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  • Request for feedback: the 2012-2013 influenza season and influenza planning

    Message forwarded on behalf of the Ministry of Health and Long Term Care, Public Health Division.

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    With the release of the 2013 Ontario Health Plan for an Influenza Pandemic (OHPIP), the ministry is turning its attention to seasonal influenza planning and the scoping the Ontario Influenza Response Plan.  To inform these plans, we are asking health system partners to share their experiences during the 2012-2013 influenza season as well as priorities for influenza preparedness and planning.  The 2012-2013 influenza season was significant in many ways, including its early start.  At the ministry, the 2012-2013 season was the first time the Ministry’s Emergency Operations Centre (MEOC) has been activated to support the health system respond to a seasonal influenza. Survey for health providers and organizations “2012-2013 influenza season – feedback”:

    The surveys will close by August 23rd, 2013.If you have any problems accessing the links below or require the survey in a different format please contact Sarah.Levitt@ontario.ca for assistance.   Click to see a hard copy of the survey for those organizations or groups of providers that wish to review the questions collectively and submit one on-line response. Thank-you for your feedback and support with this initiative, Geri Carroll Director, Emergency Management Branch Public Health Division, MOHLTC

  • ED Advisory Council to develop recommendations for greater budget flexibility and appropriate accountability

    AFHTO’s Executive Director Advisory Council (EDAC) met on July 25 with the main purpose of preparing to respond to the Ministry’s interest in extending greater flexibility for budgets with corresponding improvements in the accountability reporting process.  EDAC’s mandate is to advise the AFHTO board and staff on matters affecting the operations of our member organizations.   Please scroll down further for updates on additional operational matters covered at this meeting. Improving budget flexibility and accountability With the number of funding pressures facing primary care organizations, there is growing interest within the Ministry to grant greater budget flexibility for FHTs and NPLCs (consistent with CHCs) to solve the problems they face, balanced with appropriate accountability for public funds.  The challenge is differing expectations of the extent to which problems could be solved within existing funding envelopes. At AFHTO’s June 3rd meeting with the FHT Unit, held in conjunction with the Association of Ontario Health Centres (AOHC), the Ministry committed to convening a joint AFHTO-AOHC –MOHTLC working group in the fall to begin to understand and address the issues. This EDAC meeting therefore focused on identifying the desired “end state” for FHT budgets, particularly focusing on the implications and specific challenges for FHTs in possibly moving towards global budgets. A number of EDAC members will work over the month of August to review the issues in detail and provide a report at the next EDAC meeting, to be held on August 26. Report back on previous operational issues that had been raised:

    • Audit standards:  MOHLTC confirms FHTs are designated as “not under government control” 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.  The MOHLTC has determined that FHTs cannot be considered to be government not-for-profit organizations. Ministry legal counsel has reviewed the clauses and confirmed that FHTs are not under government control.
    • Blended salary model review:   Because this deals with physician compensation and working conditions, it is an issue for MOHLTC and OMA to address in negotiations process.  AFHTO and AOHC continue to monitor to identify timing/issues for BSM FHTs to be directly involved.

    Resources to be developed and shared with AFHTO members:

    • Preparation for implementation of the Ontario Not for Profit Corporation Act (ONCA): ONCA is currently scheduled to take effect in January 2014.  Introduction has been delayed a few times as the Act continues to undergo revisions.  Once the Act is proclaimed all not-for-profit organizations will have three years in which to conform to the new Act. Once the Act’s requirements are finalized, AFHTO will work with legal experts and FHTs who have already started to prepare for the changes to develop resources and support to ensure that all FHTs can meet the requirements of the revised legislation when it is in effect.
    • Infection control standards and policies: AFHTO will gather resources from FHTs who have developed specific infection control standards and policies and make these resources available to all FHTs by the mid-August.
    • Approach to third party billing: There appears to be wide variations in how FHTs manage the funds that they are receiving from third party billing and in the responses from the MOHLTC coordinators when request to utilize these revenues are made.  Given that physiotherapists will be joining some of our FHTs, the opportunity for revenue from third party billing may increase for FHTs.AFHTO will work with EDAC to develop a common approach to third party billing.

