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Ontario’s doctors will make less money so that more of them can be employed, under the terms of a tentative agreement between the Ontario Medical Association and the province.
The deal took most OMA members by surprise when the government and the association announced it Monday morning. The bargainers hope physicians vote for it in a referendum at the end of July, and put an end to well over a year of increasingly quarrelsome negotiations between a government that wanted to cap doctors’ billings and doctors who wanted the government to pay for patients’ increasing demands for service.
Doctors’ pay is a giant line-item in the provincial budget: about 10 per cent of all the Ontario government’s operating spending.
The exact terms of the agreement are kept from the public till after the OMA members vote, as is customary in labour negotiations — which this isn’t, precisely, but close enough. But there are a lot of doctors. I got a copy of the OMA president’s communication to her members from someone who doesn’t like the deal or the way it was negotiated.
The highest of the highlights:
They’ve agreed to set the budget for doctors’ billings at $11.584 billion, which is where they were in 2015-16. That baseline will increase 2.5 per cent a year for four years, “to reflect population growth and aging, and increasing physician supply.”
But not, that means, increases to individual doctors’ pay to cope with inflation. Individual docs who continue to do the same amount of work will continue to make the same amount of money, effectively a pay cut after inflation is worked in.
There’s some jiggery-pokery with the numbers within that $11.584 billion to make it all work out. By the end of the four-year agreement, the two sides have agreed to a $200-million reduction in what the government pays out under public health insurance. That’s a permanent cut in doctors’ billings, reflecting the government’s longstanding contention that some of them are overpaid for procedures that are a lot easier and quicker to carry out now than they used to be.
Which procedures’ prices will be cut is to be negotiated, but probably we’re talking ophthalmology, pain management and drug treatment to start with.
At the same time, the government will make four years of “one-time payments” to doctors, totalling $370 million by the end of the agreement. So that’s $200 million in annual, permanent savings, offset for now by one-time payments. What happens at the end of four years when the annual savings remain and the one-time payments have run out? They’ll argue about it then. Under the terms of this agreement, though, there’ll be a net cut to doctors’ fees as they stand today.
Note that the agreement takes its baseline from spending on doctors in 2015-2016, not 2016-2017, which is the year we’re now in. Essentially, it starts with the set of unilateral fee cuts the government imposed when it and the OMA couldn’t previously reach a deal, makes those permanent, and goes from there.
The communiqué says the two sides expect that with all this upping and downing taken into account, along with increased demand from patients and more doctors working in the system, the total increase in spending on doctors will stay within that $11.584-billion-plus-2.5-per-cent-a-year envelope. Of course, part of the reason they’re in this position is that the government is very bad at projecting actual demand for doctors’ services. It wants that cost certainty because it’s always underbudgeting.
Is there a hard cap on doctors’ collective total billings? That’s honestly hard to tell from this. I think the answer is yes, based on this wording: “The OMA and Ministry have agreed to set a predictable and sustainable annual (physician services budget) and to co-manage expenditures within that PSB.” The plain meaning of that, to the extent there is one, is that if demand for doctors’ services goes higher than this agreement anticipates, the government and the medical association will find a way together to keep spending from surpassing the budget.
That gives the government something it really wanted. More demand for doctors’ work will be paid for by cuts to what doctors are allotted for each thing they do, details TBD if necessary.
Some good news is that the deal would scrap a strange and bad decision the government made to penalize doctors for joining family-health networks, the sorts of group practices where patients are on rosters attached to the group, not to an individual family doctor, and often there are allied health workers like nurses and dieticians and social workers attached. This is supposed to be a way of delivering primary care more effectively and making sure small problems get treated before they turn into big ones. Having created a couple of hundred of these groups, the province started penalizing doctors for joining them. That’ll stop, supposedly.
Here’s the communication from OMA president Virginia Walley, which as you’ll see includes a great deal of promising to soothe doctors’ worries before they vote.
I am pleased to report an important breakthrough in our negotiations impasse with government.
