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Today’s News | a summary prepared by . . .

Kimberly Hutchings
Summer
Student, Public Affairs & Member Communications, Ontario Hospital Association

Privacy Breach is a Warning for all Ontario Hospitals | Toronto Star

At the very least, the massive privacy breach at a Scarborough hospital is a pain for affected patients. But it’s also a cautionary tale for all Ontario’s medical institutions.

RELATED STORIES

Rouge Valley Health System called…

And while the Rouge Valley Centenary hospital claims that it is now tracking employee access to patient records, the incident raises two significant questions:

Why weren’t police called months earlier — instead of waiting until the Toronto Star’s Joel Eastwood broke the story? And just how vulnerable are other hospitals to similar abuse?

Indeed, Ontario’s Privacy Commissioner Ann Cavoukian is broadening her investigation into the privacy breach after a patient from St. Michael’s Hospital in Toronto contacted authorities this week, after reading the Star’s account.

As Eastwood first reported, two employees of Rouge Valley Centenary have been dismissed for selling personal information that belonged to thousands of new mothers who gave birth at the hospital.

While it’s unclear whether the employees were working together, it seems they supplemented their income by selling the names, addresses and telephone numbers of as many as 8,300 patients. Most were women who delivered their babies between 2009 and 2013.

Those patients were later contacted by a salesperson who pitched a Registered Education Savings Plan. After reading the Star story this week, a St. Mike’s patient contacted the hospital to say that she, too, had been approached by a private RESP seller. The hospital says it has launched its own investigation.

What the news of this galling breach makes clear is that patient information has a monetary value, and without proper safeguards privacy will remain at risk.

Hospitals across Ontario should take heed and create safeguards, including those recommended by Cavoukian, to ensure that the same activity doesn’t happen under their watch.

Patient privacy rights must be taken seriously. After Rouge Valley’s first breach was discovered last October, with the second in March, the hospital did make some improvements by creating a record of employees who accessed private patient scheduling information.

Hospital officials did call the privacy commissioner and the Ontario Securities Commission. Fair enough. But no one called police until Wednesday.

Since there is obviously money to be made by selling personal information, hospitals must send a message that such activity won’t be tolerated. Whether or not charges can be laid, police should have been called earlier. It’s in the public interest.

Hopefully, stricter limits around access to patient information will provide a simple and effective solution, but for the new moms at Rouge Valley it’s already too late. The broadening investigation should serve as a warning that all hospitals are at risk.

Beware of Hospital ‘Discharge Planners’

Toronto Star – Published June 5th 2014 (Carol Goar)

Navigating Ontario’s long-term care system takes the mental acuity of a chess player, the tenacity of a sumo wrestler and the resourcefulness of a backcountry guide. It also helps to have a working knowledge of the law, medicine and pharmacology.

Most seniors and their caregivers have none of these attributes. They stumble along, get bad advice, spend too much money and fall into traps that no one told them about.

The Advocacy Centre for the Elderly (ACE), a legal aid clinic for seniors, does its best to steer people through the maze but it can barely keep pace with the number of calls coming in. It welcomes opportunities to speak to groups of older Canadians before they reach the crisis point.

These information sessions are usually small and seldom advertised. But this week, Canadian Pensioners Concerned, a voluntary organization of socially conscious seniors, opened up its meeting to outsiders. The topic was “The Law of Admission to Long-term Care — What You Need to Know.” The speaker was Jane Meadus, a staff lawyer at ACE who knows the system, knows the pitfalls and knows how innocently trusting most Ontarians are.

She began with a warning: public officials — especially hospital discharge planners — don’t always tell the truth. Their motive is to get so-called “bed blockers” out the door. They push people into costly and ill-informed decisions. They invent rules and set deadlines that have no basis in law. They take advantage of families in crisis. “I’ve seen (hospital) vice-presidents come to rooms to yell at people,” Meadus said. “The pressure that is put on families is really, really horrendous.”