  • AFHTO, AOHC and NPAO’s present compensation recommendations to MOHLTC

    Yesterday the Executive Directors of AFHTO, AOHC and NPAO reviewed their joint report – Compensation Structure for Ontario’s Interprofessional Primary Care Organizations with key members of MOHLTC’s staff – ADMs Susan Fitzpatrick and Suzanne McGurn, Provincial Chief Nursing Officer Debra Bournes, Melissa Farrell (Director, Primary Health Care Branch), Phil Graham (Manager, Family Health Teams Unit), and John Amodeo (Director, Health System Labour Relations and Regulatory Policy Branch).  This report was released on June 17 and was built upon the group’s earlier report – Toward a Primary Care Recruitment and Retention Strategy for Ontario – February 2012. This meeting was the first step in what will be a lengthy, systematic process to develop sufficient political support to induce government to make the policy and funding decisions needed to enable the interprofessional primary care models (AHACs, CHCs, FHTs and NPLCs) to implement the compensation structure our three Associations have adopted.   However, we are working in a time of fiscal restraint wherein current government policy does not allow for new funding to be made available for public sector compensation increases. The purpose of this first meeting with Ministry officials was to brief the Ministry about the methodology and findings with the goal that the Ministry can confirm the credibility of this report.  The Ministry agreed to task an internal technical group to further review the methodology used to develop the recommended compensation structure. They will advise the associations of any concerns by the middle of August.  This is an important first step. While we recognize that the Ministry will not official endorse the report, they will be asked to comment on the validity and credibility of the report internally to the Minister and her staff when this issue is raised. Next the Associations will set up a meeting with the Minister’s staff to review the report, hopefully before the end of the summer.  Following this the process of meeting with key members of the provincial legislature will begin.   We will keep you informed on the timing of these meetings. This report presents indisputable evidence that:

    • Compensation levels in primary care are below market – averaging 15.6% for all non-physician positions, and ranging up to 30% below market.
    • The gap between market and actual compensation is growing – it has increased by an average of 4.9% from 2009 to 2012.
    • Lack of pensions is a key barrier to labour mobility – primary care organizations cannot provide both the HOOPP plan and a reasonable benefits package within the imposed financial limit of 20% of salary.
    • Pay equity challenges are a real risk – two types of positions (registered dietitians and nurse practitioners) have been consistently found to be funded at a salary grade below that of comparable health professions. These positions also post the highest vacancy rates in primary care – 19% and 14% respectively. Health promoters were also found to be in the wrong band.

    Rigorous market study conducted by the Hay Group has established a recommended salary structure. It places all positions into 13 pay bands, with 3 market exceptions. Each band has a recommended salary range and steps for proceeding from minimum to maximum within the range. To access the report and its supporting documentation, please click on the following links:

  • Quality Improvement Decision Support Program Update-2013-07-24

    While FHTs await their 2013-14 funding letters (latest estimate is they’ll be out in 7-10 days), AFHTO has been working with a number of members to help FHTs prepare for implementation of the new Quality Improvement Decision Support Specialist (QIDSS) positions. A provincial lead has been recruited – Tim Burns joined the AFHTO team on July 17. In this role Tim is working closely with FHTs to support them in implementing these new positions and advancing the use of data and performance measurement to improve care. Tim’s role in the QIDS program is to foster collaboration and practice sharing among FHTs, and to help identify and coordinate execution on common priorities.  He will also ensure key partners such as the Ministry, eHealth Ontario, CIHI, HQO and the EMR vendor community are effectively engaged in order to advance FHT measurement and quality improvement capacity. Click here for more  information on Tim’s background; his e-mail address is tim.burns@afhto.ca . Tim has already begun working with a number of FHTs to accelerate implementation.  Earlier this month FHTs recommended by the FHT Unit to host the QIDS Specialist positions were surveyed to explore their implementation needs and invited to participate in preparatory activity.  (Their identities are confidential until the final funding is approved and the letters are released.) Three areas for coordinated action were identified and working groups launched in order to enable teams to move very quickly once the funding is announced:

    QIDS Specialist Recruitment and Screening—to develop a job description and support as needed through the recruitment cycle.

    Orientation and Training—to define immediate learning needs and plan a common curriculum for orientation and professional development.

    Partnership Agreements—-to develop a model Partnership Agreement to clarify the relationship and support effective collaboration among “host” and participating FHTs.

