1. Digital Readiness Special Grant Program IDCA Conference September 12, 2014 Health Services Branch Negotiations and Accountability Management Division

2. OVERVIEW OF PRESENTATION 2 1.BACKGROUND History of Program Funding Process Application Process 2013/14 Expenditures 2.PROGRAM MODIFICATIONS Administrative Eligibility/Accountability Communications 3.SUMMARY Timeline Contact Information

3. BACKGROUND 3 HISTORY OF PROGRAM In 2005 a fund was set up for retroactive fee payments to provide relief to health care facilities by subsidizing equipment costs. In 2011/12 this funding was disbursed exclusively in the IHF sector in the form of a digital readiness grant program. Funds from the retroactive fee payments have been continued as an initiative designed to assist Independent Health Facilities (IHFs) with costs associated with the purchase of digital diagnostic imaging equipment and/or components which support movement toward a digital environment. Since 2012/13, the program has been the responsibility of the Independent Health Facilities program.

4. BACKGROUND 4 The Ministry determines a facility’s allocation based on the percentage of billings for the diagnostic imaging procedures a facility performs between the fiscal year of April 1 and March 31. Receiving funding is dependent on the facility’s ability to meet application requirements (including the application deadline) and equipment eligibility criteria. FUNDING PROCESS Minimum fee-for-service facility billings requirementApplication requirementsEquipment eligibility criteria

5. BACKGROUND 5 2013/14 EXPENDITURES An analysis of the equipment/services purchased using the 2013/14 grant revealed the following purchases by approximately 500 facilities: Number of FacilitiesType of Equipment Purchased 101Ultrasound equipment 41 X-ray equipment 3 Mammography equipment 2 Nuclear medicine equipment 1 Fluoroscopy equipment 17 Other equipment (mostly Bone Mineral Density) 274 PACS storage/maintenance 167 RIS 43 Workstations* 45 PCs/laptops* *Used by radiologists interpreting the images

6. 6 OVERVIEW OF PROGRAM MODIFICATIONS 1.Administrative a)Creation of two deadlines b)Email notifications for successfully submitted applications 2.Eligibility/Accountability a)Personal computers/laptops b)Facilities in underserviced catchment areas c)Leasing equipment d)Rationale for participation 3.Communications a)Communication strategy

7. MODIFICATIONS 7 ADMINISTRATIVE Applicants had difficulty completing their applications, resulting in incomplete submissions and incorrectly documented claims (i.e. missing invoices, incorrect facility or shipping address). There was also a large number of applications submitted close to deadline. In 2013/14, 54% of the 444 applications were submitted within two days of the deadline. This caused applications to be processed late, delaying the release of funds. Implement two deadlines: Dec 15: Program Support deadline – Where applications are eligible for review and applicants may be contacted by the program regarding issues with their application. Jan 15: Final deadline – applications will be ineligible, with no opportunity for revision or resubmission. IHF program will review applications and contact applicants with any issues. Applicants will have until Jan. 15 2015 to incorporate feedback into their applications. Dec. 15 2014 Final deadline for the submission of all applications. Jan. 15 2015

8. MODIFICATIONS 8 ADMINISTRATIVE Large application files sent via email were rejected by the email system in some cases, resulting in applications not being delivered to the IHF program. Applicants did not realize their emails were not delivered. Similar issues were seen with faxed applications. To improve the transparency of the submission process, an automated email message will be created to confirm that applications have been successfully received. Applicants will be required to save this email as proof of submission for confirmation purposes. Faxing applications will follow a similar process where applicants will be asked to document proof of submission.

9. MODIFICATIONS 9 ELIGIBILITY/ACCOUNTABILITY Personal computers/laptops – These types of equipment have implications for privacy laws as they contain patient data and could potentially be removed from a facility. Applicants will be required to affirm that they will use these pieces of equipment in adherence with privacy laws.

10. MODIFICATIONS 10 ELIGIBILITY/ACCOUNTABILITY Historically, once applications have been submitted, a portion of the grant remains from the initial allocations. This is due to applications being found ineligible, Licensees failing to submit applications, claims being less than the initial allocations, etc. In order to maximize the impact of the grant, the ministry will explore options for giving priority for any remaining funds to facilities claiming equipment and/or components related to licensed services deemed under-served. A section will be added on the application, asking facilities to identify which services the eligible equipment supports (e.g. if the equipment is being used for x-ray and/or ultrasound services).

11. MODIFICATIONS 11 ELIGIBILITY/ACCOUNTABILITY Leasing equipment – Due to the large costs associated with equipment, some facilities would prefer to lease equipment over time to avoid large one-time costs. Currently, multi-year leasing is not allowed under eligibility criteria. Adapt the current eligibility criteria to allow facilities to claim leased equipment on a year-by-year basis, as appropriate. Applicants should be aware that there is no guarantee of continued funding in future years for payments related to the leased equipment.

12. MODIFICATIONS 12 COMMUNICATIONS Applicants had difficulty determining which claims would be eligible for the grant. Several types of equipment that were ineligible were submitted, such as: Transducers (probes) and generators Training, travel and installation Invoices for used/refurbished machines Cash register receipts in lieu of invoices “Ship to” locations other than the facility location were on the invoices Unsigned quotes Invoices dated prior to April 1, 2013

13. MODIFICATIONS 13 COMMUNICATIONS The IHF program will increase the amount of information it provides to applicants through a communication strategy. A sheet of auxiliary instructions will be attached to the application based on the lessons learned over the past two years. It will not form part of the legal agreement but would accompany it to assist applicants in avoiding commonly made mistakes. It will include: a summary of changes made to the 2014/15 program, and a checklist that allows applicants to “check off” requirements prior to submission. A completed application will be made available on the IHF website to be used as an example and guide. Webinar(s) will be held in November to provide verbal and visual education on common issues such as meeting eligibility criteria, documenting invoices, and submitting applications successfully.

14. SUMMARY 14 TIMELINE April ‘14Start of purchase period for eligible equipment Oct ‘14Fee-for-service billings complete Initial letters and applications sent to licencees Nov ‘14Webinar #1 released (within first week) Webinar #2 released (within last week) Dec ‘14Dec 15: Preliminary deadline for applications Dec 15 - Jan 15: IHFP reviews applications and provides feedback Jan ’15Jan 15: Final deadline for revised and all other applications Jan 15: End of purchase period for eligible equipment Feb ’15IHFP processing applications Mid-February: submit payment file for approval March ’15Release denial letters as appropriate Release letters stating allocations for eligible facilities Eligible equipment must be delivered by March 31 Payment on March remittance date for applicable facilities Fiscal year ends – all grant money must be allocated

15. 15 CONTACT INFORMATION For further information, please contact the IHF program: By email at IHFP@ontario.ca By phone at 613-548-6637 By fax at 613-548-6734 SUMMARY