This risk assessment tool is a simple matrix that helps boards to systematically identify, assess and manage risk in their FHT. This is in Word format so you can download and use it in your FHT. A completed matrix is also posted as a PDF file to serve as an example of how the tool can be used.
The 2012 AFHTO Conference is all about “Demonstrating and Celebrating the Value of Family Health Teams.” To help us do this, AFHTO is launching “Bright Lights” – a brand new program to recognize the leadership, outstanding work and significant progress being made to improve the value delivered by Family Health Teams. The conference is being developed around a set of themes that, individually and in combination, advance the value of Family Health Teams. For each of these theme categories, one or two notable “Bright Lights” will be selected to be recognized at the conference’s Celebration Dinner, October 16. Nominations for “Bright Light” awards will be reviewed by the Program Working Groups; the Awards Committee will make the final selections based on their recommendations.
Access the online form to nominate a Family Health Team or an individual for recognition as a “Bright Light”. Access the Health Promotion and Chronic Care form to nominate someone in the Best Practices in Health Promotion and Chronic Care category and an opportunity to attend the Institute for Healthcare Improvement Conference on April 7-9, 2013, in Scottsdale, Arizona. Deadline for “Bright Light” nominations is September 4, 2012
The central goal of the 2012 Ontario Budget is captured in the title of its news release: “A Plan to Balance the Budget, Create Jobs, Protect Education and Health Care.”
The 2012 Budget reiterates the Action Plan commitments to expand same-day and next-day appointments and after-hours primary care, to integrate planning for primary care into LHINs. It also references plans to introduce reforms to enable LHINs to promote a seamless coordination of treatment and continuing focus on reducing Alternative Level of Care (ALC). It once again mentions accelerating “the evidence-based approach to care by building on the mandate of Health Quality Ontario (HQO) to provide recommendations to direct funding to where evidence shows the greatest value, without compromising access to services deemed medically necessary.” It gives no additional details on these commitments. Public-Sector Compensation The budget states government’s intention to hold the line on compensation for physicians (noted above) and public sector unions (while respecting collective bargaining), and extending the pay freeze for executives at hospitals, universities, colleges, school boards and agencies for another two years. It states, “The government expects its partners to consider not only current and future compensation, but also those aspects of collective agreements that enhance productivity and facilitate public sector transformation.” It also states, “Where agreements cannot be negotiated that are consistent with the plan to balance the budget and protect priority services, the government is prepared to propose the necessary administrative and legislative measures.” For FHTs that are able to offer the HOOPP or any other public sector pension plan, note that pension changes will be introduced to reduce employer obligations to fund pension deficits or otherwise add to employer and taxpayer expense, beyond what has already been agreed.
AFHTO’s Operational Issues Working Group met yesterday (March 6) with Mary Fleming, Director of Primary Health Care Branch; Richard Yampolsky, Program Manager, FHT Implementation; Gayle Barr, Senior Program Consultant; and Erin Weinkauf, Program Analyst. Flexibility in Operating Plans and Budgets The need for greater flexibility, consistency and transparency in budgets was the central theme throughout the meeting. The Ministry confirmed:
The Ministry is open to considering a more sustainable approach to funding IT hardware replacement. AFHTO has committed to looking at methods used in other sectors and developing a proposal. Additional volunteer assistance is welcome. Ministry Policy Priorities: Integrating Primary Care into LHINs: MOHLTC continues to confirm there will be consultation as this process unfolds. MOHLTC has not yet named a lead branch for this initiative. After hours care: The Ministry is not releasing results to date from the first 3 years of the 5-year FHT evaluation study, however we are told they indicate significant improvement needed in delivering after hours care. The comments may have been prompted by the just-released ICES study – Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Dept Use. It found that FHTs, FHNs and FHOs had patient populations with higher-than-expected ED visits, whereas FHGs and CHCs had lower-than-expected ED visits. AFHTO will be examining this question more closely. House calls: Increasing house calls was part of government`s campaign promise, and FHTs are expected to do their part. A number of Toronto FHTs are part of the `Bridges` pilot to test implementation models. The issues of travel support and reduced number of client visits have been identified to date. AFHTO will be monitoring. Additional updates: NPAR: Evaluation is expected to be completed in late May. No further expansion will take place till after that date. Streamlining quarterly data collection: FHT Unit is committed to doing this and will consult with the relevant associations in the near future. Post comments on ED Collaborative Space: FYI – Briefing notes presented at this meeting are posted on AFHTO’s ED Collaborative Space. (FHT EDs received a username and password on February 24. Contact info@afhto.ca if you need help.) Use this space to ask questions and compare notes with your peers. AFHTO collaboration on operational issues with the AOHC CFHT group: AFHTO is committed to strengthening the voice for all FHTs – 93% of which belong to our association today. A number of community-governed FHTs belong to both AFHTO and the Association of Ontario Health Centres. With AOHC support their CFHT group has tackled a number of operational issues with the FHT Unit. AFHTO`s Operational Issues Working Group and the AOHC CFHT group have come together to meet jointly with the Ministry to deliver well-developed, consistent messages. The briefing notes posted on AFHTO’s ED Collaborative Space (see above) are the result of our combined work. Through AFHTO’s CFHT rep, Michelle Karker (contact info below), CFHTs will receive an update on discussions regarding the Blended Salary Model in the near future. Thank you to AFHTO`s Operational Issues Working Group The Operational Issues Working Group members volunteer their time and leadership on behalf of all FHTs. Each one is the “point person” for a group of AFHTO members and is interested in hearing from you through the ED Collaborative space or via e-mail.
Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement. Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary. Primary care recruitment and retention: Letter to Premier and Finance Minister The Ontario Government has not yet declared whether it will extend the Public Sector Compensation Restraint Act beyond its current expiry date of March 31. As part of our joint advocacy to address the challenges in recruiting and retaining qualified staff in primary care, AFHTO, in partnership with the Association of Ontario Health Centres and the Nurse Practitioners Association of Ontario, has sent a letter to Premier McGuinty and Minister Duncan urging Government to avoid extending this freeze on compensation and for immediate action to enable the HOOPP pension plan to be offered to primary care staff. Click here to read the letter. Support for 2012-13 Operating Plan development On Friday FHT EDs received a link, username and password to an online platform for FHT EDs to raise issues, ask questions of their peers and discuss potential solutions in a safe and secure environment. You are welcome to provide input for AFHTO’s March 6 meeting with the Ministry’s FHT Unit on common operational issues. This is an initial pilot to support FHTs in the Operating Plan submission process. As we learn from this collaborative space the approach will be fine-tuned and spread to support communication and collaboration among all team members across Ontario’s FHTs. Click here for a brief video (under 2 min.) on how to make the most of this collaborative space. If you are a FHT ED and did not receive your username and password please contact Sal Abdolzahraei at info@afhto.ca. New resources to help FHTs implement AODA Click here for templates, a checklist and additional resources to assist FHTs in meeting requirements of the Accessibility for Ontarians with Disabilities Act, 2005 (AODA). Template documents may be edited to match individual FHT branding and accessibility requirements. As of January 1, 2012, FHTs must comply with the first standard – Customer Service. (If you require your login information for the Member’s Only website please contact info@afhto.ca) Health Equity: tools and resources for program development If your FHT is doing strategic planning and/or program development, the following resources may be helpful. The Health Equity Impact Assessment (HEIA) tool is one part of the repertoire of equity-driven planning tools. It analyzes the potential impact of service, program or policy changes on health disparities and/or health-disadvantaged populations. It can both help to plan new services, policy development or other initiatives or assess existing programmes. The Wellesley Institute has health equity resources available on their website focused on operationalizing health equity strategies. Resources include a Health Equity Impact Assessment Tool, evidence based planning tools, sample equity strategies from LHINs, and more. Feedback survey on Provider Education Tools of the Ontario Breast Screening Program Cancer Care Ontario (CCO), in partnership with the Centre for Effective Practice (CEP), developed Provider Education Tools for healthcare providers (family physicians, nurse practitioners, genetic counsellors, radiologists) to support the changes to Ontario Breast Screening Program (OBSP). The CEP is conducting an online survey to evaluate the Provider Education Tools. This survey will take approximately 7 minutes to complete. All individual responses will remain confidential. The survey results are analyzed in aggregate only, such that you cannot be identified in any way. Please complete the survey here: https://www.surveymonkey.com/s/OBSP If you would like more information or have any questions, please contact Mary Clelland-Dube at 416 260-7885 or mary.clelland-dube@effectivepractice.org. AFHTO membership renewal invoices will go out March 1 For FHTs that may have funds remaining in their general overhead budget, AFHTO membership renewal notices will go out on March 1. If you want to use funds remaining from other overhead lines to pay for your FHT’s membership renewal, the FHT Unit has confirmed you must speak to your Ministry Rep first.
The Ontario Government has not yet declared whether it will extend the Public Sector Compensation Restraint Act beyond its current expiry date of March 31. As part of our joint advocacy to address the challenges in recruiting and retaining qualified staff in primary care, AFHTO, in partnership with the Association of Ontario Health Centres and the Nurse Practitioners Association of Ontario, has sent a letter to Premier McGuinty and Minister Duncan urging Government to avoid extending this freeze on compensation and for immediate action to enable the HOOPP pension plan to be offered to primary care staff. Click here to read the letter.
Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement. Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary.