    Once the final Ministry-approved QIDSS allocations are known, AFHTO will convene a QIDSS Steering Committee to provide the collective mechanism for FHTs to advance best practice and optimize performance measurement capacity across the FHT sector.  AFHTO also awaits confirmation of Ministry funding to employ additional provincial resources to foster collaboration and exchange and deliver support services to all FHTs participating in the QIDSS program.  Details are described in the report of our membership consultation Recommendations on the Optimal Configuration of the Quality Improvement Decision Support Specialist (QIDSS) Role.

  • Aug.16 deadline to participate in proposals for expanding IHP services in community

    AFHTO members may be interested in supporting applications from PEM physician groups that are NOT affiliated with FHTs to apply for Ministry funding to integrate IHPs into their primary care service delivery. August 16 is the deadline for these applications. Please see details in the July 19 OMA e-mail below.

    AFHTO has followed up with the Ministry to confirm that proposals from non-FHT PEM groups could include approaches such as:

    • Purchasing IHP services from a FHT, NPLC or other organization
    • Sponsoring a full or part-time IHP position that is employed by a FHT, NPLC or other organization

     

    The Ministry is open to many different approaches – the key theme in the material they’ve posted is service collaboration. This opportunity may be especially valuable for Health Link communities, to provide needed support for patients of physicians who are not in team-based models.

    Take note – the details state:

    The ministry shall pay 100% of the cost of salary and 20% for benefits. Funding is not available to cover associated supplies or overhead costs.

    Existing inter-professional health providers who are currently funded by ministry sources, contributions from sponsors, and/or community partners are not eligible for funding through this program. The ministry is interested in funding new positions or increasing the contribution of existing providers as part of the Inter-professional Health Provider program

    This call for applications stems from a provision in the 2012 Physician Services Agreement.  Another provision in the Agreement will lead to a separate call for applications for time-limited pilot projects on the care of medically complex patients.  This call is expected to go out in the next few weeks.

    —– Forwarded Message —– From: Ontario Medical Association <ontariomedicalassociation@oma.org> Sent: Friday, July 19, 2013 5:44:09 PM Subject: Interprofessional Health Provider Funding Application Info Online

    Interprofessional Health Provider Funding Application Packages Now Available

    To: Primary Health Care Patient Enrolment Model Groups

    The 2012 Physician Services Agreement includes a provision for funding to support the integration of interprofessional health providers into non-Family Health Team affiliated patient enrolment model groups.

    The Ministry of Health and Long-Term Care will provide full salary funding to non-FHT affiliated PEM groups to promote the building of small interdisciplinary and collaborative teams to enhance access to and delivery of quality primary care within their communities.

    The application information package is now available online for member reference: http://www.health.gov.on.ca/en/pro/programs/ihp

    The deadline to submit applications is August 16, 2013 at 5 p.m. Groups selected to receive funding will be advised no later than September 16.

    If you have any questions or require additional information regarding this initiative, please contact the Ministry via email (IHP@ontario.ca) or telephone (613-536-3219), or the OMA at negotiations@oma.org or 1-800-268-7215.

  • Physiotherapy in Primary Health Care settings: Applications Due by July 23, 2013

    The following information was released on June 27, 2013 via e-mail to FHTs, CHCs, AHACs & NPLCs from the Ministry: On April 18, 2013, the Minister of Health and Long Term Care announced that Ontario will be integrating physiotherapists into Primary Health Care (PHC) settings, beginning in the 2013/14 fiscal year. The initial focus of this initiative is focused on the following PHC settings: Aboriginal Health Access Centres (AHACs), Community Health Centres (CHCs), Family Health Teams (FHTs), and Nurse Practitioner Led Clinics (NPLCs). Opportunities to integrate physiotherapy into primary health care organizations will be supported in settings where the focus will be on the inclusion of physiotherapy into existing interdisciplinary primary health care programs. This could include programs related to Lung Health (COPD/Asthma), Cardiovascular Health (Congestive Heart Failure), Diabetes, Healthy Aging etc. Funding is limited in 2013/14 however there will be future opportunities for integration in subsequent years. Click on the links below for the PHC physiotherapy funding application:

    Should your organization wish to apply for PHC physiotherapy funding please submit a completed application by 5:00 pm on Tuesday, July 23rd, 2013 to the following email address:

    phc.physiotherapy@ontario.ca

    To assist with receipt of applications submitted to the ministry, please include in the Subject line:

    2013 Primary Health Care Physiotherapy Application – “(Name/Type of Organization)”

    Sincerely,

    Melissa Farrell Director, Primary Health Care Branch

  • Physiotherapy in Primary Health Care settings: Call for Applications will launch in last week of June

    To assist primary care organizations in preparing proposals to integrate physiotherapists, the Ontario Physiotherapists Association (OPA) has share the following resource document defining the role of physiotherapists in primary care settings:

    The call for applications to integrate physiotherapists into primary care settings should be sent next week directly to all FHTs, AHACs, CHCs and NPLCs by the Ministry of Health and Long Team Care.

