Ultimate Blogging Championship

Tag: Members Only News

  • EDAC Update: background on 2013/14 budget reduction and input on future budget flexibility

    AFHTO’s Executive Director Advisory Council (EDAC) met on August 26 with the main purpose of preparing for the quarterly meeting with the FHT unit later in September. At the same meeting, EDAC invited Phil Graham, (manager, Family Health Teams & Related Programs, Primary Health Care Branch) and Fernando Tavares (program manager) to clarify the context and the process for 2013/14 budget adjustment experienced by many FHTs. EDAC’s mandate is to advise the AFHTO board and staff on matters affecting the operations of our member organizations. Budget Reduction in 2013/14: Phil Graham, manager of MOHLTC’s FHT Unit, gave EDAC the following background on the ministry’s decisions to adjust the budgets of a number of FHTs:

    • In a managed-growth budget environment, the MOHLTC wants to maximize the use of existing dollars available within the FHT program.
    • In reviewing expenditure trends over the past three years, the MOHLTC determined there is on average a ~12% gap between what is allocated by the ministry and what is spent by FHTs. This means that $20-$40 million has been recovered following the end of each fiscal year.
    • Based on this data, the ministry undertook a budget right-sizing effort to bring the ministry’s allocation in better alignment with FHT expenditures. This included a 0.5% base funding adjustment for FHTs with budgets between $1-$2 million and a 1% base funding adjustment for FHTs with budgets in excess of $2 million. FHTs with budgets less than $1 million were not impacted by this adjustment nor were FHTs who were utilizing their full allocation.
    • The ministry also looked at Specialist Sessional funding and found that this area in particular was considerably underspent. Adjustments were made to Specialist Sessional funding based on historical trends.
    • Looking forward, this adjustment will help to enhance financial flexibility for other FHT initiatives and to address service needs.

    A total of 105 out of Ontario’s 185 FHTs experienced this adjustment. While each of these FHTs received notice of the reduction to their own FHT’s budget, based on the feedback received, the communication process will be improved in the future. Phil acknowledged there may be some gaps that have resulted from this approach, particularly but not exclusively related to Specialist Sessional adjustments. To ensure that the budget reductions do not impact negatively on service delivery, he noted that the Ministry coordinators have been instructed to be flexible and to work with FHTs on a case-by-case basis to free up funds within the approved FHT budget. Other options will be considered if solutions can’t be found within the FHT’s current budget.  He also confirmed the Ministry is looking at enhancing budget flexibility in future years, to give FHTs greater ability to manage their budget to meet patient need. Preparation to address Budget Flexibility and Accountability with MOHLTC: The ministry’s interest in greater budget flexibility is welcome news for FHTs, however the question for FHTs is, what is the “desired future state” to aim for?  To help answer this question, a group of EDAC volunteers looked into the advantages, constraints and risks associated with global budgets. Having reviewed and discussed the issues, EDAC members are recommending to the AFHTO Board the following position to take in discussions with the FHT Unit:

    • A global budget divided into “two buckets”, one for HR and the other for operations.
    • The HR “bucket” should allow for complete flexibility in determining the positions.
    • A provincial salary grid for each position should continue to be enforced to avoid unproductive competition for staff.  (AFHTO continues to join with our primary care partners in advocacy for a more competitive primary care compensation structure.)
    • Ask MOHLTC for clarity on existing funding formulas, in order to understand and advise on ways to ensure global budgets remain current with service needs and market conditions.

    Accountability for wise use of the funds goes hand-in-hand with the desire for greater budget flexibility; EDAC will engage in further discussion on this topic. Agenda items for the quarterly meeting with the Ministry FHT unit: The EDAC members are recommending the following agenda items for the September meeting with the MOHLTC FHT unit:

    • Preparing for the 2014/15 Budget process
      • Budget flexibility is a particular focus
    • Current fiscal year budget issues
    • Request for updates on:
      • Transfer of Rostered patient issue
      • QIDSS program
      • IHPs in non- FHT models
      • Physiotherapy in FHTs
      • QIP – process for determining mandated domains for next year.
      • Possible review of sessional fees in MOHLTC-OMA negotiations
    • “Good news” items: AFHTO conference and Bright Lights Award nominees

  • FHTS to receive QIP feedback in next week (+ other support to come from HQO)

    AFHTO is working on a number of fronts to support members in their work to improve quality. Last week we reported on support available to help members implement the QIDSS partnership agreements and recruitment/orientation for these new positions, and the sessions available at the AFHTO Annual Conference to help FHTs in streams such as Leadership and Governance for Quality and Using Data to Improve Care. AFHTO also continues to work with Health Quality Ontario (HQO) to ensure FHTs receive the support they need to implement their Quality Improvement Plans (QIPs). Here’s an update on the support activities HQO is rolling out: 1. HQO to send individual reports on the Quality Improvement Plan by end of August 2013: HQO will be sending individual feedback to the FHT Board Chair and Executive Director on the QIP that they submitted. The feedback is intended to support the on-going improvement efforts and provide constructive feedback that will enhance the ability of the FHT to move forward with their improvement initiatives. At the AFHTO Annual Conference in October, FHTs interested to meet with an HQO QIP specialist to discuss in person their QIP feedback will have the opportunity to do so. AFHTO will provide space and coordinate the feedback sessions with HQO staff. 2. Upcoming Webinar on Survey Methodology in mid- September 2013: In response to request from some FHTs, HQO is planning a webinar on “survey methodology” that will provide FHTs with an overview of methodologies relevant to FHTs: sampling approaches, good survey practices, focus surveys as a mechanism for improvement and change. The webinar will discuss practical strategies to answer questions from FHTs. 3. Navigator Tool to be launched in November 2013: Starting in November 2013, FHTs will be able to develop and submit their QIPs using an online tool called the QIP Navigator. Announcements will be sent out as testing opportunities are created as well training sessions. 4. Primary Care Sector Report in November 2013: HQO received 295 QIPs from the Ontario’s four primary care models this year (FHTs, CHCs, NPLCs, AHAs).  Each QIP was reviewed by QIP specialists and a quantitative and qualitative analysis of the QIPs was completed.  A complete report of the results of the analysis will be published to acknowledge the work and commitment of primary care organizations to improving quality, to identify strength and challenges encountered during the development of the QIPs, and to provide guidance and recommendations to support the strengthening of quality improvement initiatives in primary care.

  • QIDS Program: Links to information from Aug.21 “Town Hall”

    Yesterday’s interactive QIDS Program “Town Hall” was an opportunity to share information and gather input.  Participants raised questions concerning sharing of QIDS Specialist positions, costs, and lines of accountability among other issues.  These questions and others are posted on a “Frequently Asked Questions” document that will be updated from time to time as new information becomes available.  Input received via participant polling and comments are already being used to plan next steps. Finally, in our update we indicated that funding approval for the AFHTO provincial team was “expected shortly.”  I am very pleased to share the news that this funding was confirmed almost immediately following the Town Hall.  We are very pleased to have been supported by the province to work with all of you on this exciting and timely program. Links to QIDS program information:

    Keep in mind the AFHTO Annual Conference, Oct. 22-23, features a number of sessions that will help your FHT in its use of data to improve care, in streams such as Leadership and governance for quality, Using Data to Improve Care, Meaningful use of EMRs and EMR vendor sessions.

  • Invitation to participate in a QIDS program town hall meeting for members

    Please join AFHTO for an interactive, online “members town hall” on the QIDS program. When: Wednesday, August 21, 2013, 12:00pm to 12:45pm The town hall is open to all members and will provide an opportunity for you to:

    • Hear about work your colleagues are doing to develop QIDS partnerships and QIDS Specialists recruitment
    • Learn more about the status of implementation supports and resource available from AFHTO
    • Contribute your ideas and advice to key elements of the program, such as QIDS Specialist role descriptions, partnership agreements and the provincial steering committee
    • Get answers to Frequently Asked Questions

    To register for the webinar:

    1. Click on the registration link: https://attendee.gotowebinar.com/register/290705729229163008
    2. Enter your contact information in the form.
    3. You will receive an email confirming your registration for the webinar and a unique link to join the session, along with the option to add the webinar information to your Outlook® Calendar.

    If you cannot access the online webinar, you can join the session by phone in “listen only” mode. (Unfortunately, those who are not connected to the webinar as well will not be able to speak.) To phone in :

    • Dial (647) 497-9416 or toll-free 1-866-952-7297.
    • Enter Access Code: 969-381-144.

  • FHTs are moving forward with QIDS partnership agreements and Specialist Recruitment

    Family Health Teams have now received their 2013/14 funding packages. AFHTO is very pleased that funding for 34 full time equivalent Quality Improvement Decision Support (QIDS) Specialist positions has been confirmed for 33 “Host” FHTs.  Up to 110 additional FHTs will have access to QIDS Specialist support and expertise through partnership agreements with Host FHTs. The final groupings for partnerships were arrived at by the ministry based on its review of Annual Submissions and discussions with the field. Although it is not stated explicitly in the funding package, the Ministry has confirmed that it expects Host FHTs to work toward a formal arrangement with each partner identified for them in either the Annual Submission or through subsequent discussions. Many Host FHTs are already in active discussion with their partners. However, if you are uncertain who you should be working with as a “partner” or “Host” please get in touch with Tim Burns at 647-234-8738 or your Ministry Contact. AFHTO is working with FHTs in the development of partnership agreement and recruitment tools:

    • Partnership agreements: The Partnership Agreement Working Group is due to meet again August 13 to provide its feedback on a draft QIDS Partnership Agreement for Host FHTs and their partners.  A template agreement will be available for broader circulation by the end of August.  (Earlier working drafts can be shared on request if this would be helpful for local discussions).
    • Recruitment of QIDSS positions: Host FHTs are eager to initiate QIDS Specialist recruitment and some will begin posting the positions immediately. Click here for a sample job posting to assist with recruitment.
    • Tools and Resources on AFHTO website: AFHTO has created a QIDS Program page on the Members Only website, check this section regularly for the latest updates, tools and newest resources.

  • 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.

    ****************************

    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.