Directional Plan Vision Care Strategy. Central East LHIN Board of Directors December 17, 2014

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1 Directional Plan Vision Care Strategy Central East LHIN Board of Directors December 17, 2014

2 Agenda Project Overview Key Current State Findings Recommendations What it Means for Central East LHIN Next Steps Questions 2

3 Directional Plan Vision Care Strategy PROJECT OVERVIEW 3

4 Project Context The Provincial Task Force developed a provincial planning framework along with 34 strategic recommendations for ophthalmology in Ontario in its May 2013 report, A Vision for Ontario: Strategic Recommendations for Ophthalmology in Ontario The Central East LHIN has established a Central East LHIN Vision Plan Working Group (VPWG) to guide the development of a strategy and implementation plan This strategy has been developed under the umbrella of the Central East LHIN s Clinical Services Plan (CSP) project, which envisions One Acute Care Network 4

5 Project Scope While the Directional Plan Vision Care Strategy documents several approaches to thinking about the continuum of care, the following diagram is helpful for placing our work in context: Primary Role(s) Vision Care System Element System Policy, Surveillance and Monitoring Prevention, Care Local Collaboration Integrated, Focused Care LHIN and Public Health System Optometric Vision Care and Primary Care Community-Based Ophthalmic Vision Care Hospital-Based Specialized Ophthalmic Vision Care (Surgical and Medical) 5

6 Project Scope Scope of the VPWG s work was limited to inpatient and outpatient ophthalmic surgeries currently delivered by Central East LHIN hospitals and/or ophthalmic surgeries that are required by the Central East LHIN catchment area. Note that VPWG s deliberations have taken into account the nuances of how people access vision care services before and after ophthalmic surgeries. 6

7 Project Approach 7

8 Project Timelines and Milestones 8

9 Stakeholder Engagement Approach 9

10 Directional Plan Vision Care Strategy KEY CURRENT STATE FINDINGS 10

11 Current Strengths The population in the Central East LHIN is currently well-served compared to the rest of Canada with hospitals performing well with respect to wait times for cataract surgeries, quality, and efficiency Most patients can receive care close to home and in a reasonable amount of time Access to retinal surgical procedures in most regions is perceived to be good In certain regions, there is early screening of diabetic; the overall vitrectomy rate for diabetes is lower in the Central East LHIN than other regions of Ontario There exists 24/7 access to ophthalmology in most hospital Emergency Rooms 11

12 Growth in Durham Among Seniors The most significant population growth will in the 65+ age group Durham will have the highest population growth for individuals aged 65+ (projected at 38% in ) Projected Population Growth for Individuals Aged 65+ by Region Region % Increase Population Size from 2013 to 2018 (magnitude of increase provided in brackets) % Increase in Population Size from 2019 to 2023 (magnitude of increase provided in brackets) DURHAM REG. MUN. 21.1% (+22,359) 37.8% (+50,675) HALIBURTON 13.2% (+7,48) 25.5% (+1,680) KAWARTHA LAKES 13.0% (+2,586) 26.1% (+6,120) NORTHUMBERLAND 15.4% (+3,554) 28.6% (+7,840) PETERBOROUGH 12.9% (+4,371) 25.5% (+10,008) TORONTO 12.3% (+12,375) 24.0% (+27,844) Central East LHIN 15.9% (+45,993) 30.0% (+104,239) Data Source: IntelliHealth 12

13 Net Inflows and Net Outflows LHIN Name Central East LHIN Outflows (# of patients leaving Central East LHIN for procedures) Central East LHIN Inflows (# of patients entering Central East LHIN for procedures) Net (Inflow Outflow) Central Toronto Central Central West Champlain Erie St. Clair Hamilton Niagara Haldimand Brant Mississauga Halton North Simcoe Muskoka North East North West South East South West Waterloo-Wellington Unknown Total 4,217 3, % out of a total of 18,361 Central East LHIN residents who had an ophthalmology procedure 23.0% (Outflows) 21.2% (Inflows) Data Source: IntelliHealth 13

14 Inflow and Outflow Procedures by Volume A large proportion of patients leave the Central East LHIN for cataract removals, vitrectomy / retinal release, other major eye interventions and corneal transplant / reconstruction 14

15 Opportunities The main concern the VPWG identified was access to subspecialty care The focus of the Directional Plan Vision Care Strategy is to address this concern and improve access to subspecialties 15

16 Directional Plan Vision Care Strategy RECOMMENDATIONS 16

17 Recommendation Development The VPWG identified and evaluated two main options: 1) Distributed Model for Cataracts with One LHIN Centre for Subspecialties 2) Distributed Model for Cataracts with Two Cluster Centres for Subspecialties Under both options, cataract extractions would continue to be provided by the five (5) existing hospitals in the Central East LHIN The VPWG evaluated these two Options using the Central East LHIN Decision Making Framework and Expert Choice software and chose the Two Cluster Centres model 17

18 Broad Recommendation At a broad level, the VPWG recommends that the Central East LHIN create two cluster centres and divide subspecialists across these two centres Given the size, scale, and infrastructure requirements of a cluster centre, these centers would be located at: Lakeridge Health (Durham Cluster); and The Scarborough Hospital (Scarborough Cluster) Note that the specific distribution of specialists (e.g., vitreoretinal) will be determined later through the implementation process 18

19 Detailed Recommendations Two Cluster Centres Model: Key Recommendations (#1- #4) Recommendation 1: The 5 hospitals that currently provide cataract extractions should continue to offer the service. Recommendation 2: The VPWG should establish a regional approach to providing surgical retina and vitrectomy with the goal of increasing volumes and ophthalmology health human resources. Specifically, Lakeridge Health should continue to provide surgical retina and vitrectomy. Services presently provided at Rouge Valley Health System (Centenary site) should be transitioned to the other cluster centre at The Scarborough Hospital. LH and TSH should collaborate on recruiting and retaining 1 additional vitreoretinal subspecialist at one of the two hospitals (for a LHIN-wide total of 3 subspecialists) to support the volumes in the LHIN. Recommendation 3: The VPWG should establish a regional approach to providing glaucoma surgery with the goal of increasing volumes and ophthalmology health human resources. The hospital that is currently providing glaucoma surgery should continue while a 2 nd hospital should be identified by the VPWG to provide glaucoma surgery in the LHIN. The recruitment and retention of a 2 nd glaucoma subspecialist should be completed (for a LHIN-wide total of 2 subspecialists). Recommendation 4: The VPWG should recruit and retain 1 corneal transplant subspecialist in order to meet the needs of the patient population in the Central East LHIN (for a LHIN-wide total of 1 subspecialist). 19

20 Detailed Recommendations (cont d) Two Cluster Centres Model: Key Recommendations (#5 - #9) Recommendation 5: The LHIN should continue to provide oculoplastics with no change in ophthalmology health human resources. Recommendation 6: The VPWG should recruit and retain 1 pediatric ophthalmologist in order to meet the needs of the patient population in the Central East LHIN (for a LHIN-wide total of 1 pediatric ophthalmologist). Recommendation 7: All 6 hospitals providing ophthalmology services should participate in one of the existing on-call coverage networks. Recommendation 8: The Central East LHIN should establish an ongoing advisory board similar to the existing VPWG to ensure ongoing attention to vision care issues and to oversee the implementation of the recommendations identified in the Vision Care Directional Plan. Recommendation 9: The VPWG should collaborate with the Ontario Telemedicine Network (OTN) to identify how teleophthalmology could be applied in certain scenarios to build capacity and serve the patient population living in all communities (both rural and urban) in the LHIN. 20

21 Detailed Recommendations (cont d) Two Cluster Centres Model: Key Recommendations (#10- #12) Recommendation 10: The 6 hospitals providing ophthalmology care should improve integration with centres for diabetes care. Recommendation 11: The 6 hospitals providing ophthalmology services should develop a marketing strategy to repatriate volumes back to the Central East LHIN. The strategy development and implementation should be consistent with the onboarding of the new ophthalmologists/subspecialists. Recommendation 12: The 6 hospitals that provide ophthalmology services should explore potential partnerships with local community agencies in order to improve access to care for patients. 21

22 Directional Plan Vision Care Strategy WHAT IT MEANS FOR CENTRAL EAST LHIN 22

23 Impact on Central East LHIN Hospital Operations Cataracts will continue to be performed at existing sites for the foreseeable future Central East LHIN would add four (4) new subspecialists: vitreoretinal, glaucoma, corneal transplant, and pediatric ophthalmology Core capacity will be concentrated at Lakeridge Health (Durham Cluster) and The Scarborough Hospital (Scarborough Cluster) Pediatric ophthalmology services would be situated at one of the two LHIN Cluster Centres Northumberland Hills Hospital s cataract program will need to join the broader Central East LHIN vision care call network and include a means of ensuring it captures as much as possible of the required services from its local catchment area and also ensuring that it is robust for the community 23

24 Estimated Cost Impact of Additional Subspecialists Costs are for information purposes only and are based on limited available case costing data and industry sources Estimated costs can vary based on assumptions about: (1) volumes performed by each subspecialist; and (2) cost per case These estimates represent annualized costs including overhead, staff, and other costs for in-hospital surgical procedures. They do not include any up-front capital costs. Additional Subspecialist Annualized Cost Estimate Range Vitreoretinal $200,000 - $1,100,000 Glaucoma $200,000 - $800,000 Corneal transplant $100,000 - $500,000 Pediatric $200,000 - $800,000 Total $700,000 - $3,200,000 24

25 Directional Plan Vision Care Strategy NEXT STEPS 25

26 Next Steps Incorporate feedback from the Central East LHIN Executive Council Present the Directional Plan to the Central East LHIN Board for approval Finalize the Directional Plan and provide an update to VPWG Circulate evaluation survey to the VPWG as part of on-going efforts to improve future engagement and planning activities Transition from planning to implementation of the Vision Care Strategy 26

27 Directional Plan Vision Care Strategy QUESTIONS 27