Community-Based Specialty Clinics

1. Community-Based Specialty Clinics Ministry of Health and Long-Term Care Presentation to IDCA September 20th, 2013 Presented by Pearl Ing, Director

2. Why Community-Based Specialty Clinics? “We will shift more procedures out of hospital and into non-profit community-based clinics if it will mean offering patients faster access to high-quality care at less cost.” – MOHLTC Action Plan for Health Care, 2012 • Ontario’s Action Plan for Health Care has three pillars: • Keeping Ontario Healthy • Faster Access to Stronger Primary Care • Providing the Right Care, Right Time, Right Place • Specialty Clinics will help patients receive timely access to care and improve patient experience. • This Fall, the Ministry is planning to proceed with a phased strategy to establish Specialty Clinics, starting with low-risk cataracts. • Cataract Specialty Clinics are supported by evidence, including: • Advice from Ontario’s Vision Strategy Task Force, a clinical expert panel group • The Ministry’s Quality-Based Procedures Clinical Handbook for Cataract Surgery • Experience funding cataracts/low-risk vision procedures in community-based settings • Over the course of 2013 and 2014, we are planning calls for proposals for other routine procedures, including colonoscopies. CONFIDENTIAL

3. What are Community-Based Specialty Clinics? • Specialty Clinics will be non-profit clinics offering select low-risk procedures. • A range of low-risk procedures are being considered, including cataract and other vision care procedures, colonoscopies, MRIs, minor orthopaedics, and dialysis. • Eligible Specialty Clinics may operate as either: • A non-profit Independent Health Facility (IHF) licensed under the Independent Health Facilities Act (IHFA); or • A public hospital-based ambulatory care centre that operates under the Public Hospitals Act (PHA) • Existing hospital and IHF legislation will ensure oversight, quality and accountability. • Applicants will be expected to meet price, service volume, and quality requirements, while improving access, and patient experience. • Detailed requirements and criteria will be included with the applications process. CONFIDENTIAL

4. Health System Funding Reform Specialty Clinics are aligned with Ontario’s Health System Funding Reform (HSFR) • HSFR is changing the way services are funded in Ontario. Ontario is introducing a patient-based funding model where ‘money follows the patient’ using Quality-based Procedures (QBPs). • Community-Based Specialty Clinics will be funded using QBPs. • QBP pricing sets standard and consistent prices for procedures based on best practices, evidence, and defined clinical pathways. • QBPs are reimbursed on a ‘price X volume’ basis. • The Ministry has developed a QBP for cataract procedures, and is working with Cancer Care Ontario on a QBP for GI Endoscopy (colonoscopies). This will support the shift of cataract and colonoscopy procedures to Specialty Clinics. CONFIDENTIAL

5. Funding Specialty Clinics • There is no new funding for Specialty Clinics. Funding will be re-allocated from the hospital where volumes of procedures are transferred out to Specialty Clinics. • Physicians working in Specialty Clinics will continue to bill OHIP for professional fees, as per current practice. • QBP prices will cover the direct costs, such as nursing care and medical supplies, and may also cover indirect costs, such as housekeeping and utility costs, associated with performing a procedure.   • For more information on Health System Funding Reform and Quality-based Procedures, please visit: http://health.gov.on.ca/en/pro/programs/ecfa/funding/hs_funding.aspx CONFIDENTIAL

6. Relationship with the Broader Health Community Shifting services from an acute hospital to another setting requires the support and readiness of health providers in the local community. • Successful Specialty Clinic applicants will need to demonstrate the support of their LHIN for the proposal. • They will be required to have a formal agreement with the hospital(s) shifting out procedures, that considers support for procedures that remain in hospital (e.g. more complex cases, emergency room coverage). • Applicants must work with LHINs to consider broader system integration to ensure continuity of patient care. CONFIDENTIAL

7. Proposed LHSIA/IHFA Regulatory Changes • Regulation changes are being proposed to support the strategy to shift low-risk procedures out of hospitals and into the community. • Changes will allow overhead costs to be paid by LHINs or Cancer Care Ontario for services such as colonoscopies performed in a licensed IHF: • Changes to the SOB under Reg. 552 made under the Health Insurance Act (HIA) • Proposed changes allowing facility fees to be payable in respect of colonoscopy services may be effective January 1, 2014. • A new regulation made under the Independent Health Facilities Act (IHFA) • Proposed regulation prescribing CCO as an entity that can pay facility fees may be in place by November 2013. • Proposed regulation changes have been posted online for public comment until October 11, 2013 and can be found at: http://www.ontariocanada.com/registry/ CONFIDENTIAL

8. Questions? CONFIDENTIAL