Medical associations from coast to coast to coast called on the Ontario government Wednesday to stop its “wrong-headed” approach of imposing fee reductions on physicians.

“Imposing your views on physicians and the public is a leadership style that comes with great risk. Patients expect that governments will work with physicians and that, together, they will put patients' interests first,” the heads of 12 provincial-territorial associations and the Canadian Medical Association said in an open letter to Ontario Premier Dalton McGuinty.

The Ontario government recently made $338 million in fee cuts to move closer to its target of a “real wage freeze” for physicians. More reductions are reportedly in the works.

This past weekend Mr. McGuinty wrote other premiers to urge them to join in the effort of putting a limit on the growth of physician expenditures. According to the Canadian Institute for Health Information, physician expenditures are the fastest-growing component of provincial-territorial government health spending.

"I recognize that each province and territory has its own plans to reform medicare – and each of us has our own starting point for payment arrangements with doctors," he said in his letter Sunday. "But I urge you to consider how we might work together through strong, forward-looking reforms – such as those we are implementing in Ontario."

Dr. Arthur Sweetman, Ontario Research Chair in Health Human Resources at McMaster University, told the Globe and Mail he believes the letter was primarily aimed at Alberta which recently signed a two-year deal with physicians with a 2.5 per cent annual increase in fees.

Alberta Health Minister Fred Horne told the Calgary Herald this week he supports the need to talk about ways to bring fees in line with improving technology which allow physicians to see more patients or perform more procedures. He emphasized that the physician contract (still to be ratified) is a short-term fix. “We have to be discussing these things,” he said.

Ophthalmologists were one of the targets of the Ontario fee cuts. They are reportedly grossing an average of $642,503 and new technology has allowed cataract removals to be done in as little as 15 minutes.

British Columbia is currently in negotiations with physicians over a new contract and reducing the fee for cataract removals is on the agenda. An overhaul of the decades-old fee schedule is also poised to get underway in Nova Scotia.

Nova Scotia Health Minister Maureen MacDonald told the Halifax Chronicle-Herald this week she understands the motive behind Ontario’s actions.

“Part of what I think has triggered Premier McGuinty’s letter to the provinces is a concern that the way we are reimbursing doctors has not kept pace with the changing realities of practice.”

But physicians are warning that Ontario will pay a steep price for cutting physicians’ pay. On Tuesday, the Coalition of Family Physicians and Specialists of Ontario (COFPS) urged physicians in the province “to explore options in more hospitable practice jurisdictions.”

“Since the beginning of medicare, nowhere across Canada have physicians been under such disgraceful public attack by its provincial government,” COFPS President Dr. Douglas Mark said in a news release. “In addition, no other province has laws that give it the power to unilaterally alter physician funding at will as is the case here in Ontario.”

Last Thursday, Ontario Medical Association President Dr. Doug Weir, standing on the bank of the Detroit River in Windsor, told reporters the U.S. faces a shortage of over 90,000 physicians in the next decade and predicted that Ontario will be prime recruiting ground.

In an opinion piece published in the Toronto Star Monday, Ontario Health Minister Deb Matthews defended the need to make the fee cuts and said the government is anxious to “get back to the negotiating table so we can focus on better access to patient care, including more access to same-day/next-day appointments and after-hours care.” HE

Ontario is being asked to beef up the number of direct-care staff in long-term care facilities to curb problems of resident abuse.

This is one of 18 recommendations made in a report Wednesday by the Long Term Care Task Force on Resident Care and Safety. It was formed last November by a number of organizations representing owners, operators, residents and their families to respond to media reports of incidents of abuse and neglect at the province’s 634 long-term care homes.

Eleven of the report’s recommendations focus on areas where the long-term care sector can take a leadership role. This includes making prevention and zero tolerance of abuse and neglect their number one priority over the next year.

The health ministry is being called on to not only increase the number of direct-care staff but address the need for specialized facilities and dedicated units within long-term care homes for residents with complex needs including dementia.

The Ontario Nurses Association, which participated in the work of the task force, said in a news release this week that most long-term care facilities are not designed to safely manage residents suffering from cognitive impairment or mental/development illnesses.

“They are simply not able to safely house these residents without risks to other residents and staff, and yet they’re often placed in these homes because there is nowhere else for them to go,” ONA President Linda Haslam-Stroud said in the release.

More than half the 2,773 cases of alleged abuse in 2011 involved clashes between residents.

Health Minister Deb Matthews told the Toronto Star this week she would take a close look at the recommendation to create specialty units, and she indicated that she will move forward on another recommendation to set up coaching teams to help poor-performing homes improve resident quality and safety. However, she is not making any commitments about new funding.

The recent budget contained a modest 2.8 per cent increase for the long-term care sector with just one per cent more for direct care costs.

An Action Plan to Address Abuse and Neglect in Long-Term Care Homes can be found at http://longtermcaretaskforce.ca. HE

Early detection of mental health issues is a goal of Nova Scotia’s new mental health and addictions strategy, and will include mental health clinicians working in about 80 per cent of the province’s schools.

The strategy, unveiled Wednesday, contains 33 measures which were recommendations in the report of an advisory committee last month.

The five-year plan, the first of its kind for the province, contains $5.2 million in new funding of which $1.4 million will be used to place an unspecified number of psychologists, nurses and social workers in schools.

Other measures include extending the existing toll-free crisis line across the province, as well as expanding peer support programs and a telephone coaching service for families of children with behavioural or anxiety issues.

Together We Can: The Plan to Improve Mental Health and Addictions Care for Nova Scotians can be found at www.gov.ns.ca/health/mhs/mental-health-addiction-strategy.asp. HE

On Thursday, Manitoba Health Minister Theresa Oswald tabled a plan with three pillars to protect universal health care: healthier Manitobans (including tobacco reduction, injury prevention and increased access to screening), better health services (expanding home care and ensuring all Manitobans have access to a family doctor) and better value.

The last component includes the recent announcement to reduce the number of health regions from 11 to five. It will also involve limiting corporate spending and improving financial accountability. In addition to this, the government plans to “aggressively” expand bulk purchasing, ensure fair prices for generic drugs, reduce workplace injuries, and continue to hire alternate health care providers such as physician assistants.

The plan can be found at www.gov.mb.ca/health/plan.html. HE

The Canadian Life and Health Insurance Association (CLHIA) has questioned forecasts of private insurers’ drug spending that were contained in the recent Canadian Institute for Health Information report, Drug Expenditures in Canada, 1985 to 2011.

The report provided actual data on drug spending by different public and private sector sources up to 2009 as well as forecasts for 2010 and 2011. It said private insurer drug spending rose by an estimated 6.4 per cent in 2010 and 7.2 per cent in 2011.

But the forecasts for private insurers “are completely incorrect,” according to CLHIA. Actual drug spending by its member companies went up by only three per cent in 2010, and “early indications are that the drug cost trend will be either flat or slightly declining” in 2011.

CLHIA recently met with CIHI to discuss its concerns, and in an email to Health Edition this week it said “new processes will be put into place between the private payers and CIHI to avoid similar mistakes going forward, and CIHI will be working to correct the record on this matter in the short term, prior to the release of their 2013 report.” HE

Self-management support for Canadians with chronic health conditions should be a routine part of primary health care delivery, the Health Council of Canada says in a report this week. Self-management support includes education and health coaching and is key to ensuring patients manage their health successfully, the Council says. It will also help save money and keep patients out of hospital. Chronic disease in Canada costs more than $90 billion a year in lost productivity and health care costs. With half of all Canadians reporting at least one chronic condition, these costs will continue to rise. The report is at http://healthcouncilcanada.ca/rpt_det.php?id=372.

The Saskatchewan International Physician Practice Assessment (SIPPA) has been fully implemented, Health Minister Don McMorris has announced. Previously, some international medical graduates (IMGs) were limited in their opportunities to practice in the province because of their country of training. Now family physician IMGs from all countries will be assessed as long as they meet the licensure criteria. SIPPA is expected to allow 90 IMGs to be assessed each year versus 55 under the old system. (Regina Leader-Post, May 17; News release at www.gov.sk.ca/news?newsId=0e98d820-8d26-4efe-a32e-2afec3af9c06)

The time has come for activity-based hospital funding, a report Thursday from the Montreal Economic Institute says. The concept has been endorsed by both the director general of the McGill University Health Centre and the Quebec Association of Health and Social Services Institutions (AQESSS). The government has also set up a three-person expert panel to evaluate different activity-based funding methods with a view to start implementing pilot projects in the spring of 2013. The report can be found at www.iedm.org/files/note0612_en.pdf.

Quebec is changing legislation governing the health premium which collects over $1 billion a year from taxpayers. The money goes into a special fund called the Fonds pour le financement des établissements de santé et de services sociaux (FINESSS). The changes are contained in budgetary legislation (Bill 73) tabled by Finance Minister Raymond Bachand Tuesday, and broaden the scope of what the FINESSS money can be used for including family medicine groups, improvement of home care and training of nurse practitioners. However, it basically allows it to be used for any initiative to maintain the accessibility and quality of health and social services or improve system performance. (La Presse, May 17; Hansard)

Ontario’s cancer system could be more responsive to patients according to the 2012 Cancer System Quality Index released Wednesday. It said more could be done to improve the patient experience and help them navigate the system. Wait times for surgery and radiation treatment have improved, but gaps in equity of care exist. (Toronto Star, May 16. More at www.csqi.on.ca)