Outcome of AFHTO-AOHC-NPAO meeting with ADM on primary care recruitment & retention This morning representatives of our three associations met with senior Ministry staff to review the findings and recommendations of our joint report – Toward a primary care recruitment & retention strategy for Ontario. (See details below). Ministry attendees included three members of MOHLTC’s Health Human Resources Strategy Division – Suzanne McGurn, ADM; Jeff Goodyear, Director, HHR Policy; and Debra Bournes, Provincial Chief Nursing Officer – as well as Phil Graham, Manager of the FHT Unit in Negotiations and Accountability Management Division. The ADM and Ministry staff were receptive to the report. They welcomed the information it contained, saying it validated a number of issues being looked into by the Health Human Resource Strategy Division. They particularly appreciated seeing the three associations representing all interprofessional models of primary care delivery working jointly on this issue, and doing so from the perspective of strengthening all of these primary care organizations. Two statements from the ADM stand out – “there is no disagreement with the principles in the report” and “timing is the big issue”. The key constraint is the province’s need to rein in spending. While the Drummond report does not endorse a continuation of public sector wage restraint (it suggests that broader public sector employers and bargaining agents should be responsible for bargaining outcomes and bear responsibility for delivering value for public money), there remains the possibility that public sector compensation restraint could be continued past March 31. The Ministry representatives clearly understand that the inability of primary care organizations to offer both the HOOPP pension plan and reasonable benefits creates significant disadvantage in competing for staff with other parts of the health system. While the likelihood of funding increases for compensation in the next fiscal year is very small, the Ministry has agreed to look into the idea of giving greater flexibility to allow primary care organizations to go beyond the 20% cap for pension and benefits, within their current overall budgets. Immediately after this meeting we briefly touched base with Shawn Kerr, Policy Advisor for primary care in the Minister’s Office and will meet with him in the near future to discuss more fully. As always, we will keep our members informed. For further information, please view past AFHTO, AOHC and NPAO message to members:
The statement above appears on p.24 of the 543-page Drummond Commission report, released this afternoon. Consuming over 40% of the province’s budget, health care receives much attention in this report (pp.145-202). There are a number of recommendations that are specific to FHTs/primary care, and are pasted below. AFHTO is pleased to see some of the themes in its submission to the Drummond Commission reflected in these recommendations. For the report overall, the Globe and Mail has identified three themes that run throughout: “One is that government decisions should be “evidence-based.” Another is integration, which is to say fewer silos and more co-operation between people working toward the same goal. A third is that the public service should be more of a meritocracy, where productivity is rewarded and a lack of it is punished.” For health overall, the Commission sets a target of a 2.5 per cent annual increase in health care funding by the province, which implies that real inflation-adjusted spending per person on health care will have to FALL by 0.8 per cent per year. This requires significant reform to the system, and so the first recommendation for health calls on government to develop and publish a comprehensive plan to address health care challenges over the next 20 years. (#5.1) At the system level it also calls for integration of all health services in a region, including FHTs, FHOs, etc. under the LHINs (#5.5). It also includes public health, moving it out of the municipalities (#5.78 – 5.81), and reducing the number of organizations with which the LHINs must deal on a day-to-day basis by forming merged leadership and boards, or physically by forming merged agencies (#5.12). LHINs would be granted the authority, accountabilities and resources necessary to oversee health within the region, including allocating budgets, holding stakeholders accountable and setting incentive systems for primary care (physicians), acute care (hospitals), community care and long-term care (#5.27). Performance pay targeted to health outcomes would apply to CEOs and senior executives in all parts of the health care system and be mirrored at the physician and health care worker levels (#5.28). Where feasible, services should be shifted to lower-cost caregivers working to full scope of practice (#5.18) and all back-office functions such as information technology, human resources, finance and procurement would be centralized across the health system (#5.95). Recommendations specific to FHTs/primary care: Case Management Recommendation 5-32: Empower primary caregivers and physicians in the Family Health Teams (FHTs) or specialized clinics to play the role of “quarterback,” tracking patients as they move through the integrated health system. All FHTs should work in tandem with clerical system navigators and hospitalist63 physicians to track their patients who are in hospitals, from admission to discharge (see Recommendation 5-55 on hospitalists for more details). Recommendation 5-37: Complex care patients should be managed through interprofessional, team-based approaches to maximize co-ordination with Family Health Teams and other community care providers. Hospitals Recommendation 5-52: Create policies to move people away from inpatient acute care settings by shifting access to the health care system away from emergency rooms and towards community care (i.e., walk-in clinics and Family Health Teams), home care and, in some cases, long-term care. Recommendation 5-55: Use hospitalist physicians to co-ordinate inpatient care from admission to discharge. Hospitalists should work with Family Health Teams to better co-ordinate a patient’s moves through the health care continuum (acute care, rehabilitation, long-term care, community care and home care). Physicians Recommendation 5-56: Make primary care a focal point in a new, integrated health model. Recommendation 