The OMA Board of Directors, after very thorough review and deliberation, has endorsed a tentative four-year Physician Services Agreement (PSA) with the Ministry of Health and Long-Term Care, and we are now bringing that PSA to you for your consideration and support.
Highlights
Background
I know that today’s news is unanticipated, and many members will rightfully ask, “How did this come about?” I will provide further updates, but in short and as I reported in May, for some time the OMA, on your behalf, has been having exploratory discussions with government in an attempt to resurrect formal bargaining.
These talks, undertaken by OMA and Ministry representatives, with OMA Board direction and guidance, initially focused on Council’s direction to pursue a binding dispute resolution mechanism. While we were unable to achieve the binding dispute resolution mechanism, these talks proved fruitful and in a fairly short time span, accelerated into a framework dialogue resulting in a tentative PSA (and the continuation of our Charter challenge claim for binding arbitration).
Communication and Consultation
Over the next three weeks, I will lead an extensive member communication and consultation plan to ensure that you have full understanding of all aspects of this tentative PSA and how it was achieved.
These communication efforts will include face-to-face meetings in every OMA District and a series of teletown halls and web-ex sessions. The meeting schedule will be posted online, and personal invitations will be emailed to you shortly. Our first teletown halls will take place tomorrow (Tuesday, July 12) at 7 am and 7 pm.
I know you will have many questions about the tentative PSA, and I commit to you that we will use all available means and technology to ensure that your questions are answered, and that there is full understanding and transparency regarding all facets of this proposal.
I have initiated personal calls to explain the tentative PSA to all OMA Section, District, MIG, and Fora Chairs, and we are planning to host two Physician Leader consultation sessions. Where desired, we will provide tailored information to constituency groups.
We will be providing further backgrounders and more specific details on various aspects of the tentative PSA as the next days go by. We will be making available a series of robust Frequently Answered Questions summaries that will be updated on a continuing basis. Please forward your questions and comments to (removed). All materials will be posted and updated regularly on the OMA member website.
A member referendum vote will take place July 27 through August 3; more details about how you can participate in the referendum will be part of my updates to you in the coming days. A Special Meeting of Council will be held August 6, at which time Council will vote on ratification of the tentative PSA.
Considering the Proposal
This tentative PSA marks a pivotal shift, and a marked improvement, in our profession’s ability to influence government and to provide vital leadership in shaping Ontario’s health-care system of the future.
Your Association has carefully weighed the benefits and risks associated with this proposal, the economic climate in Ontario, the experience and outcomes of physician negotiations in other provinces, the current situation we are in under unilateral action, and the time it will take for our Charter challenge to work its way through the court system.
On balance, I and the Board believe this PSA will begin to restore much-needed stability and predictability for doctors and patients, and that it warrants the profession’s support.
I want to assure you that every member of the OMA Board is deeply sensitive to and aware of the challenges that our members have endured recently. I want to thank you for your incredible ongoing dedication and support of patients and our profession through the difficult last years when we have been without a PSA.
Do you have more details than this? Anything in my understanding of the situation that’s wrong? Email me. Confidentiality is assured.
dreevely@postmedia.com
twitter.com/davidreevely
查看原文...
The deal took most OMA members by surprise when the government and the association announced it Monday morning. The bargainers hope physicians vote for it in a referendum at the end of July, and put an end to well over a year of increasingly quarrelsome negotiations between a government that wanted to cap doctors’ billings and doctors who wanted the government to pay for patients’ increasing demands for service.
Doctors’ pay is a giant line-item in the provincial budget: about 10 per cent of all the Ontario government’s operating spending.
The exact terms of the agreement are kept from the public till after the OMA members vote, as is customary in labour negotiations — which this isn’t, precisely, but close enough. But there are a lot of doctors. I got a copy of the OMA president’s communication to her members from someone who doesn’t like the deal or the way it was negotiated.
The highest of the highlights:
They’ve agreed to set the budget for doctors’ billings at $11.584 billion, which is where they were in 2015-16. That baseline will increase 2.5 per cent a year for four years, “to reflect population growth and aging, and increasing physician supply.”
But not, that means, increases to individual doctors’ pay to cope with inflation. Individual docs who continue to do the same amount of work will continue to make the same amount of money, effectively a pay cut after inflation is worked in.
There’s some jiggery-pokery with the numbers within that $11.584 billion to make it all work out. By the end of the four-year agreement, the two sides have agreed to a $200-million reduction in what the government pays out under public health insurance. That’s a permanent cut in doctors’ billings, reflecting the government’s longstanding contention that some of them are overpaid for procedures that are a lot easier and quicker to carry out now than they used to be.
Which procedures’ prices will be cut is to be negotiated, but probably we’re talking ophthalmology, pain management and drug treatment to start with.
At the same time, the government will make four years of “one-time payments” to doctors, totalling $370 million by the end of the agreement. So that’s $200 million in annual, permanent savings, offset for now by one-time payments. What happens at the end of four years when the annual savings remain and the one-time payments have run out? They’ll argue about it then. Under the terms of this agreement, though, there’ll be a net cut to doctors’ fees as they stand today.
Note that the agreement takes its baseline from spending on doctors in 2015-2016, not 2016-2017, which is the year we’re now in. Essentially, it starts with the set of unilateral fee cuts the government imposed when it and the OMA couldn’t previously reach a deal, makes those permanent, and goes from there.
The communiqué says the two sides expect that with all this upping and downing taken into account, along with increased demand from patients and more doctors working in the system, the total increase in spending on doctors will stay within that $11.584-billion-plus-2.5-per-cent-a-year envelope. Of course, part of the reason they’re in this position is that the government is very bad at projecting actual demand for doctors’ services. It wants that cost certainty because it’s always underbudgeting.
Is there a hard cap on doctors’ collective total billings? That’s honestly hard to tell from this. I think the answer is yes, based on this wording: “The OMA and Ministry have agreed to set a predictable and sustainable annual (physician services budget) and to co-manage expenditures within that PSB.” The plain meaning of that, to the extent there is one, is that if demand for doctors’ services goes higher than this agreement anticipates, the government and the medical association will find a way together to keep spending from surpassing the budget.
That gives the government something it really wanted. More demand for doctors’ work will be paid for by cuts to what doctors are allotted for each thing they do, details TBD if necessary.
Some good news is that the deal would scrap a strange and bad decision the government made to penalize doctors for joining family-health networks, the sorts of group practices where patients are on rosters attached to the group, not to an individual family doctor, and often there are allied health workers like nurses and dieticians and social workers attached. This is supposed to be a way of delivering primary care more effectively and making sure small problems get treated before they turn into big ones. Having created a couple of hundred of these groups, the province started penalizing doctors for joining them. That’ll stop, supposedly.
Here’s the communication from OMA president Virginia Walley, which as you’ll see includes a great deal of promising to soothe doctors’ worries before they vote.
I am pleased to report an important breakthrough in our negotiations impasse with government.
The OMA Board of Directors, after very thorough review and deliberation, has endorsed a tentative four-year Physician Services Agreement (PSA) with the Ministry of Health and Long-Term Care, and we are now bringing that PSA to you for your consideration and support.
Highlights
- We have secured important safeguards for members that will protect physicians against additional unilateral cuts and other actions by government, and provide much-needed stability and predictability for our practices, our patients, and the health-care system overall.
- While this tentative Agreement does not contain binding arbitration, our Charter challenge against the government will continue for a legal declaration that we are entitled to binding arbitration, as we firmly believe this is our right.
- The OMA will once again be formally recognized as co-manager of health-care system resources and the Physician Services Budget (PSB).
- The tentative Agreement provides funding for population growth and aging, and increasing physician supply.
- Government has formally agreed to a process to significantly amend contentious provisions in Bill 210 (the Patients First Act).
- The unilaterally imposed restrictions on primary care physicians joining FHNs and FHOs have been reversed, and the managed entry process has been restored to its previous form.
