• Communications role for EDAC
• Issues discussed at the April 29 meeting
  • Operational issues to press with the MOHLTC FHT Unit
  • Input for AFHTO board on broader operational issues
  • Supporting FHTs to address their operational issues
• Next steps to be taken
• List of representatives and their contact information

Communications role for EDAC:

As the key link between their teams and the Ministry’s FHT Unit, EDs are in the unique position to identify the opportunities and challenges with respect to the on-going operations of their FHTs and their interactions with the FHT Unit. The ED Advisory Council builds on the existing ED networks and supports the development of new networks in areas where a formalized network does not exist. Each group of FHT EDs – one for each LHIN and one for each group of FHTs that has distinct needs and perspectives (i.e. FHTs with blended-salary physicians, aboriginal/Inuit FHTs, francophone FHTs, academic FHTs) – was invited to name their representative.EDAC members are asked for their perspective and advice to help in triaging and resolving operational issues identified. The triage process includes determining:

• The potential scope and prevalence of the issue
• The level of action at which action is required: Could it be resolved within the “FHT family”? Is the required action within the MOHLTC FHT Unit mandate? Or, is it a much broader issue that will require influence at a higher level or multiple domains to resolve?

Issues discussed at the April 29 meeting:

Operational issues to press with the MOHLTC FHT Unit:

1. Expanding flexibility in budgets:MOHLTC has introduced greater flexibility in spending in the overhead budget.  What’s the next priority?  Recognizing the Ministry’s duty to ensure value for use of taxpayer funds, what can FHTs do to demonstrate this if the budget were to be made more flexible?2. Streamlining data requirements for quarterly reporting:Are there some aspects of these data requirements that clearly have little to no value and could be eliminated or streamlined?3. Improving quality of data  on orphan patients:Several FHTs in the North East LHIN feel that they are not receiving reliable and consistent information about orphan patients.  Some of the FHTs report that data has been cobbled together from a variety of sources, from census data, hospital admissions, MOHLTC remittance advices and other databases.  Although this may provide a picture, it does not provide accurate information on a consistent basis. FHTs need more adequate information to plan for orphan patients and fulfill MOHLTC expectations for increasing rostered numbers of patients.

Input for AFHTO board on broader operational issues:

The issue of advocacy on compensation was brought forward for information to the group. Almost two years ago AFHTO, AOHC and NPAO began joint advocacy work to address recruitment and retention challenges in interdisciplinary primary care models.In the past number of months three associations have jointly supported a study conducted by the Hay Group to update compensation survey data and to factor in positions that are in FHTs and NPLCs but not in CHCs (e.g. pharmacist). The Hay Group’s report is close to completion, and the approach to advocacy is being discussed among the three associations. This will be brought to each of the three boards for approval.  Communications to members and the advocacy work will begin thereafter.

Supporting FHTs to address their operational issues:

1. QIDSS implementation and QIDSS Steering Committee:In January AFHTO developed the document – Recommendations on the Optimal Configuration of the Quality Improvement Decision Support Specialist (QIDSS) –through a consultation process with AFHTO members. This document provided advice for both FHTs and the Ministry on allocation of the limited number of positions. It also recommended establishment of a provincial committee structure to guide and support information management activities across FHTs, and small number of provincial level resources to support implementation, collaboration and evaluation. The QSC will ensure the work it does benefits all FHTs and will seek active involvement and support from those who lead and work in FHTs. Once the allocation of the QIDSS positions is known, AFHTO will be able to move forward with implementing the QSC.2. Insurance and Home visits:Many more FHTs are introducing home visits as part of the range of services provided to patients, specifically to home bound elderly patients. The question of adequate insurance coverage has been raised, particularly given that many FHTs cannot afford WSIB coverage. AFHTO will seek out FHTs who have resolved this issue and ensure that the information is dessiminate to all FHTs developing home visit programs.3. Designation of FHTs under new auditing standards and payment of Ontario employer health tax:Canadian accounting and auditing standards have gone through some changes. The Accounting Standards Board has decided to pursue separate reporting strategies for each major category of reporting entity: publicly accountable enterprises, private enterprises and not-for-profit organizations.FHTs are very clearly “Not for Profit” organizations, but they also have to determine if they fall under one of two categories: “Not for Profit – private sector” or “Not for Profit – Government Controlled”.  This determination will affect the way that their statements have to be done and changes a few rules, specifically regarding exemption to the Employer Health Tax.FHTs seem to have received differing advice on this issue. AFHTO will seek to respond to this question.4. Physiotherapy in FHTs:MOHLTC announced that Ontario is improving access to physiotherapy services for eligible Ontarians by changing how and where these services are provided.  The Ministry will integrate physiotherapy positions into primary care settings, including Family Health Teams, Nurse Practitioner-Led Clinics, and Community Health Centres. The total number of positions is not yet known. Beginning August 1, 2013, the province will expand availability of community-based physiotherapy, exercise classes and falls prevention services.The Ministry has committed to work with AFHTO when they are ready to begin implementation planning. AFHTO staff will seek input from the EDAC on how to optimize access and capacity for these physiotherapy services within FHTs, for review by the AFHTO board.5. Quality of Care Information Protection Act (QCIPAct):QCIPA is designed to encourage health professionals to share information and hold open discussions to improve patient care, without the fear that the information will be used against them.  Information prepared by or for a Quality of Care Committee is shielded from disclosure in legal proceedings under QCIP Act.   FHTs are not organizations that fall under the jurisdiction of QCIP Act.Some FHTs have done significant work to understand this issue and feel that FHTs should be included under this Act. AFHTO will seek to understand further the implication of FHTs not falling under the jurisdiction of QCIPA, and take action as may be determine by the consultation with the EDAC.

Next steps:

The EDAC members will be communicating with their network to identify operational issues to be brought forward and to seek input into the identified issues. At the next meeting priority and action items will be identified.It was agreed that the next meeting would take place within 4-6 weeks.

ED Advisory Council members and contact information: