on this year’s report. Who knows what Bill will be created from this report.

    A dedicated team of engaged Ontario physicians correcting the weaknesses in the AG’s report is needed to serve patients best.

    • Thanks, Del. Please call me Gail. There are inaccuracies, but the AG’s office put a lot of time into this report. The glaring inaccuracies are around the number of days worked per week – the report cites 3.5 – 4 days per week average for many Physician Enrolled Models – that’s leaving out unbillable hours and call, I believe.

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