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    On Friday, June 14, 2013, AFHTO sent out the notice below from the Ministry regarding the applications process and criteria for successful applications: Following a consultation meeting yesterday with associations representing interprofessional primary care organizations (AFHTO, AOHC and NPAO), the Ministry has providing the following advance notice about physiotherapy to share with our members:

    On April 18, 2013, Minister of Health and Long Term Care (MOHLTC) announced that Ontario will be integrating physiotherapists into Primary Health Care (PHC) settings, beginning in the 2013/14 fiscal year.

    Opportunities to integrate physiotherapy into primary health care organizations will be supported in interdisciplinary Primary Care settings where the focus will be on the inclusion of physiotherapy into existing interdisciplinary primary health care programs. This could include programs related to Lung Health (COPD/Asthma), Cardiovascular Health (Congestive Heart Failure) Diabetes, Healthy Aging etc.

    Successful applications will be those that demonstrate an advanced state of readiness (e.g. mature programs), evidence of collaboration with other primary health care organizations/providers and the impact of physiotherapist integration on patient needs and organizational programming.

    The ministry is planning on running a Call for Applications process for PT integration in 2013/14.  This will be open to FHTs, AHACs, CHCs, and NPLCs.  Please note that the Call for Applications is expected to be released the last week of June from phc.physiotherapy@ontario.ca.  Applicants will be given a fairly short timeframe for completion (approximately 3 weeks).  Please organize accordingly if you are interested in this initiative.

    An information package will be sent along with the Call for Application with additional information.

    From what was discussed at this consultation meeting, AFHTO would encourage all who are interested in integrating physiotherapy into your programs to apply. This will give the Ministry a sense of overall need and interest. The Call for Applications applies to the current fiscal year, and the criteria for successful applications are listed above. The Ministry indicates you will be able to apply for these positions again in future years, through the usual business planning process. While waiting for the Call for Applications, you are encouraged to develop your collaboration ideas with potential partners. The Ministry has stated a preference for joint proposals from groups of providers. This could include partnering with other FHTs, NPLCs, CHCs, AHACs and/or opening up programs to patients in the community who are not rostered/registered to the team. The scope includes requests to approve new PT positions (salary, benefits and appropriate overhead funding) and re-profile existing vacancies. Beyond this the applications are intended to be resource-neutral. You will receive the Call for Applications directly from the Ministry. There will be one central intake and review/approval process for all primary care organizations, regardless of model. If you have questions, you are welcome to contact Clarys.Tirel@afhto.ca (she’ll be back July 2) or Angie.Heydon@afhto.ca and/or your Ministry Consultant.

  • Update on employment of Physician Assistants

    AFHTO members may be interested in the time-limited funding to be made available by MOHLTC in the “Physician Assistant Career Start” program and other news related to the employment of PAs.  Click here to read the memo from Suzanne McGurn, ADM, Health Human Resources Strategy Division, Ministry of Health and Long-Term Care.

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    In case you missed AFHTO’s June 5 e-mail, please click here for the full report of our recent meeting with the FHT Unit. Topics covered:

    • QIDSS implementation: how the allocations have been made and what to expect in their implementation
    • Physiotherapy in FHTs: timing and process to apply for positions
    • Health Links: staffing implications for FHTs that are coordinating and/or taking on care for more patients
    • Changes in Ministry reporting: ensuring FHTs have adequate training and lead time
    • Flexibility and accountability in FHT budgets: finding the way toward greater budget flexibility while enabling the Ministry to ensure good value and appropriate oversight for public funds
    • A number of specific budget pressures:  recognizing that 2013-14 budget packages are already in the approval process, these were noted with the view to improving the situation for the 2014-15 budget cycle
    • Transfer of rostered patients within a group: FHTs are seeking clarification of Ministry policy and application
    • As well as quick updates on other issues.