5-57: Regional health authorities must integrate physicians into a rostered health system and adopt the appropriate measures to address compensation issues across disciplines; that is, the proper blend of salary/capitation and fee-for-service. The primary goal for physician performance should be prevention and keeping people out of hospitals. Collective administrative support would allow physicians to concentrate on providing better care, a value proposition that should appeal to them. Recommendation 5-58: Reduce the sole proprietorship nature of the offices of many primary care physicians and encourage more interdisciplinary integration through performance incentives and accountability. Recommendation 5-59: Compensate physicians using a blended model of salary/capitation and fee-for-service; the right balance is probably in the area of 70 per cent salary/capitation and 30 per cent fee-for-service. Physicians’ compensation, and especially performance pay, should be linked to positive health outcomes that are linked to strategic targets, not to the number of interventions performed. Recommendation 5-60: Aggressively negotiate with the Ontario Medical Association for the next agreement. The government must be very strategic in its objectives to ensure the promotion of a high quality care system that runs efficiently. Since Ontario’s doctors are now the best paid in the country, it is reasonable to set a goal of allowing no increase in total compensation. However, the negotiations must go well beyond compensation. They must also address the integration of physicians into the rest of the health care system and the objective of working towards the best possible health quality regime. Recommendation 5-61: Adjust fee schedules in a timely manner to reflect technological improvements, with the savings going to the bottom line of less expenditure on health care. Technological improvements often reduce the time required for procedures. Will Falk has recently pointed to the example of radiology, where government investments, including those made through the Canada Health Infoway program, have resulted in vast productivity improvements. Despite the fact that these improvements have drastically reduced the time it takes to diagnose (and hence greatly increased the volumes of diagnoses that can be made in any given day), the fee schedule has not been adjusted to reflect these effects.64 Recommendation 5-62: Make Family Health Teams (FHTs) the norm for primary care and design the incentive structure of physicians’ compensation to encourage this development. Among the key characteristics of FHTs are the following:
Recommendation 5-63: Require Family Health Teams (FHTs) to accept patients who choose them, and the FHTs should work with each patient to connect them with the most appropriate constellation of care providers. Recommendation 5-64: The regional health authority should establish incentives to discourage Family Health Teams from referring patients to acute care. Recommendation 5-65: Regional authorities should also be responsible for assigning heavy users of the health care system to the appropriate Family Health Team (FHT). If, for example, there are 300 heavy users within a region and three FHTs, the regional health authority would try to steer 100 to each, so that no FHT is overburdened. Recommendation 5-66: Because Family Health Teams (FHTs) will be responsible for patient tracking, they will need to build a critical mass of an administrative arm to carry out this task. This administrative arm should be shared among a number of FHTs. Recommendation 5-67: Better after-hours care must be offered and telephone/Internet services should direct patients to the most appropriate and convenient care provider. Recommendation 5-68: All Family Health Teams must be encouraged to add more specialists to their teams, which will reduce referrals and ease some of the complexities of patient tracking. Recommendation 5-69: The Ministry of Health and Long-Term Care should allow the flexibility necessary for Family Health Teams to share specialists by permitting part-time contracts. Recommendation 5-70: All Family Health Team physicians must begin engaging in discussions with their middle-aged patients about end-of-life health care. Recommendation 5-71: Improve access to care (e.g., in remote communities) and productivity for specialists by triaging appropriate patients for telemedicine services (e.g., teledermatology, teleophthalmology). Recommendation 5-72: Remove perverse incentives that undermine the quality and efficiency of care. For example, physicians are penalized when one of their patients goes to another walk-in clinic, but not when the patient goes to the emergency department of a hospital. More generally, the fee-for-service compensation model gives an incentive for medical interventions without due consideration to quality and efficiency of care. Such incentive issues must be addressed by focusing the Ontario Medical Association’s negotiations more on quality of care and amending payment systems for physicians and throughout the health care system. Recommendation 5-73: The model described in the above recommendations must be supported by a robust data collection and sharing system that allows the creation of the necessary records. For example, the model works only if we know how many patients are not visiting emergency departments or how many diabetes patients are not experiencing complications (see Recommendations 5-17 and 5-50 on Health-Based Allocation Model data for more details).
Three weeks remain to submit presentation abstracts and award nominations for AFHTO 2012 conference – Demonstrating and Celebrating the Value of Family Health Teams.
Click on the links below to:
This year the call for presentation abstracts may be of particular interest to Pharmacists and Mental Health/Social Workers. Leaders from these two IHP groups have come forward to put together interdisciplinary presentations that have particular focus on, respectively, medications and mental health.
Contributing to the AFHTO conference in any of these ways gives you the opportunity to showcase the value of FHTs and promote the conditions to build on that value. It also gives you the personal opportunity to use your leadership skills, learn more from your peers, strengthen your personal network across FHTs, and receive greater recognition across the FHT community.
Key dates: