Changes to Publicly-Funded Physiotherapy Services Presentation to the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) Board of Directors Education Session June 26, 2013 Donna Cripps, CEO HNHB LHIN 1
Agenda Part 1 Background Publicly-Funded Non hospital Physiotherapy (PT) Services Designated Physiotherapy Clinics What is Changing? Impetus for Change Future Lens for Publicly-Funded Non-hospital PT Services and Summary of Changes by Stream Timelines and Progress Part 2 HNHB LHIN Implementation of PT Changes Falls Prevention (FP) and Exercise 2
Changes to Publicly Funded Physiotherapy Services On April 18, 2013 the Ministry of Health and Long-Term Care (ministry) announced changes to publicly-funded non-hospital PT services These changes will take effect August 1, 2013 3
Background Legislation Regulation 552 of the Health Insurance Act (ACT) prescribes eligibility, coverage, care settings and payment model for publicly funded PT services. Eligibility Persons under the age of 20 or 65 years of age and older Client of the Ministry of Community and Social Services between the age of 20-64 years Residents of Long -Term Care (LTC) Homes People of all ages who need PT services in their home or after overnight hospitalization Care Settings OHIP funds PT services on a fee for service (FFS) basis when they are provided by a Designated Physiotherapy Clinic (DPC) in a client s home and in a clinic setting. OHIP will also fund PT services provided by a DPC in a LTC home. Payment Model and Referral Process A maximum of 50 services are insured by OHIP following discharge from hospital. In all other cases, eligible individuals are covered for up to a 100 services per year and in exceptional cases 150 services per year. A written referral from a physician (or a nurse in a LTCH) for OHIP-funded PT services OHIP pays $12.20 per PT service Source: MOHLTC Fact Sheet Physiotherapy Reference Number Catalogue # 018059 & Ontario Regulation129/05 made under the Health Insurance Act., March 23, 2005 Amending Regulation 552 4
Background - Designated Physiotherapy Clinics (DPC) DPC is a PT clinic prescribed as a health facility for the purposes of the Health Insurance Act under subsection 35 (10). DPCs are the only PT providers currently permitted by the law to be paid FFS for the delivery of OHIP-funded PT services. The number of DPCs cannot be increased without legislative amendment. There are 90 clinics in Ontario, geographically concentrated in the Greater Toronto Area - 15 are located in the HNHB LHIN. The license owner does not have to be a physiotherapist. Unlike other OHIP-funded FFS providers, the billing licenses issued to the business rather than an individual provider. OHIP payments are made to the owner/operator who, in turn, pays the physiotherapist or support worker who provides the insured service. 5 Source: MOHLTC Changes to Publicly Funded Physiotherapy Services April 18,2013 Bulletin Reference # 3095, Ontario Regulation129/05 made under the Health Insurance Act., March 23, 2005 Amending Regulation 552 and MOHLTC Fact Sheet Physiotherapy Reference Number Catalogue # 018059
What is Changing? Effective August 1, 2013 Non-hospital PT services will be removed from the Health Insurance Act as insured services and established as budget-based programs for specific programs and health sector. There will be no clinics designated under the Health Insurance Act and the OHIP billing privileges held by DPCs will be eliminated. 6
Impetus for Change Access to publicly-funded PT services is uneven across Ontario. Eligible patients may not have access to a DPC. Expert Reports speak to needed changes to publicly funded PT services (Drs. Walker and Sinha Reports and the Drummond Report). The current funding model does not reflect best practice. People who may benefit from publicly- funded PT may not have access to these services. Walker s report noted that publicly- funded PT was growing in the double digits and that the ministry has lost the leverage to direct providers to provide service to those Ontarians that need it the most. Source: MOHLTC Website Accessed June 18, 2013 Helping Ontario s Seniors Stay Healthy and Active. Dr. Walker s Report 2011 Caring for our Aging Population and Addressing Alternate Level of Care. 7
Impetus for Change Continued OHIP funded PT is one of fastest growing expenditures in the healthcare system. Since 2005, growth tripled that of hospitals, drugs and physician expenditures. 300% Public Sector Health Expenditures Growth Physio Hospitals Physicians Drugs The projected expenditures for OHIP funded PT are set to double the existing allocation by 2014. Growth is largely provider driven. FFS model and maximum service levels per year encourages provision of high volume services to lower acuity patients. 250% 200% 150% 100% Regulation 552 of the Health Insurance Act does not define PT explicitly leading in some cases for PT treatment to be reframed from time limited treatment plans to exercise/activation maintenance programs of indefinite duration. Source: MOHLTC June 2013 50% 2005 2006 2007 2008 2009 2010 2011 Note: In home PT services have increased from $12M in 2007 to projected $81 M in 2013 8
Future Lens for Publicly Funded Non-hospital PT Services Effective August 1, 2013, the government is implementing a comprehensive program for community and primary care PT. PT will be established as budget-based programs for specific programs and health sectors. PT services in community settings will continue to be funded and access will be improved for Ontarians across the province. The new model: directly funds the physiotherapy and exercise that seniors need; expands the availability of these services to more locations in communities across Ontario; and serves more seniors - while ensuring eligibility remains the same or increases. Source MOHLTC Website Accessed June 18, 2013 Helping Ontario s Seniors Stay Healthy and Active: Healthcare, Public & Professionals 9
Publicly Funded Physiotherapy Services Going Forward OHIP-funded PT, exercise and FP services will be funded directly. $44.5 M to Community Based PT Providers to preserve and expand access t o PT services in community setting (clinic) across Ontario; $33 M to Community Care Access Centres to treat more patients needing PT in their home; $68.5 M to LTC Homes in order that they can manage the PT and exercise needs of their residents; and. $10M for Group Falls Prevention and Exercise classes for seniors to positively affect seniors' health and well-being and reduce falls and related injuries. In addition, Ontario will integrate PT into interdisciplinary family health care settings such as Family Health Teams, Nurse Practitioner Led Clinics, Community Health Centres. Source: MOHLTC News Release April 18, 2013 10
Summary of Changes Community-Based Physiotherapy Providers Current Transition of DPC service delivery model from Health Insurance Act to a contract-based framework. June 19, 2013 ministry issued a call for application for PT providers who are interested (existing and new) in providing publicly -funded clinic-based PT services. Future and Outcomes Increase access and improve geographic equity goal 90,000 additional patients annually. Community PT to restore movement caused by injury pain and/or decreased function. Enhanced reporting requirements. Restructured payment process more responsive to need and higher quality care. Supports future health system funding reform planning. Source: MOHLTC News Release April 18, 2013 11
Summary of Changes - In-Home Current CCAC provides assessment and arranges (funds) in-home PT services for eligible clients. OHIP also funds in-home PT on a FFS basis for patients referred for in-home PT. In 2011-12 CCAC reported over 91,500 clients received PT services. Future & Outcomes CCAC will be the single point of access for in-home PT services. Standard assessment process for all clients receiving in-home PT services, which will be part of more comprehensive assessment of needs. Opportunity to expand options to provide PT in-group/congregate settings. Establishment of best practice care pathways. Source: MOHLTC Physiotherapy Changes June 2013 12
Summary of Changes - Long-Term Care Home Current Providers currently bill OHIP for resident therapy in LTC homes. LTCHs within their annual allocation, receive funding to provide occupational therapy, speech language therapy, exercise/activation classes and recreational/social activities. Future and Outcomes LTCHs will receive direct funding through LHINs to provide PT services. Residents who have an assessed need for PT in their plan of care will receive one-on-one episodic PT in their LTCH to help them restore their mobility and function. LTCHs will receive additional funding for exercise/activation activates. Appropriate and resident specific care. Restoration/recovery to pre-injury/surgery function, in convalescent care beds. Promotion of wellness in LTCH. Source: MOHLTC Physiotherapy Changes June 2013 13
Physiotherapy vs. Senior Exercise Classes Physiotherapy Is a health profession that is regulated by the government. Involves the assessment of neuromuscular, musculoskeletal and cardio respiratory systems; and the diagnosis and treatment of physical dysfunction, injury or pain from a physiotherapist registered with the College of Physiotherapists of Ontario. Seniors Exercise Classes Focus on improving functional performance through strength and balance to prevent frailty, injury and falls. Classes may be led by fitness instructors, trained peer facilitators or support workers. Are not required to be led by a physiotherapist. 14 Source: MOHLTC Website Accessed June 21, 2013
Summary of Changes - Falls Prevention and Exercise Current Ministry is investing $10M to benefit approximately 130,000 seniors. LHINs will receive funding to: Outcomes 1. Maintain seniors access to exercise and FP classes for seniors affected by the changes to PT services. 2. Expand access to exercise and FP classes in communities across the province in order to increase access to regular physical activities and FP programs for seniors. Improved supports for seniors to stay healthy and stay at home longer by increasing availability and access to regular exercise and FP classes. Regular physical activity positively affects seniors overall well-being, functional capacity, strength, and ability to better manage chronic conditions. Reduced falls and hospitalizations due to falls among seniors. Source: MOHLTC Physiotherapy Changes June 2013 15
Timelines and Progress PT Stream Current Progress Lead Timeline FP and exercise classes for seniors. Two-phased approach: 1) Maintain existing services 2) Expand access to services Environmental scan to identify existing locations completed LHIN-funded agencies identified to maintain existing service CCAC engaged in LHIN process LHIN Complete Phase 1 by August 1, 2013. Expansion of ambulatory PT services in clinic-based settings June 19, 2013 ministry issued a request for applications Selection of successful applicants and volumes assigned will reflect community needs and priorities as determined by each LHIN Ministry Publicly-funded clinic-based PT will be governed and funded under transfer payment agreements with the ministry as of August 1, 2013. In-home PT CCAC reviewing proxy data to identify locations and volumes LHIN met with CCAC Ministry and LHIN CCAC will have providers in place to provide services to all clients receiving OHIP inhome PT by August 1, 2013. LTC Home Ministry discussions with stakeholders Ministry and LHIN LHIN to have amended L-SAA in place by August 1, 2013. Integration of PT into Family Health Care settings Ministry discussions with stakeholders Ministry TBD 16
Part 2 HNHB LHIN Implementation of Physiotherapy Changes - Exercise and Falls Prevention Stream 17
Physiotherapy Changes Exercise and Falls Prevention - Maintaining Seniors Health and Wellness Falls are the leading cause of preventable injuries among seniors with an estimated annual cost to Ontario s health care system of $962 M. 2011-12 HNHB hospitals reported 14,313 emergency room (ER) visits due to falls or 4.7 per 100,000 ER visits higher than the provincial average (4.5)* by residents > 60 years. In 2009-10 the LHIN supported a FP Strategy that focused on the population at high risk for Falls. June 21, 2013, HNHB approved $814,200 base funding for 2013-14 effective August 1, 2013, annualized to $1,221,300 in 2014-15. This approval increases access to publicly funded exercise and FP programs to all seniors. Source: * MOHLTC May 2013 ** Ontario Regional Injury Data Report: South West Ontario, Parachute Toronto 2013 & MOHLTC Physiotherapy June 2013 18
HNHB LHIN Implementation of PT Changes for Exercise & Falls Prevention LHIN Process Review of initial proxy data that identified potential locations of publicly funded exercise and FP programs revealed 23 locations. Initial data limited to classes with > 20 participants. 23 Locations Second analysis that expanded the analysis to classes with > 10 participants identified 68 locations. To confirm locations the LHIN contacted retirement homes known to be located in the HNHB LHIN, Public Health Units, HNHB Community Care Access Centre (CCAC), Municipalities, and other LHIN stakeholders. As of June 21, 138 locations identified. 68 Locations 138 Locations LHIN issued a Request for Proposals for group FP and exercise programs, total of 19 proposals were received. 19
Implementation of PT Changes Exercise and Falls Prevention Continued HNHB LHIN Two Phased Approach: Phase 1 prioritized proposals that replaced existing publicly funded FP and exercise classes Phase 2 proposals for new or expanded exercise/fp programs will be evaluated within the context of available funding. Proposals replacing existing FP and exercise classes were evaluated for: Continuity of provider Geographic area Proposal from non LHIN-funded agencies were assessed for the number of programs proposed and whether a LHIN-funded agency was available to provide the program. Proposal addressed needs of a specific population (i.e. Francophone). 20
Implementation of Physiotherapy Changes - Exercise and Falls Prevention Risks and Mitigation Strategies Risks Mitigation Strategies The LHIN expects, that 100% of the 138 locations identified by the LHIN as of June 21, 2013, will be replaced through LHINfunded agencies with the following caveats: o Availability of funding to support indirect costs. The ministry is working with LHIN s to identify an appropriate rate for indirect costs. The LHIN is working with the ministry to address indirect costs. The LHIN has implemented a two-phased approach and is not proposing to support any new or expanded group FP and exercise programs until existing programs are covered with a projected timeline of September 2013. o o The LHIN cannot confirm that all programs have been identified as these classes may exist in seniors apartment buildings or other congregate settings within the LHIN. The LHIN is unable to identify the number of unique individuals participating until the programs are operated by LHIN-funded agencies. The LHIN will hold back 10% of its allocation as a contingency plan to support the identification of additional publicly funded locations. The LHIN has two providers that have indicated they would be able to provide services at additional sites across the LHIN. 21
Implementation of Physiotherapy Changes - Exercise and Falls Prevention - Opportunities Build on HNHB LHIN s FP Strategy Optimize opportunities to standardize processes and programs Collaborate with the HNHB CCAC to support the transition of clients who would benefit from exercise or FPs following completion of in-home PT treatment in a group setting 22
Changes to Publicly-Funded Physiotherapy Services Aligns with the HNHB LHIN s Strategic Directions Quality Integration Value Dramatically improving the patient experience by embedding a culture of quality throughout the system Dramatically improving the patient experience by integrating service delivery Dramatically improving the patient experience by evolving the role of the LHIN to become health system commissioners 23
The HNHB LHIN will build windmills! 24
Questions? 25