    These topics zeroed in on the priority issues identified and developed by AFHTO’s ED Advisory Council and Board of Directors, with input from the AOHC CFHT ED Executive group.

  • Letter to AFHTO Members: Nominations to the AFHTO Board open until August 1

    Dear fellow AFHTO members: Are you interested in serving on the AFHTO board of directors? The Governance Committee of AFHTO’s board invites anyone who works within an AFHTO member’s team to apply.

    FOUR people are to be elected for a 3-year term on the 14-member AFHTO board. The AFHTO bylaws call for balanced representation on the board to include the various forms of FHT governance, the regions of the province, and a mix of the professions working within FHTs. Due to existing gaps on the AFHTO board, candidates from eastern Ontario, and from professions other than EDs and MDs are particularly encouraged to apply. The AGM takes place in conjunction with the AFHTO annual conference.  This year it will be held: Tuesday, October 22, 2013 11:30 AM – 12:30 PM The Westin Harbour Castle 1 Harbour Square Toronto, Ontario M5J 1A6 The Governance Committee of the AFHTO board will review all applications to assist the AFHTO board to determine the slate of candidates to recommend to the AFHTO membership for election at the AFHTO annual general meeting. Nominees will be informed of their status by September 20. Following from AFHTO member advice at the last AGM, nominees who are not recommended for the slate can choose whether they wish to proceed with having their name go forward on the election ballot. Please:

    • Click here to read AFHTO’s Nominations and Elections policy.
    • Click here for information on the role and requirements of AFHTO board members.
    • Click here to fill in the nominations form.

    Sincerely, John Stanczyk Chair, Governance Committee AFHTO Board of Directors Pharmacist, Delhi Family Health Team

  • Report from quarterly meeting with MOHLTC FHT Unit, June 3, 2013

    FHT Executive Directors representing AFHTO and AOHC members met with the FHT Unit on Monday.  Topics covered included:

    • QIDSS implementation: how the allocations have been made and what to expect in their implementation
    • Physiotherapy in FHTs: timing and process to apply for positions
    • Health Links: staffing implications for FHTs that are coordinating and/or taking on care for more patients
    • Changes in Ministry reporting: ensuring FHTs have adequate training and lead time
    • Flexibility and accountability in FHT budgets: finding the way toward greater budget flexibility while enabling the Ministry to ensure good value and appropriate oversight for public funds
    • A number of specific budget pressures:  recognizing that 2013-14 budget packages are already in the approval process, these were noted with the view to improving the situation for the 2014-15 budget cycle
    • Transfer of rostered patients within a group: FHTs are seeking clarification of Ministry policy and application
    • As well as quick updates on other issues.

    These topics zeroed in on the priority issues identified and developed by AFHTO’s ED Advisory Council and Board of Directors, with input from the AOHC CFHT ED Executive group. Please click here for the full report from the meeting. This report details the background, updates from the meeting and next steps on each of these items. Understanding the financial constraints within which the FHT Unit must operate, the AFHTO and AOHC group appreciated their openness to involving FHTs, through their associations, to find ways to optimize these scarce resources to deliver the best outcomes possible for patients.  The specific next steps include:

    • Consulting with AFHTO, AOHC and NPAO on implementation of physiotherapy positions in the interprofessional primary care models.
    • Convening a joint working group in the fall, with the aim to implement some initial improvements in the accountability reporting for the 2014-15 fiscal year, and thereby set the stage to enable greater flexibility in use of budgets.
    • Receiving evaluation and recommendations on the QIDSS roll-out from AFHTO’s QIDSS Steering Committee.
    • Giving the opportunity for FHTs, through their association structures, to give input into priorities for funding.

    The meeting participants were:

    • MOHLTC: Phil Graham (Manager, FHTs and Related Programs), Richard Yampolsky (Program Manager, FHT Implementation), Fernando Tavares (Senior Program Consultant).
    • FHT EDs: Randy Belair (Sunset Country FHT in Kenora), John Golanch (Owen Sound and Sauble FHTs), Lynne Poff (North Hastings FHT in Bancroft), Keri Selkirk (Thames Valley FHT in London)
    • Association staff:  Angie Heydon and ClarysTirel (Association of Family Health Teams of Ontario), Sophie Bart and Tara Galitz (Association of Ontario Health Centres).