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

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 Ontarios Action Plan for Health Care has three pillars: 1.Keeping Ontario Healthy 2.Faster Access to Stronger Primary Care 3.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 Ontarios Vision Strategy Task Force, a clinical expert panel group The Ministrys 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. CONFIDENTIAL2

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: 1.A non-profit Independent Health Facility (IHF) licensed under the Independent Health Facilities Act (IHFA); or 2.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. CONFIDENTIAL3

Health System Funding Reform Specialty Clinics are aligned with Ontarios 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. CONFIDENTIAL4

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: CONFIDENTIAL5

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. CONFIDENTIAL6

Proposed LHSIA/IHFA Regulatory Changes CONFIDENTIAL 7 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: 1.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, 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 Proposed regulation changes have been posted online for public comment until October 11, 2013 and can be found at:

Questions? CONFIDENTIAL8