- The OMA and Ministry have agreed to set a predictable and sustainable annual PSB and to co-manage expenditures within that PSB. The baseline PSB will be set at $11.584 billion (reflecting actual expenditures for fiscal year 2015-16), and the Ministry will provide a 2.5% increase to that base each year for the next four years, to reflect population growth and aging, and increasing physician supply.
- In addition, the Ministry has agreed to provide one-time payments to physicians to assist with maintaining the PSB targets, with $50 million in fiscal year 2016-17, $100 million in 2017-18, $120 million in 2018-19, and $100 million in 2019-20.
- To manage the PSB, there will be a modernization of the OHIP Schedule of Benefits (SOB) and other payments, with $100 million in permanent reductions in each of fiscal years 2017-18 and 2019-20, and based on relativity and appropriateness, through the co-management process.
- It is anticipated that with the growth funding, one-time payments, and SOB modernization expenditures on physician services will remain within the PSB.
- Where expenditures on physician services fall below the PSB, there is opportunity for investment into physician fees and programs.
- Beyond co-management, physicians will be appropriately and collaboratively engaged by government in the design and reform of the provincial health-care system going forward.
Background
I know that today’s news is unanticipated, and many members will rightfully ask, “How did this come about?” I will provide further updates, but in short and as I reported in May, for some time the OMA, on your behalf, has been having exploratory discussions with government in an attempt to resurrect formal bargaining.
These talks, undertaken by OMA and Ministry representatives, with OMA Board direction and guidance, initially focused on Council’s direction to pursue a binding dispute resolution mechanism. While we were unable to achieve the binding dispute resolution mechanism, these talks proved fruitful and in a fairly short time span, accelerated into a framework dialogue resulting in a tentative PSA (and the continuation of our Charter challenge claim for binding arbitration).
Communication and Consultation
Over the next three weeks, I will lead an extensive member communication and consultation plan to ensure that you have full understanding of all aspects of this tentative PSA and how it was achieved.
These communication efforts will include face-to-face meetings in every OMA District and a series of teletown halls and web-ex sessions. The meeting schedule will be posted online, and personal invitations will be emailed to you shortly. Our first teletown halls will take place tomorrow (Tuesday, July 12) at 7 am and 7 pm.
I know you will have many questions about the tentative PSA, and I commit to you that we will use all available means and technology to ensure that your questions are answered, and that there is full understanding and transparency regarding all facets of this proposal.
I have initiated personal calls to explain the tentative PSA to all OMA Section, District, MIG, and Fora Chairs, and we are planning to host two Physician Leader consultation sessions. Where desired, we will provide tailored information to constituency groups.
We will be providing further backgrounders and more specific details on various aspects of the tentative PSA as the next days go by. We will be making available a series of robust Frequently Answered Questions summaries that will be updated on a continuing basis. Please forward your questions and comments to (removed). All materials will be posted and updated regularly on the OMA member website.
A member referendum vote will take place July 27 through August 3; more details about how you can participate in the referendum will be part of my updates to you in the coming days. A Special Meeting of Council will be held August 6, at which time Council will vote on ratification of the tentative PSA.
Considering the Proposal
This tentative PSA marks a pivotal shift, and a marked improvement, in our profession’s ability to influence government and to provide vital leadership in shaping Ontario’s health-care system of the future.
Your Association has carefully weighed the benefits and risks associated with this proposal, the economic climate in Ontario, the experience and outcomes of physician negotiations in other provinces, the current situation we are in under unilateral action, and the time it will take for our Charter challenge to work its way through the court system.
On balance, I and the Board believe this PSA will begin to restore much-needed stability and predictability for doctors and patients, and that it warrants the profession’s support.
I want to assure you that every member of the OMA Board is deeply sensitive to and aware of the challenges that our members have endured recently. I want to thank you for your incredible ongoing dedication and support of patients and our profession through the difficult last years when we have been without a PSA.
Do you have more details than this? Anything in my understanding of the situation that’s wrong? Email me. Confidentiality is assured.
dreevely@postmedia.com
twitter.com/davidreevely
查看原文...