Registered nurses in Nova Scotia are looking for the same wage increase as those working at the Capital Health District in Halifax who are represented by a different union. Last year, the latter received a 7.1 per cent increase over three years from an arbitrator. Their colleagues in the rest of the province, who have been without a contract since the end of last October, are threatening strike action if they do not get the same deal. (Halifax Chronicle-Herald, May 16; CBC, May 15)

Doctors across Canada this week protested the federal government’s plan to curtail health benefits for refugees. The protests included a sit-in by some 90 Toronto-area physicians at the constituency office of Cabinet minister Joe Oliver. The Interim Federal Health Program offers temporary health insurance to refugees and claimants who are not eligible for regular provincial or territorial coverage. As of June 30, it will not include coverage of supplemental health care services, including prescription drugs, dentistry, vision care and mobility assistive devices. Immigration Minister Jason Kenney says the supplemental benefits are more generous than what Canadians themselves are getting, and will remove an incentive for people to file a fraudulent refugee claim. It will also save the government about $100 million over the next five years. However, Dr. Paul Caulford, a Toronto doctor who participated in the sit-in, told the CBC he cannot understand how the government “can take the most vulnerable of people and decide it's appropriate to make them more vulnerable.” (Toronto Star, May 12; CBC, 11)

Elections for positions on the boards of New Brunswick’s two health regions were held Monday. Upwards of nine candidates, representing people in 16 geographic zones, were vying for one of eight positions on each board. It is the first election of board members since 2008. Elections were abolished in 2009. Now eight members of each board are elected and seven appointed by the health minister. One of the successful candidates in Monday’s election was Mary Schryer, the former Liberal health minister, who was defeated in the September 2010 provincial election. (New Brunswick Telegraph-Journal, May 15)

The Toronto Star (May 11) says the changes made by the Ontario government to the physicians’ fee schedule “painful as they are, will be just the beginning” as the government continues to look for savings in its fight to eliminate the deficit. But the Star is concerned about the “unhelpful rhetoric” on both sides of the debate about the fairness of the fee cuts. “No one can afford to lose sight of the long-term agenda to fundamentally reform Ontario's health system.”

In a letter-to-the-editor of the Star (May 11), Dr. Doug Weir, president of the Ontario Medical Association, says the fee changes made by the government are counterproductive. “We all need to work together to find systemic long-term solutions, not short-term cuts, that will inevitably come back to haunt us. Maligning physicians and pretending they're responsible for all the ills in the system is irresponsible.”

Last week, a Quebec legislative committee completed its review of Bill 59 (An Act respecting the sharing of certain health information) and concerns were raised by some presenters about the security of personal information on electronic health records. Le Soleil columnist Brigitte Breton (May 14) says the health minister needs to tighten up security provisions in the bill “so health files become invaluable tools for health professionals, and not incomplete documents which nobody dares trust because of overarching doubts about their contents and use.” She says that if patients fear disclosure of details about their private life they will refuse to be part of the electronic health record.

In the Saskatchewan legislature over the past week, Health Minister Don McMorris has been questioned about surgical wait times in the Regina Qu’Appelle Health Region. He admitted there are concerns, and has asked the management of the region to report back on steps they will be taking to address the issue. Health Critic Cam Broten said eight operating rooms in the region are functioning at full capacity only two days a week, and nine at full capacity only three days a week.

Last Thursday, he also said “Doctors are worried that if they speak up and advocate for their patients, this could have an effect on the availability of operating room time.” However, Mr. McMorris said “Nothing could be further from the truth” and the input of surgeons is needed.

This Wednesday, the Saskatchewan Medical Association and the Regina Qu’Appelle Medical Association issued a news release saying there is no evidence of any punitive action, but they added that physicians in the region are “extremely frustrated that the ORs are not functioning to their capacity.” As part of the Saskatchewan Surgical Intitiative, the goal this year is to reduce all surgical wait times to less than six months and be just three months by 2014.

In the New Brunswick legislature last Friday, Social Development Minister Sue Stultz was asked about the government’s announcement that nursing home rates are going up from $95 to $113 a day over the next three years. She said the change will only apply to those (about 800 people) who can pay the daily fee and the rest will continue to be subsidized. Social Development and Seniors Critic Bernard Leblanc asked how much of the additional revenue will go toward achieving the government’s promise to boost the average daily number of hours of direct care per resident from 3.1 to 3.5. Ms. Stultz indicated that the matter is still under study.

In the British Columbia legislature last Thursday NDP Health Critic Mike Farnsworth asked when the government will make good on its promise to create a Seniors’ Advocate. Health Minister Mike de Jong said consultations are set to begin “to ensure that the mandate that is identified for the seniors’ advocate is one that enjoys the broad support of seniors’ organizations and seniors themselves right across British Columbia.”

While a number of legislatures are wrapping up their spring sessions, the Alberta legislature will be back next Wednesday with a Speech from the Throne.