·         To strengthen seniors’ defences, she did some myth-busting:

·         A hospital cannot charge a patient who is waiting for a nursing home vacancy its “uninsured rate” of $1,500 to $1,700 a day, as some threaten to do. There is only one circumstance under which a hospital can recoup the full cost of a bed; it occurs when a patient applies to a long-term care facility, gets a placement and turns it down.

·         A hospital cannot tell a patient which — or how many — of Ontario’s 630 nursing homes to apply to. They frequently try to push people into picking a facility with a short waiting list and reject high-demand selections. They have no authority to do this; every Ontarian is legally entitled to choose as many as five facilities (or as few as one) anywhere in the province. Individuals can set their own priorities: religion, language, reputation, proximity to family and friends.

·         A hospital cannot force a family to care for a patient at home. Nor does it have the authority to promise round-the-clock home care. Only the region’s Community Care Access Centre can do that and very few offer 24/7 home care.

·         A hospital cannot coerce a patient to move to a retirement home . These private facilities typically cost $5,000 to $6,000 a month. They provide a lower level of care than government-funded nursing homes.

Having said all this, Meadus did not advise listeners to stay in hospitals any longer than necessary. Nurses seldom have time to feed or bathe elderly patients, she explained. There are no activities or opportunities to socialize. The longer they stay, the higher the risk of a hospital-borne infection. Her counsel: get on the waiting list for long-term care as soon as the doctor says it is safe to go.

Meadus receives roughly 300 inquiries a year on this issue. Most callers assume hospital workers are telling them the truth. Some cash in their RRSPs and remortgage their homes. Others quit work to become full-time caregivers. “We should require more of our hospitals,” she said grimly.

Her audience was taken aback — in a few cases overwhelmed — by her presentation. “It’s a lot of information to take in,” Meadus acknowledged. “I realize that.” The host of the meeting deftly stepped in, promising the group a written record of her presentation.

Shaken as they were, the pensioners in the room were the lucky ones. Most seniors are still in the dark. Many are isolated. Some are physically and cognitively impaired. Who looks out for them?

As the meeting wrapped up, a bigger question hung in the air: why does the government make it so hard?

Queen’s Park

All 3 Parties Have Some Positivies; Here’s a Smart Guide to Help You On Election Day

Hamilton Spectator – Published June 9th 2014
Page: A15 | Section: Opinion

The June 12 election campaign has been dominated by negativity and mobility – the Tories lurching right, the Liberals shifting left and the New Democrats going in circles. Voters who find themselves in the broad centre of Ontario politics may be feeling confused, if not neglected. Who speaks for you?

Progressive Conservative Leader Tim Hudak wants to streamline the way skilled tradespeople are trained. Union leaders oppose the reforms, but the ratios of journeymen to apprentices are skewed in Ontario compared to most other provinces.

When the Liberals created a new College of Trades, it required a lopsided ratio of five journeymen bricklayers for every apprentice, compared to 1:1 elsewhere. In other trades it’s 4:1. Hudak wants to right those ratios by putting them on a par with the rest of Canada.

Common sense so far. But Hudak oversells his plan by claiming that the mere training of more apprentices will automatically create 200,000 new jobs for them. Increased training won’t resolve our jobs shortage, but it could help reduce our skills shortage.

Liberal Leader Kathleen Wynne proposed a new Ontario Retirement Pension Plan in the spring budget that the NDP rejected. Wynne seized the initiative after Ottawa rejected a request from the provinces to enhance the outdated Canada Pension Plan. Ontario’s proposal would mirror the CPP, providing a modest, fully funded pension supplement to those without a similar workplace plan.

The plan has won backing from actuarial experts, economists, major unions and anyone who worries about how the next generation will plan for retirement in an era of precarious employment and disappearing pensions (replaced by glorified savings plans known as “defined contribution” schemes). The Tories, NDP and small business oppose it, opting for passivity over activism. Managed independently of government, the plan would offer best value to future pensioners, at the lowest fees.

The NDP’s Andrea Horwath wants to raise corporate taxes by one percentage point. This makes good sense in light of Ontario’s record low rates (cut by Dalton McGuinty’s Liberals), and given former Bank of Canada Mark Carney’s complaints that corporate Canada is sitting on a $500-billion stash of dead cash. It still won’t go very far – raising about $700 million annually for a province that takes in about $120 billion a year.

Had Horwath played her cards right, she might have persuaded the Liberals to go along with a corporate tax hike in budget negotiations. Instead, she plunged the province into an election that may yet make Hudak premier – with his plan to lower the existing tax rate from 11.5 per cent to a dumbfounding (and just plain dumb) 8 per cent, making it North America’s lowest. For those who care about cutting our $12.5-billion deficit (corporations keep raising their hands, but count me in, too), raising the business tax rate seems only prudent.

But having raised that extra $700 million in corporate revenue, the NDP platform would give it all away – and more – with pointlessly populist tax cuts: nearly $300 million in a small business tax cut, more than $800 million from taking the HST off hydro bills (only the provincial portion), and $250 million for a new Caregiver Tax Credit (for people who would have looked after loved ones anyway).

There are other good ideas from all three parties that rate honourable mentions: The Liberals would cap or cut unfairly high hospital parking fees. They would also raise wages for poorly paid child-care and home-care workers, while indexing the minimum wage. The PCs would upload the TTC’s rail links to Metrolinx (fee to be determined). New Democrats would cap CEO salaries at twice the rate of the premier, and reunite the old Ontario Hydro that the Tories broke up into OPG and Hydro One.

And here’s some they all forgot – or more precisely, are too scared to touch: A pharmacare program to ensure everyone gets the medicine they need, not just those who have workplace drug plans or welfare. An updated sex-education curriculum so that our children can hear it from teachers before they see it online. And, oh yes, a little tweak to our alcohol laws allowing all licensed retailers to sell beer, not just those three massive foreign-owned multinationals who control the privately-run Beer Store’s de facto monopoly.

Martin Regg Cohn writes on provincial affairs.

Ontario is Deeply in Debt; The Liberal Record on Energy, Health Care and Education

Hamilton Spectator – Published June 9th 2014

Page: A15 | Section: Opinion

In a Comment page article May 23, Bryan Kerman compared apples to oranges in comparing Canadian provincial politics to American state politics.

Let us look at the facts and forget about the past and the Mike Harris era. Now Ontario is a province deeply in debt and sitting on a poor credit rating and lavishly spending taxpayers’ money.

In simple numbers, after 10 years of Liberal government, Ontario has a provincial debt that has doubled from $150 billion to $300 billion. Ontario has increased yearly spending from $65 billion to $130 billion. Ontario is running a $10 billion-plus deficit each year.

Where have all the jobs gone? Where has all the money gone? The size of provincial government has increased dramatically, along with the total provincial debt and yearly deficit.

Government mismanagement is the reason. There is plenty of opportunity to allow 100,000 government employees to be released by attrition over the next four to eight years. This means the well-paid remaining government employees will have to work more efficiently just like the private sector.

Energy:

Energy is not a luxury, it’s a necessity. Ontario’s population cannot cut back on energy usage to heat their homes, run their appliances or turn on the lights when it is dark. Steel mills or any manufacturing company cannot run a business on expensive electric power and try to compete internationally. The Ontario Liberals signed an untendered $19-billion electrical energy contract for 25 years with Samsung without a cost-benefit analysis.

The excess electricity Ontario generates, it sells to Quebec at a loss, which resells it to the Northern New York power grid for a profit. A billion dollars-plus, wasted on cancelling two natural gas plants for political reasons. This is not responsible management of taxpayers’ money. This is a blatant example of misguided ideology, needlessly saving the planet on the taxpayers’ dime!

A billion dollars has been spent on smart meters, yet Ontario’s electricity rates are at 15 cents per kilowatt hour in Burlington and Hamilton. Before Dalton McGuinty took Ontario’s rudder, electricity was four cents per kilowatt hour.

Currently there are 1,000 wind turbines in Ontario and another 5,000 planned and they will be forced upon municipalities by the Liberal government. Why did the Liberal government spend billions on the new tunnel at Niagara Falls to get inexpensive hydro electricity and still go ahead with very expensive wind turbines?

Why did the government plow ahead with a solar panel installation in southern Ontario? They promised it would provide 300 jobs, yet when finished it provided only three jobs and they are low-paying security guard positions.

Health care:

Billions of dollars have been spent on an unfinished computerized eHealth database and taxpayers are still not reaping the benefits. Money has been wasted on the Ornge helicopter mess, an arms-length, government company that only benefitted its directors.

Privatization:

At one LCBO location, a union leader justifiably pointed out there are eight employees and 11 managers. This is insulting to taxpayers.

Religious Schools:
Kerman appeared to be intentionally regurgitating the religious school issue by alluding to a hidden Conservative “agenda,” saying at least one lobbyist is running under the Conservative banner in the provincial election, thus rekindling fear in the voters. Who is this lobbyist? Name him or her.

Ontario is in deep, deep financial trouble. Kathleen Wynne’s government needs to be replaced. When you vote on Thursday consider jobs, jobs.

Ron Cirotto, BASc., P.Eng., lives in Burlington.

PCs Tout Health Care Platform

Brant News – Published June 8th 2014

The Progressive Conservatives want to enhance health care services in the province, not cut them. If elected on June 12, PC candidate Phil Gillies said it would be the bureaucracy of the health care system that would be facing cuts. “We want to strengthen frontline services with the money that will be saved,” Gillies said. “But we definitely have a problem with the (Local Health Integrations Networks).” With Brantford General Hospital visible behind them, Gillies and PC health critic Christine Elliott met with reporters on Friday to discuss the party’s health care priorities. Elliott, who is also the party’s deputy leader, is the incumbent candidate in Whitby-Oshawa and has been handling the health care portfolio for the party for five years. She said some of the money saved by trimming the LHINs and Community Care Access Centres would be reinvested in nurses and other frontline staff. “We want to strengthen the role of nurses in our health care system to be able to practice to their full scope,” Elliott said. “But we also need more nurses. If we are going to have more people staying in their homes longer, it stands to reason we need more nurses.”

The PC candidates also said that nurses will play a role in eliminating wait times at a 24-hour clinic that is a need in Brantford. “We need one that is available to everybody,” Gillies said. “That would help take the pressure of the emergency units at both the BGH and the Willett in Paris.” To find the money for health care investments, Gillies said that the LHINs would be on the chopping block. Created in 2007, the 14 LHINs in Ontario serve as hubs to co-ordinate health care funding distribution for hospitals, long-term care facilities, community care access centres, community support service agencies, mental health and addiction agencies and community health centres. The LHIN serving Brantford is the Hamilton-Niagara-Haldimand-Brant LHIN. “I don’t think we can justify having 19 people working away at the LHIN office, pushing paper around, while our people at the BGH or the Willett are having to wait seven, eight or nine hours in emergency,” Gillies said. “We want the people in emergency to be seen quickly and efficiently by the nurses, doctors and nurse practitioners that they need – and we want fewer, harder-working bureaucrats to make that happen.” Elliott said that – overall – the PC plan is to turn Ontario’s health care system toward being more proactive than reactive. That would include investments in home care, chronic disease management and mental health services. Gillies said that includes a detox and rehabilitation centre that his opponent, Liberal candidate Dave Levac, has been working on securing for the Brant riding for some time. “That is one area Mr. Levac and I agree on,” Gillies said. “A detox centre is something this community needs.” In a phone interview, Levac said he thinks the plan to do away with the LHINs is “absolutely backward.” “The local LHIN has done a fantastic job here,” he said. “The detox centre is a perfect example of that. It was the LHIN that was responsive to our needs and provided the funds that will be used for it.” Levac said the PC plan to dismantle LHINs and push the work that they do back into hospitals would be a mistake. “We need to de-centralize hospitals and allow them to deliver health care,” he said. “(Closing the LHINs) would recreate the same monster we just brought to heel.” Levac also criticized Gillies and NDP candidate Alex Felsky for calling for a 24-hour walk-in clinic in Brantford. “Are they automatically going to force doctors to be on call?” Levac said. “Clinics are a business that are run in the community. We need to have supports in place to entice doctors to run that practice. “I haven’t seen any details from someone about how they intend to make those doctors perform.” Felsky, who has been promoting a petition for a 24-hour walk-in clinic in Brantford since April, said her party’s platform has committed to create 50 new 24-hour Family Health Clinics in the province. She said Brantford would be the location for one of them. NDP leader Andrew Horwath has said the new clinics would cost $205 million per year for the first two years, rising to a cost of $215,000. But the NDP platform says the new clinics would serve about 5,000 people each that don’t have access to primary care, thus giving people an alternative to the emergency room for non-critical after-hours medical care. Felsky, Gillies and Levac are also challenged by Green Party candidate Ken Burns, independent John Turmel, Libertarian candidate Rob Ferguson and Freedom Party candidate Brittni Mitchell.

Health Care, the Forgotten Issue In Ontario’s Election. The Canadian Press (Therese Boyle)

Too many Ontarians cannot get appointments with their family doctors on short notice. Too many go to ERs even though they don’t need emergency treatment. And too many fall through the cracks when multiple health-care providers are involved in their care.

It’s widely accepted that Ontario taxpayers should be getting much more value for all the money they spend on health care, an amount that last year totalled $51 billion or 42 per cent of the entire provincial budget.

The three major political parties each claim to have the answers. Progressive Conservatives are proposing the most drastic solution, with major structural reorganization. The Liberals have put a strong focus on improving access. And the New Democrats’ platform emphasizes reducing wait times.

But substantive debate on their plans has been scant during the election campaign, not really unusual even though health is always at the top of the list of voter concerns. What little discussion there has been has largely been focused on the eHealth and ORNGE scandals.

The health system is convoluted and full of acronyms that are meaningless to most. It’s difficult for politicians to engage voters on important nuances. And some ideas on how to fix the system are so explosive, politicians are wary of discussing them, especially during an election.

So the Star has turned to a dozen high-level players, leaders and advocates in the system to get their takes on what’s behind the problems and what it will take to fix them. Many agreed to speak only on background.

Among the biggest stumbling blocks, they agree, are a struggling primary care system, lack of accountability, and systemic fragmentation.

THE NUMBER of visits to Ontario hospital emergency departments has jumped by 14 per cent over eight years, according to an internal study by the Institute for Clinical Evaluative Sciences (ICES), the results of which have never before been made public.

After population growth is taken into account, the rise in ER volumes is 5.5 per cent.

There were 391.5 visits per 1,000 residents in 2011-12 compared to 371 in 2004-05, with the biggest increase seen over the last three years of the study. (The H1N1 outbreak is likely related to the jump in 2009/10.)

The overall increase has left policy-makers scratching their heads given that so many reforms have been aimed at taking pressure off hospitals.

A prevailing theory is that it is a reflection of the difficulty patients have in accessing primary care. When patients have easy access to family doctors and other primary care providers like nurse practitioners, they are less likely to visit ERs.

“There are still questions about access to alternatives” to ERs, says the institute’s president, Dr. Michael Schull. “There is still a disconnect between primary care and some parts of the health system. But at this stage we are not sure what is driving the increases.”

A REPORT released earlier this year by the now-defunct Health Council of Canada shows only 42 per cent Ontarians can get a same-day or next-day appointment with a family doctor.

Ontario’s health system ranked last in comparison with 11 developed countries in providing quick primary care appointments, according to the Health Council report and the Commonwealth Fund Health Policy Survey.

The studies reveal 58 per cent of Ontarians have difficulty getting care on weekends and evenings without having to go to an ER. Only four countries rank worse.

Roger Martin, former dean of the University of Toronto’s Rotman School of Management, says Ontario’s primary care system also lags behind that of international peers on wait times, delivery of chronic care, use of IT and provision of team-based care.

Inaccessible primary care leads to higher health costs, warns Martin, who recently released a report on what Ontario can do to improve the health system.

TO BE FAIR, the Liberal government has made some headway in improving primary care. More than two million more Ontarians have a family doctor today compared with a decade ago.

The government has made a big push to change the way Ontario’s 9,500 family doctors are paid. Traditionally, they were paid a fee for each service they provided, billing OHIP for every patient visit. The problem with the fee-for-service model is that it gives doctors incentive to see lots of patients and not spend much time with them.

Today, 40 per cent of family physicians receive much of their income through a capitation model of payment that gives them a lump sum for each patient enrolled in their practices.

Many of these doctors work in teams with other family physicians and health professionals, including nurse practitioners, registered nurses, dieticians and social workers.

But critics say too many doctors are still paid fee-for-service. And too many continue to work in solo practices.

Primary care reform needs to accelerate and more family physicians need to move into multidisciplinary teams to better treat an aging population, Martin says. The health system needs to change from one that focuses on acute care — serious illness that lands people in hospital — to one that focuses on chronic care, for conditions such as diabetes, heart disease and dementia, he says.

Reforms implemented so far have been costly. In 2010, family doctors received $3.7 billion, 32 per cent more than four years earlier.

But despite hopes that changed practices would go along with the extra money, the big payouts did not have as much effect as desired, such as a reduction in ER usage. A 2012 ICES study shows patients in the new primary care team models still visit ERs too much.

“Emergency volumes are going up because the primary care system is still not well enough organized and primary care providers are not accountable for having extended hours to keep people from wanting to go to the emergency department,” charges Tom Closson, former president of the Ontario Hospital Association.

If doctors were financially penalized when their patients unnecessarily use ERs, they would have incentive to improve access, he says.

MAKING PRIMARY CARE doctors more accountable means attaching more strings to payments.

Terrence Sullivan, a professor in the Dalla Lana School of Public Health at the University of Toronto and former president of Cancer Care Ontario, is calling for wholesale change in the way doctors are paid.

It’s a bold statement and one you are not likely to hear on the campaign trail from politicians loath to take on doctors at the best of times.

Sullivan says the province should change the way it bargains with doctors and move further away from fee-for-service. Payments should be tied to quality objectives whether doctors work in primary care, hospitals or long-term care, he says.

“If physicians order procedures that are not wise … does anyone come back to them and say, ‘Why are we doing this? There is no evidence that supports this.’ In some cases, they just do procedures to make money,” he charges.

ONTARIO’S HEALTH system is notoriously fragmented with silos that include hospitals, home and community care, long-term care, primary care, specialist care and public health.

When patients move from one sector to another, the handover is often sloppy. Family doctors don’t know their patients were in an ER. Home-care agencies don’t get word that recovering patients need visits from nurses. Referrals get lost. Tests are unnecessarily repeated.

The PCs’ solution is to gut Ontario’s local health integration networks, which they criticize for failing in their mandate to plan and integrate services within the boundaries of 14 geographic regions of the province.

The Tories also want to scrap the province’s 14 community care access centres, which are tasked with co-ordinating home and community care and authorizing admission to long-term-care homes.

LHINs and CCACs are bloated bureaucracies, the party charges. It wants to replace them with 30 to 40 “health hubs,” which would be linked to regional hospitals and co-ordinate and deliver all aspects of patient care.

There is much agreement in the upper echelons of the system that fundamental restructuring is necessary to reduce fragmentation.

“No government that is serious about improving health care is going to be able to avoid the fact that what we need to do now is structurally redesign our health-care system,” says one high-ranking health official.

He says LHINs should be scrapped or given more teeth to properly do their job. They were created in 2005 as a way to organize health care regionally, an impossible task given that they only have jurisdiction over parts of it, he says.

LHINs have authority over CCACs, hospitals, long-term care, community services, mental health agencies and some parts of primary care.

But they do not have authority over most doctors and public health.

