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Physician HHR planning in Ontario Leonard Kaizer Resident Rounds June 8.2012.

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Presentation on theme: "Physician HHR planning in Ontario Leonard Kaizer Resident Rounds June 8.2012."— Presentation transcript:

1 Physician HHR planning in Ontario Leonard Kaizer Resident Rounds June

2 Objectives – to Review: History of manpower planning for medical oncology in Ontario Current model for service delivery and HHR planning for systemic treatment – RSTP Provincial Plan HHR forecasting and allocation Future state – What will the system you work in be like? burden of disease, manpower projections, and models of care. 2

3 Historical Perspective 1997 RBRVS Commission (OMA & CCO) Submission from OMA section for Hematology and Medical Oncology Suggestion that AFP might be a consideration 3

4 Historical Perspective 4

5 Historical Perspective - STTF Delivery of systemic therapy threatened by the scarcity of health professionals Task Force mandate was to make planning recommendations to avert a crisis  Expand training programs  Expand roles of nurses and other providers  Workload standards for key providers  Specific recommendations for medical oncology 5

6 Historical Perspective - STTF 6 Benchmarks

7 Historical Perspective - STTF 7 Role statements

8 Historical Perspective - STTF 8 Model of care and compensation

9 Historical Perspective - SSTF 9 Need for data

10 Historical Perspective Combination of RBRVS and STTF led to the initial AFP agreement in 2002 and allocations to CCO, PMH and community (COMET) programs Since 2002 there have been several reports which have addressed physician workload and the need for incremental physician resources and evolution of model of care  Human Resource Planning for Medical Oncology in Ontario (2005)  Regional Systemic Treatment Program Provincial Plan (2009) Since 2002 there have been 4 incremental allocations of medical oncology positions, the last in

11 Current State Although we are much further ahead, we are still trying to deal with the same demands as we were in 2000  Demand for health human resources  Demand for better data, especially information on physician resources and activity  Demand for better processes to deliver care to patients 11

12 Current model for service delivery and HHR planning for systemic treatment – RSTP Provincial Plan

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18 Medical Oncology Historical Planning New Cases as a Standard Measure of Workload 18 ReferenceYearCommunityAcademic Systemic Therapy Task Force Report Human Resource Planning for Medical Oncology in Ontario Principles for Allocation of ONTMOA APP Positions Regional Systemic Treatment Program Provincial Plan*

19 Medical Oncology Historical Planning RSTP Provincial Plan September 2009 Methodology Measured baseline treated cases and projected treated cases over time (11% & 17% 5 year lower and upper demand) Used a factor of 1.2 (validated) to convert treated cases to new consult projections (historical benchmark) for upper demand. The projected new consult demand was related to HR baseline consult rates (188 Academic and 247 Community), recognizing they were higher than benchmark (145A and 215 C) Assumed that A:C ratio for new cases was going to move from 50:50 to 25:75 Concluded the demand would be 40 new positions by

20 Medical Oncology Historical Planning RSTP Provincial Plan September

21 Planning and Forecasting Current forecasting is still tied to new patients (incidence) Benchmarks for medical oncology service provision (planning documents) Relating growth in incident cases to benchmark service provision yields a number of AFP positions for the province The active treatment of prevalent cases is becoming a larger proportion of our ongoing work and is not factored into these estimates Data collection outside level ICPs is less robust Assumption that 75% positions go to Level centers 21

22 What has happened since 2009 to implement this HHR plan? Two HHR requests, involving CCO (planning + forecasting) and ONT-MOA (negotiation) Joint allocation process – Consideration to POAFP Provincial recruitment to AFPs in general since

23 Allocation Methodology - Principles 1.The allocation process should be fair, clear, transparent and data driven. 2.Allocations will be assigned to enable additional patient services. 3.Allocation will be made to institutions, through regional programs. Institutional level allocation will be authorized through a consultative process involving the RVP and medical oncology leads for the region (i.e. Head, Cancer Centre and Regional Quality Lead, systemic Treatment) 4.In assessing current HHR resources, all medical oncologists, where possible, will be counted. 5.In assessing current activity, all activity, where possible, will be considered and benign work will be excluded. This will be done using a mix of data sets. 6.Modifiers to workload measures will be defined. 7.Additional considerations will be made for special circumstances 23

24 Measuring Supply Census of Physician Supply 2011 DefinitionTotal FTEs Total FTEs AFP X X AFP-EX X X AFP-Hired X X AFP-Unfilled X X FFS X X FFS-C X X CF-C X X GPO X APN X 24

25 Measuring Supply CCO Census of Physician Supply 2011 Currently there are total MO FTEs in Ontario This represents an increase of 28 FTEs since allocations Some new FFS positions Of the total MO FTEs, (53.5%) are associated with level 1 academic centers. 25

26 Allocation Methodology – Inputs into Core Model  HHR census: October, 2011 o Total FTEs, clinician scientists, complex hematology  NACRS treated cases: Oct 2010 – Nov 2011  OHIP consults: November 2010 – October 2011  RVP consultation o Centers for consideration of allocation (incremental work) o Regional perspective – Grouping – Commentary 26

27 Allocation Methodology – Model 2012 RANK = Sum Activity/Adjusted FTE SUM Activity Take Total FTE from census Adjust contribution of CS and CMH to establish Adjusted FTE Adjusted FTE Take SUM OHIP consults and NACRS derived treated cases Remove non medical oncology treated cases - gynecologic oncology Adjust for academic vs. community SUM Activity /Adjusted FTE = RANK score 27

28 Allocation Methodology – Model 2012 Discussion reserved for the bottom of the allocation if there are insignificant differences between institutions or if there are obvious outliers – based on last position +/- 5%. Other measures of activity Billings per FTE LHIN demographics - Incidence and Import/Export ratio APN & GPO totals APP allocations empty or filled by extenders RVP inputs Consideration to 2 nd allocation 28

29 Allocations 2007, FACILITYAllocation 2007Allocation 2010 LHIN 1Windsor* 0.5 LHIN 2London* 0.5London 1 Owen Sound 1 LHIN 3Grand River 1 LHIN 4Niagara 1Hamilton Brantford 1 Niagara 1 LHIN 5/6Trillium 1 LHIN 7PMH* 2.8 Sunnybrook* 0.6 PMH (1) LHIN 8Markham* 0.6Markham 1 York Central 1 LHIN 9Durham 1 LHIN 10Kingston* 0.5 Belleville* 0.5 Kingston 1 LHIN 11Ottawa 1 LHIN 12Barrie 2 LHIN 13Sudbury 1 LHIN 14 TOTAL ALLOCATION (13.0)

30 What is wrong with this picture? Currently available data to measure human resources and clinical activity has strengths & weaknesses. The allocation model is fair and reasonable given these limitations We are undervaluing work related to cancer prevalence and oral chemotherapy The stated allocation principle is to direct positions to increase capacity for new clinical activity. However, the final methodology uses retrospective data to define RSTP centers who are in greatest HHR deficit. We assume that allowing “catch up” will enable future growth. A prospective model for resource prediction and planning should take many other factors into consideration – patient travel, all human resources, LHIN demographics, … 30

31 Cancer Incidence by LHIN 5 Year Projection 31 LHINLHIN name Estimated incidence Count Estimated incidence Count GrowthIncrease 1Erie St. Clair18,50120,70212%2,201 2South West27,40931,20814%3,799 3Waterloo Wellington17,65920,85318%3,193 4Hamilton Niagara40,60645,51012%4,904 5Central West15,67819,41124%3,733 6Mississauga Halton26,18131,64021%5,458 7Toronto Central27,13229,0797%1,948 8Central40,75048,74620%7,996 9Central East40,17346,75416%6,580 10South East15,11416,96412%1,851 11Champlain31,48736,17615%4,688 12North Simcoe Muskoka13,57716,25720%2,680 13North East18,25420,12410%1,869 14North West6,7947,51211%717 Grand Total339,316390,93415%51,619

32 Future state – What will the system you work in be like? 1.The burden of disease is increasing dramatically – incidence and prevalence 2.Financial reality means constrained resources – timely and appropriate care at risk 3.Human Resource issues are imminent – projected shortages….. It is true!! 4.Patient expectations are changing – improved patient experience means better integration and coordination of care and enhanced patient engagement in self management. 32

33 Burden of Disease 33

34 Burden of Disease 34

35 Burden of Disease 35

36 Manpower shortages? 36

37 Models of Care Program “1. Develop new models of care delivery to support evidence- informed, efficient, patient-centered care. 2. Implement the models and address necessary remuneration, regulatory, scope of practice and other policy changes. 3. Develop and implement a mechanism for continuous evaluation, modification and improvement of the models.” Ontario Cancer Plan III 37

38 Models of Care - Principles 38 Innovative approaches to models of care delivery in oncology Based on best-practice Patient-centered Collaborative, multidisciplinary, team-based care Working to optimize the use of scarce and expensive physician and other human resources Maximizing existing health human resources by fully utilizing potential of current scopes of practice Bending cost curve Build on principles of ECFAA and OCP to work towards fully integrated cancer system, alignment of physician resources and accountability with system level resourcing and planning

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40 Objectives – to Review: History of manpower planning for medical oncology in Ontario Current model for service delivery and HHR planning for systemic treatment – RSTP Provincial Plan HHR forecasting and allocation Future state – What will the system you work in be like? burden of disease, manpower projections, and models of care. 40


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