Kimby N. Barton, MSc
Assistant Editor,
Geriatrics & Aging
This past month, the Ontario Medical Association governing council and the Provincial Government of Ontario ratified a comprehensive four-year agreement, which will pave the way for the trimming of $50 million annually in medical services from OHIP. In a telephone referendum that took place May 3 to May 10th, 66% of OMA physician members who took part across Ontario voted 'yes' to the agreement (in total 10,603 members voted, a number that represents less than half of the OMA's total membership). The number of Ontarians over the age of 65 has increased by 31% in the past decade and per capita seniors utilize up to five times more health services than the rest of the population. The new agreement is designed to address some of the issues resulting from the need to allocate sufficient resources to treat this aging population.
The agreement provides for a 1.95% increase in physician billing this year and a 2% increase to be implemented in each of the next three years. It also raises thresholds by $10,000, allowing family doctors to bill up to $330,000 a year and specialists up to $410,000 before discounts on their billings kick in.
The parties have also agreed on several initiatives to enhance delivery of needed services to patients and to provide physicians' incentives motivating them to deliver those services. Some of the initiatives include changes to the Schedule of Benefits with respect to home care application, home care supervision, complex care of the elderly and after-hour premiums. Specifically, a 20% premium ($10.30) will be added to the general assessment code for services provided to patients who are 75 years of age or older. This general assessment premium can be charged only once per patient per year. Physicians who submit a home care service request form to the Community Care Access Centre (CCAC), or who provide information in response to an inquiry from CCAC staff can charge a Home Care Application fee ($16.50) or a Home Care Supervision fee ($10.40). Changes have also been made to the Schedule of Benefits for the after-hours premium codes. Physicians may charge a premium for visiting hospital inpatients, for visiting a patient's home or a multiple resident dwelling and for making a special visit to a long-term care institution. Exact fees for these services are listed in Appendix B of the Agreement.
The Agreement has not met with universal acceptance. A release from the Coalition of Family Physicians (COFP) states that the agreement has merely guaranteed that "for the next four years family physicians will fall further behind inflation". The number of allowable non-emergency visits per month to patients in long-term care facilities and chronic hospitals (complex continuing care) were left unchanged. The allowable number of visits was cut in the last agreement and this is a problem for nursing home physicians. There are also concerns amongst specialists and advocacy groups about the possible delisting of several services. "What it means is $50 million less in health-care spending," says Ray Foley, execu- tive director of the Ontario Association of Radiologists. It is rumoured that optometry, physiotherapy, and audiology tests will no longer be insured. If the committee decides to delist hearing tests it means that patients who require audiology testing are going to have to pay for it themselves. Since many patients who visit optometrists and audiologists are senior citizens, it is apparent that improving geriatric care in one area may result in deficiencies in other areas. If you have any comments about the new deal and how it affects your practice, please email us at geriatrics@ribosome.com.