On paper, hospitals are under the purview of LHINs, but in reality hospitals often big-foot the networks. That’s because they have bigger budgets, larger workforces, powerful CEOs and more clout on boards of directors.

THE JOB OF LHINs is made even more difficult because there are, in fact, more than 2,000 boards of directors for organizations that deliver health care in the province, making lines of accountability fuzzy and intensifying competition for resources.

“This makes the system extremely complicated for patients to understand and the resulting fragmentation negatively impacts the care that patients receive,” says Closson, who believes there should be more consolidation and fewer boards.

But the allegiance of communities tends to be to local institutions and boards, particularly hospital boards, explains health policy consultant Steven Lewis.

“The LHINs are always playing bad cop and every time they try to do something that makes good sense like rationalizing the system or consolidating services, all hell breaks loose,” he says, citing a 2008-09 uproar in the Niagara area, when the local LHIN decided to overhaul hospital services and close two ERs.

But it’s precisely for this reason that advocates like the Ontario Health Coalition are wary of regionalization. It argues that regional bodies like LHINs allow politicians to distance themselves from controversial decisions. And consolidation with fewer boards reduces avenues for community input.

The coalition is upset over the PCs’ plans to regionalize the health system through the creation of health hubs, arguing it would lead to the amalgamation of 146 hospitals into 30 or 40.

If the Conservatives get elected, get ready for “merger mania,” says the coalition, warning that the system “would be in upheaval for years to come.”

Ontarians have little idea of what would happen to health care under a Conservative government, the coalition says. The Tories would privatize hospital surgeries, diagnostic tests and other health-care services, the coalition contends, based on its reading of promises to increase competition and expand the role of specialty clinics.

MEANWHILE, some senior officials think LHINs should be replaced with a regional system of seven or eight geographically located “accountable care organizations,” similar to the much heralded Kaiser Permanente model in the United States.

Such organizations are structured to cut through silos by taking full responsibility for patients — from primary to acute care. They place an emphasis on disease prevention and try to keep patients out of hospital.

“You look after the entire span of the care continuum and if you think the money is better spent on obesity management rather than building a new wing, you can make that decision,” explains one official.

CCACs HAVE COME under fire for adding another layer of bureaucracy between the patient and front-line health-care provider. To explain the problem, health policy analyst Dr. Michael Rachlis describes what it takes for a frail senior to get home-care support from a personal support worker:

“Before somebody can get a bath, the money has to go from the Ministry of Health to the LHIN, then it has to go from the LHIN to the CCAC.”

The CCAC then spends a big chuck of its budget getting home and community-care companies to bid on contracts to provide front-line services, Rachlis continues. Those companies, in turn, hire employees like personal support workers on contract.

“There are four levels of contracts before a patient gets a bath,” Rachlis exclaims. “That’s a problem.

“The policy people here think that for whatever reason you cannot have the purchaser providing services.”

But some insiders — including government policy people — concede Rachlis may have a point. Still, they say instead of nixing CCACs, the organizations should be allowed to hire employees like (personal support workers) rather than contract out work.

TO WHAT EXTENT the health system can be restructured after the election will depend on whether there is a minority or majority government.

“If you do change the status quo, you are going to have to gore some oxen,” says Lewis, explaining that he doubts a minority government will want to create a big wedge issue in health care and precipitate another election.

“If you are a minority government, what hills do you want to die on? I don’t think you want to die on the hill of whether or not you have LHINs.”

Whatever the outcome on June 12, the system needs to be organized more around patients than providers, says Closson, adding that the province needs to improve its rankings on international comparisons.

The first order of business for the next health minister should be primary care reform, Lewis says.

“If we get that right, if we have really good primary care that really focuses on chronic disease management and aging and frailty, you are going to get dividends down the road in terms of reduced demand on more expensive services, even if the rest of the system still looks a bit chaotic.

“If we get that right, I am not sure the rest matters so much.”

This entry was posted on Monday, June 9th, 2014 at 10:22 am and is filed under Publisher's Page.