Ultimate Blogging Championship

Tag: Members Only News

  • Added support for FHT EDs at year end: new AFHTO staff and re-launched ED discussion forum

    AFHTO is pleased to announce two new resources to support you through the crunch of operating plan and quality improvement plan submissions – a former FHT ED joins AFHTO staff and a new secure discussion forum to facilitate communication among FHT EDs.

    New staff:

    On Monday, Jan. 28, Clarys Tirel joins AFHTO on a three-month contract.  Clarys was ED of the North York Family Health in 2008-2011, and most recently, interim executive director of the Mount Sinai Academic Family Health Team. In between she managed a primary care project for the Toronto Central CCAC on integration issues for non-FHT family physicians.

    Her main focus will be to support FHTs as they respond to their reporting and operational requirements in the January to April time frame, namely development of annual operating plans, formal quality improvement plans, and participation in planning and development of Health Links. She will also be gauging opportunities to support and augment the Ministry-sponsored “Governing for Quality in Primary Care” training program.

    To contact Clarys, e-mail her at clarys.tirel@afhto.ca or phone 647-234-8601.

    Executive Director Discussion Forum:

    One of Clarys’s support roles will as moderator for our newly re-launched Executive Director Discussion Forum.  This is a secure forum, accessible to only FHT EDs via username and password, to enable you to freely discuss topics that could possibly be sensitive, such as operating plans, HR issues, relations with vendors and funders, risk management, etc.

    To access the AFHTO Members Discussion Forums:

    1. Login to AFHTO’s Members Only website, using your FHT’s Members Only username and password.
    2. Click on the Connect to Member’s Forum link on the bottom left corner of the webpage.
    3. Enter your Member’s Forum username and password to log-in.  (HINT: If you click on “log me on automatically each visit”, you can skip this step in future.)
    4. Click on Board index to see the discussion forums. The Executive Director Discussion Forum is visible only to those who have been authorized to use it, i.e. FHT EDs.
    5. You are now able to post topics and reply to discussions. Click here if you need instructions on how to post and reply.
    6. If you need assistance, contact Sal at info@afhto.ca.

    You will see three (or four) additional discussion forums that are open to all AFHTO members. All of these forums are intended for asking questions and sharing ideas, advice and information resources among peers.

    • FHT Governance Forum: focuses on the roles, responsibilities, structures, policies, processes and leadership that all combine to promote good governance in FHTs.
    • Quality Improvement Planning Forum: is about developing and submitting QIPs, implementing the plans, collecting and reporting data, and other factors that contribute to advancing improvement.
    • General Forum:  for any other topics affecting Family Health Teams across Ontario
    • If your FHT is involved as the coordinating body for one of the early adopter Health Links, you will also see the Health Links Forum.  Membership in this forum is restricted at the moment as Health Links work their way through the early “growing pains”.  Access to this forum will expand over time.

    We will announce these forums more broadly next week when the Ministry is ready to launch the Quality Improvement Plan templates and guidance documents, and registration opens for the “Governing for Quality in Primary Care” training program. New forums can be added as needs and interests evolve. Member participation and feedback is always welcome. Please use the Member’s Forum to share your comments, questions and ideas.

  • Renewing AFHTO’s strategic vision and priorities: link to survey and webinar presentation

    If you missed the AFHTO membership webinars this past week, click here to access the full presentation. It gives you an overview and update on the current environment for FHTs and action underway by AFHTO to support its members. AFHTO is striving to ensure your association continues to reflect the aspirations and respond to the priority needs of the AFHTO membership.  The two webinars, held on Jan. 22 and 24, provided context and gave members the opportunity to contribute to AFHTO’s strategic vision and priorities going forward. We are also collecting feedback via membership survey; if you haven’t done so already, please click here to respond to the survey, by Feb. 5 please. The AFHTO board will review all input received via the webinars, survey and e-mails. This will provide guidance to finalize the AFHTO strategic plan and 2013-14 operating plan. The plans along with the survey/webinar results will be communicated to members around mid-March. During the call members also asked questions about the additional $2,000 the Ministry provided to FHTs last August, specifically earmarked for FHT membership in AFHTO (and/or AOHC for 28 community-governed FHTs).  Click below to access:

    Friendly reminder:  AFHTO sent out invoices for voluntary contributions to enable each FHT to make full use of the funding they have received, but not yet used, within this 2012-13 fiscal year. If your FHT has not yet used its full $2000 for membership, please consider investing it in the work of your association.

     

  • Minister releases Seniors Strategy for Ontario

    The full report, Living Longer, Living Well is now available in both English and French on the Ministry’s website at: English: http://www.health.gov.on.ca/en/common/ministry/publications/reports/seniors_strategy/ French: http://www.health.gov.on.ca/fr/common/ministry/publications/reports/seniors_strategy/default.aspx ************************************************************ January 8, 2013 – Living Longer, Living Well – Highlights and key recommendations from the report of Dr. Samir K. Sinha, Provincial Lead, Ontario’s Seniors Strategy – was released on Tuesday, January 8, 2013. Government committed to developing such a strategy in Ontario’s Action Plan for Health Care. The full 200 page report, containing 169 recommendations, is not yet released and is in the process of being translated. With the release, the Minister committed to moving ahead immediately with two of the recommendations:

    • Match every older Ontarian who wants one with a primary care provider through Health Links and new physician incentives to care for high-needs patients. (These incentives were included in the most recent Physician Services Agreement.)
    • Improve access to home care by expanding personal support worker services through community support agencies for low-needs patients.

    The Seniors Strategy is built on five principles:  Access, Equity, Choice, Value, Quality. Its recommendations cover a comprehensive range of topics: promoting health and wellness, primary/community/acute/long-term care, caring for caregivers, developing elder-friendly communities, addressing ageism and elder abuse, medications, and addressing unique needs of older aboriginal peoples and others with diverse needs, such as those from LGBTQ and ethnocultural communities and those with limited abilities. The section on primary care is reproduced below.  Implementation details have not been announced – the Minister stated that Dr. Sinha is developing the detailed implementation plan. —————– Excerpt from Living Longer, Living Well : Strengthening Primary Care for Older Ontarians Through our consultations, we learned that strengthening the provision of primary care will be essential to securing the health of older Ontarians. As they are likely to have more complex and often inter-related health and social care issues, they will often benefit from a team-based approach to primary care that prioritizes continuous quality improvement. We also learned through our consultations that communication among primary care providers, hospitals, and community care co-ordinators in particular, is not currently required. This often can create care gaps that everyone agrees should not exist. We also learned that there still are older Ontarians who cannot easily find a primary care provider. This is especially the case for those who are homebound and would benefit from house calls. We need to do more to improve primary care for older Ontarians by building models of care that deliver high quality care and best serve their needs, while ensuring that every older Ontarian who wants a primary care provider can get one. Key Recommendations:

    • The Ministry of Health and Long-Term Care should promote and develop mechanisms in accordance with legislative/regulatory frameworks to advance the goal that all older Ontarians who want a primary care provider will have one.
    • The Ministry of Health and Long-Term Care should ensure that its development of Quality Improvement Plans in Primary Care and Health Links support a core focus around the care of older Ontarians – with an emphasis on supporting primary care access for older adults and focusing attention on areas of care that influence the health and well-being of older adults.
    • The Ministry of Health and Long-Term Care should mandate that care co-ordinators from Community Care Access Centres (CCACs), Community Support Services (CSS), and community mental health agencies providing care or service co-ordination support must identify and notify a patient’s primary care provider of their name, their role, their contact details, and the services being co-ordinated for the patient/client.
    • The Ministry of Health and Long-Term Care should maintain and improve funding levels to support the provision of house calls by primary care providers.

  • Inviting input on AFHTO’s strategic direction/Maximizing value from Ministry funding for FHT memberships

    Thanks to our FHT members, AFHTO has built a strong foundation to serve family health teams. We are reaching out to FHTs to move to the next stage in your association’s development: 1.      As FHTs and AFHTO have matured, it’s time to renew the strategic vision and priorities for this association. You are each invited to give input on AFHTO’s strategic direction, to ensure your association continues to reflect the aspirations and respond to the priority needs of the AFHTO membership.  Responses are requested by February 5, 2013. 2.      A key platform for expanding AFHTO’s capacity to serve its members is the $2000 funding increment for FHTs last August – an increment the Ministry has indicated can only be used for membership in AFHTO (and/or AOHC for the 28 FHTs that are community-governed). At the October 16 Annual Meeting, AFHTO members approved a plan to request a voluntary contribution to enable each FHT to make full use of the funding they have received, but not yet used, within this 2012-13 fiscal year. AFHTO board members will conduct webinars to provide additional background and answer member questions. Click here to register for one of these sessions:

    • Tuesday, January 22, 2013, from 4:30 to 5:30 pm
    • Thursday, January 24, 2013, from 12:00 to 1:00 pm

      Why should FHTs make a voluntary contribution to their association? FHTs are facing immediate pressures and opportunities – delivering operating plans by February 20, making the case for new Quality Improvement Decision Support Specialist positions, delivering the first Quality Improvement Plans by April 1, and some are leading or participating in development of Health Links. With the addition of contract staff and consultant assistance, AFHTO is immediately adding to our capacity to help you navigate these uncharted waters. This expansion of service is made possible by the Ministry’s $2000 funding increment for FHT membership fees in AFHTO (and/or AOHC). The Ministry has indicated these funds are specifically earmarked for this purpose. For AFHTO members who paid 2012-13 fees that were less than this, or those who expensed their membership fees in the previous fiscal year, you are invited to calculate a voluntary amount based on your own unique budgetary circumstances. Please note that 2013-14 membership renewal notices will go out after April 1. Auditors have advised that membership fees should be expensed in the year in which the benefit is received. Since the AFHTO membership year runs from April 1 to March 31, AFHTO is adopting the practice of issuing renewal invoices at the start of the membership year. FYI – One hard copy of this package has been mailed to each FHT. This invitation is also being e-mailed to the addresses we have on file for the board chair, lead physician and executive director for all member FHTs. If you have any comments, questions or concerns please don’t hesitate to contact AFHTO’s Executive Director (angie.heydon@afhto.ca or 647-234-8503) or Membership Coordinator, Sal Abdolzahraei (info@afhto.ca or 647-234-8605). AFHTO looks forward to continuing to support FHT success in improving and delivering optimal, sustainable interprofessional care.

  • FHT Annual Operating Plans / AFHTO help will be available in January

    Executive Directors: You have received your Family Health Team 2013/14 Annual Operating Plan Submission Package at some point today.  Plans must be submitted to the Ministry by February 20. To support FHTs in this submission process, AFHTO will re-launch a Peer-to-Peer discussion forum in early January.  This facility will help you seek and share advice with your peers as you develop your plans. The 2013/14 package offers FHTs the opportunity to propose implementation of a new role – the Quality Improvement Decision Support Specialist (QIDSS). The package states, “The ministry strongly encourages and will give preference to requests for this resource that are shared among a collection of FHTs, where appropriate. … This new position is meant to assist FHTs in moving forward with their use of data to guide clinical decision-making, develop patient-centred programs and other improvement activities. With the assignment of these resources, the ministry expects demonstrated improvements in these and other areas.” To help FHTs with their proposals for the new QIDSS position, AFHTO is preparing an advice document for FHTs. With the view to gaining the greatest value from these new positions, AFHTO is looking into various ways FHTs could structure and frame their proposals for shared use of this resource. We are aiming to complete this advice document for members no later than January 23. With the many new initiatives FHTs will be responding to over the next few months – e.g. the first Quality Improvement Plans by April 1, development of Health Links – AFHTO is enhancing its ability to support FHTs in these common needs by recruiting a contract position, Senior Project Lead- FHT Governance, Quality, Operations.  We expect to have this additional assistance in place before the end of January. We look forward to continuing to support FHT success in improving and delivering optimal, sustainable interprofessional care.

  • Family Health Teams play a prominent role in Ontario’s Health Links

    The first 19 Health Links were announced today by Minister of Health and Long-Term Care, Deb Matthews. Health Links bring together health care providers in a community to better and more quickly coordinate care for high-need patients. Seven of the 19 Health Links announced today will be coordinated by family health teams:

    This is a natural progression in the evolution of FHTs.  FHTs were created to join family doctors, nurse practitioners, pharmacists, dietitians, nurses, social workers and others to strengthen primary care – the first level of care over a person’s lifetime. Health Links promise to extend the care team – they will strengthen links between primary care providers and specialists, hospitals, and other community support agencies, to give high needs patients the wrap-around care they need. Health Links start by looking at the people who have complex care needs, and build on primary care as the foundation for a person’s health care. In choosing the Taddle Creek Family Health Team as the site for her announcement, the Minister underlined the central role that primary care plays for patients, and for the health system.  In addition to the seven Health Links to be coordinated by FHTs, four will be coordinated by community health centres, one by a family health organization and one by a community service agency. The remaining six will be coordinated by a mix of hospitals and community care access centres.  Click here for the list of the first 19 Health Links. Many details about Health Links are being worked through. AFHTO expects there will be additional information forthcoming from the Ministry in the weeks and months ahead.  The following paragraphs summarize what AFHTO has learned to date from Ministry sources. Health Links are designed around, and will be accountable for, system-level metrics established by the province. Click here to see DRAFT areas to be measured. We understand the Ministry will set up an advisory table to define the indicators. The next phase for these early adopters is to prepare a business plan over the next 3 months. A guidance document is to go out early next week. The early focus is on relationship building among providers. The Ministry will encourage more applications for Health Links beginning in January. The Minister stated, “I envision that every doctor will be involved in a Health Link.”  They anticipate seeing about 75 across the province – to be rolled out as communities are ready. Health Links are accountable to their LHIN for progress in the outcome measures.  Health Links include providers who are accountable to their LHIN, and others who are accountable to the Ministry (such as FHTs). The coordinating body for each Health Link commits to plan to improve indicators, and each member is to include their role in achieving these improvements in their respective business plans.  Providers who do not have direct accountability to the LHIN will have a joint Memorandum of Understanding with the Ministry and the LHIN. LHIN Primary Care Councils will continue as well.  Both are important – PCCs focus on coordination and planning of primary care, and Health Links focus on coordination and planning of multiple types of care for high-needs patients. Health Links will be supported by Health Quality Ontario’s bestPATH initiative – quality improvement tools, a framework to collect and report on outcomes, and other supports that will help them deliver more integrated care. As Health Links identify issues that get in the way of delivering more seamless care, the Ministry has committed to work with them to lower these policy barriers. Throughout this journey, AFHTO’s role is to:

    • Facilitate idea and information exchange among members;
    • Work with FHTs to identify the support they need to succeed as coordinators and members of Health Links and, where needed, to advocate for that support.

    Click here for the Ministry’s press release and backgrounders, including the list of the first 19 Health Links. Click here for a Ministry presentation to key stakeholders, prior to the public announcement. Click here for presentations that describe the population of high users that is the focus of the Health Links initiative.

  • Tentative 2012 Physician Services Agreement: A Family Health Team Perspective

    AFHTO congratulates the Ministry of Health and Long-Term Care and Ontario Medical Association on reaching a Tentative 2012 Physician Services Agreement.  AFHTO’s Executive Committee has reviewed the agreement to assess what it may mean for family health teams. Overall, the tentative agreement contains a number of provisions that are aligned with the vision for FHTs to deliver accessible, comprehensive, high-quality, patient-centred primary care. These include measures to improve care for vulnerable populations, support evidence-based care, incorporate technology into the process of care, ease the ability of FHTs to bring in new doctors, and include FHT physicians in FHT quality improvement plans. The Tentative Agreement also contains a number of fee reductions and revisions. The amounts are varied, and in the OMA’s words, “… have been negotiated to be as fair and reasonable as possible, reflecting a balance of the government’s fiscal priorities, and the proposed evidence-based changes and program revisions set out in the Tentative Agreement.” There are a number of details to be worked through. The tentative agreement includes establishment of a Primary Care Policy Committee to imple­ment primary care initiatives and address policy issues identified in this agreement.  AFHTO will monitor the issue of staffing pressures on FHTs related to the increase in after hours requirements and the expansion of access to interdisciplinary services to non-FHT physicians, to ensure that FHTs are supported to improve and deliver optimal care. Further details on these topics are presented below for information. AFHTO encourages all FHT physicians to review the documents available to them through the OMA website (www.oma.org) and vote in the OMA referendum – November 28 to December 5.  Informed by the referendum results, OMA Council will meet on December 9 to vote on ratification. …………………………………………………………………………………………………………………………………………………………… Provisions in the Tentative 2012 Physician Services Agreement that could affect Family Health Teams Supporting care for vulnerable populations:

    • Existing bonuses for house calls will be enhanced.
    • A one-time acuity modifier is proposed and will be developed by the Primary Care Policy Committee (see below), until an acuity-adjusted capitation model is developed and implemented.  Forty million dollars is set aside for this initiative and the funding will come from other cuts.
    • To develop proposals for medically complex patients, both post-discharge and ongoing, demonstration projects will be established to measure results, which will be evaluated after one year.
    • Fee codes for group appointments will be introduced for chronic diseases and some mental health issues. These diseases include diabetes, congestive heart failure, asthma, chronic obstructive pulmonary disease (COPD), hypercholesterolemia, and fibromyalgia.

    Supporting evidence-based care:

    • Annual health exam will be replaced by personalized health review for ages 18 to 64.
    • The lab requisition will be modified to remove ferritin, TSH, Chloride, CK and B12 but these tests may still be ordered.
    • Only ALT (but not AST) may be ordered by non-specialists in community labs.
    • Only red cell folate may be ordered by non-specialists.
    • Thyroid scans should only be ordered for hyperthyroidism, congenital hypothyroidism, and masses in neck or mediastinum.
    • Follow up colonoscopies will be at intervals of 5 or 10 years based on indicators.
    • Paps will be every three years from age 21 to 70.
    • The following tests will no longer be billable to OHIP:  annual stress tests for asymptomatic patients at low risk for CAD; preoperative cardiac testing for low/moderate risk patients; routine chest films.
    • A working group will be established to review evidence to minimize overuse, misuse and underuse of best practice.

    Incorporating technology in patient care:

    • The Northern Health Travel Grant will be modified to encourage virtual visits where appropriate.
    • A working group will evaluate existing pilots and use the data to recommend a model for better communication between hospitals and primary care.
    • An evaluation will be developed to examine patient-initiated to provider eConsultations.
    • eReferral fee codes will be developed for specialist referral with dermatology and ophthalmology as the initial trial specialties.
    • An OTN Working Group will evaluate Personal Video Conferencing (PVC) deployment progress, utili­zation, volume and workflow trends to reduce the need for full telemedicine premiums and a new premium for northern and non-northern telemedicine consultations will be developed.

    Increasing the opportunity for physicians to enter FHO and FHN models:

    • Current stream of 25 entries into FHNs and FHOs will be expanded to 40 physicians per month beginning April 1 2013— 20 in a prioritized stream based on local need; and the remainder on a first come, first serve basis. Unfilled spots can be shifted to either stream or into subsequent months.  (There will be unrestricted entry to FHGs for all physicians.)

    After hours requirements:

    • New enhanced after hours requirements will apply to groups with 10 or more physicians:
      • 10-19 physicians – 7 blocks (2 additional)
      • 20-29 physicians – 8 blocks (3 additional)
      • 30-74 physicians – 10 blocks (5 additional)
      • 75-100 physicians – 15 blocks (10 additional)
      • 100-199 physicians – 20 blocks (15 additional)
      • 200+ physicians – 25 blocks (20 additional)
    • Existing exemptions continue for ED coverage and obstetrics. If the FHN/FHO contract requires that 50% of FPs are required to have hospital privileges, then the group is exempt from the additional requirement.
    • Some FHTs may be challenged to support additional after hours clinics with the necessary administrative and IHP staff.  AFHTO will monitor staffing pressures and advocate for the resources needed to meet requirements.

    Annual quality improvement plans:

    • Following from the Excellent Care for All Act, all interprofessional models of primary care (FHTs, CHCs, AHACs, and NPLCs) will be required to submit annual qual­ity improvement plans to Health Quality Ontario as of April 1, 2013. The tentative agreement expands participation to include phy­sicians practicing in these models.

    Fee reductions and revisions:

    • Diabetes management fee will be reduced from $75 to $60.
    • Preventive care management fees ($6.86) will be discontinued but the annual preventive care bonuses will continue.
    • Access Bonus rebate will be discontinued.  The Access Bonus itself is not changed.
    • Two special bonuses that had been rarely accessed (In Office Service and Out of Office Care) will be discontinued.
    • Physician payments for Telephone Health Advisory Service will be discontinued. Physicians will not be required to provide on call to THAS, however physician groups may continue to do so on a voluntary basis. Physician groups will still be required to report after hours clinic schedules. PEM groups will continue to receive a report when enrolled patients use Telehealth Ontario.
    • Individual PEM physicians with more than 2,400 patients will receive the full value of the CCM fee for the first 2,400 rostered patients. For each subsequent patient, the fee will be reduced by 50%.
    • Global payment discount of 0.5% will apply to all physician payments regardless of model.

    Access to interdisciplinary services:

    • Patient access to interdisciplinary primary health-care services will be expanded by allocating IHP resources to non-FHT affiliated phy­sician groups of three physicians or more, including Family Health Groups, Family Health Networks, Family Health Organizations and RNPGAs.  An implementation plan will need to be developed. What this could mean for the future direction of interdisciplinary primary care and the role FHTs could potentially play in implementation is unknown.

    Once again, AFHTO encourages all FHT physicians to review the information available to them through the OMA and vote in the referendum.

     

     

  • Update on Ministry initiatives to promote and support quality in primary care

    “Faster access and a stronger link to family health care” is one of three key planks in Ontario’s Action Plan for Health Care. To do this, the Ministry of Health and Long-Term Care has intensified focus on improving quality in this sector. Here is an overview and update on Ministry and related initiatives to promote and support quality:

    • Quality Improvement Plans (QIPs):  As AFHTO reported in a Sept.24 e-mail to members, all FHTs must submit a QIP by April 1. Ministry plans were presented at the AFHTO 2012 Conference. See update below.
    • Primary Care Performance Measurement Framework: Health Quality Ontario and the Canadian Institute for Health Information are leading this development. AFHTO e-mails on Nov.7 and 13 invited members to attend an HQO-CIHI webcast on this initiative and give input on priorities for measurement.
    • Governance for quality:   AFHTO is working with the Ministry, Association of Ontario Health Centres and Canadian Patient Safety Institute on plans to support primary care boards with skills and tools.
    • Data and measurement support: AFHTO has been advocating for this critical requirement for quality improvement.  The Ministry clearly understands this need and is investigating ways to do this, recognizing fiscal constraints. To support the QIP process, HQO is developing a few standardized patient survey questions and EMR searches for some measures.

    Quality Improvement Plans The key facts about QIPs in primary care:

    • All inter-disciplinary team-based organizations will be required to submit a QIP to HQO through existing contractual requirements with the Ministry.
    • The Ministry (with HQO) will develop a template and guidance material that will be available and applicable to all primary care settings, most likely by January 2013.
    • QIPs are to be submitted to HQO by April 1, 2013.

    On November 15th, the Ministry and HQO held a forum with 14 FHTs to get feedback on the design of the QIP template and on the supports required by FHTs to develop and implement QIPs. AFHTO identified 12 individuals who provided a cross-section of: all regions of the province; rural and urban settings; large and small-sized FHTs; all 3 governance types; those experienced in quality improvement planning and those that are not; academic and non-academic FHTs; those focused on aboriginal and francophone populations; and ED, physician, and IHP roles.  The AOHC CFHT ED group was invited to name two representatives as well. During the forum Ministry representatives confirmed that QIPs are a tool for improvement. FHTs will be accountable for submitting a plan, however the improvement results will not be used to adjust funding levels. They emphasized – perfection is not the goal – the initial focus will be on getting started. The group was told the purpose of QIPs is to ensure there is a uniform commitment and consistent approach to improving the quality of care delivered to Ontarians. For this reason, the Ministry has identified three quality dimensions for this first round of quality planning – access, integrated and patient-centred – and core set of measures will be provided.    Participants noted the dimension of “effectiveness”, i.e. clinical outcomes for chronic disease, should also be included as an option.  As well, the group suggested the “access” dimension should go beyond physicians to include same day access to other interprofessional health providers. HQO presented the supports they would provide to build capacity for improving quality.  These include live and web-based learning opportunities, programs in Advanced Access and Efficiency and Chronic Disease Management, and a 1-800 “dial-a-specialist” service.  FHT participants identified additional needs, in particular the need for standardized EMR queries and other support to get data out of EMRs. Peer training and on-site coaching were also identified as highly desirable supports.  HQO committed to consider these ideas within their resource capacity. As reported in AFHTO’s Sept.24 e-mail to members, the Ministry had also committed to reduce administrative reporting on a quarterly and annual basis so as to free-up capacity to focus on quality improvement planning and implementation.  Work is underway to streamline the reporting burden on FHTs. The direction of these initiatives are consistent with AFHTO’s vision – that FHTs are recognized by patients, FHT boards and staff, other health organizations, the public at large and their government as an innovative and efficient model for delivering accessible, comprehensive, high-quality, patient-centred primary health care. As the advocate, champion, network, and resource center for FHTs, AFHTO will continue to work to ensure FHTs are well-positioned and appropriately supported to succeed in improving and delivering optimal interprofessional care.

  • Potential impact of proposed wage restraint legislation on FHTs

    DRAFT legislation – the Protecting Public Service Act, 2012 – has been released for public consultation. It is very important to note that this proposed legislation has NOT YET been tabled for first reading. Government has not yet indicated how long it will hold open this consultation phase, but for comparison, the consultation period for the legislation affecting collective agreements for teachers lasted 11 days. Key points for Family Health Teams:

    • Over half of all FHTs would be affected by this proposed legislation, since it covers all not for profit organizations that have received at least $1 million from Government in 2011-12. (Organizations may be prescribed by regulation, so it’s conceivable this could possibly affect all FHTs.)
    • The bill could affect all employees. Schedule 1 sets compensation rules for non-bargaining employees.  Schedule 2 creates a new framework for provincial control of the collective bargaining process, e.g. establishing enforceable bargaining mandates and a standing power to impose a collective agreement.
    • For non-bargaining staff, the bill would impose a two-year freeze on pay and no movement up an established salary grid.
    • With very limited exceptions, there may be no increases to an affected employee’s existing benefits, perquisites or other payments and no new or additional benefits, perquisites or payments for two years.
    • Renewal of an employment contract would not permit a compensation increase during this wage restraint period.
    • This Act would prevail over any compensation plan.
    • The Minister of Finance would be permitted to issue directives requiring compliance reports to be filed.

    AFHTO continues to work in collaboration with the Association of Ontario Health Centres and the Nurse Practitioners’ Association in research and advocacy on the issue of recruitment and retention of staff in interprofessional primary care organizations.  Drawing from the facts and issues presented in our joint report – Toward a Primary Care Recruitment and Retention Strategy for Ontario (https://www.afhto.ca/news-events/news/toward-a-primary-care-recruitment-retention-strategy-for-ontario/) – our three associations will develop a joint response to this legislation.  Ontario’s Action Plan for Health Care calls for “Family Health Care at the Centre of the System”; developing the primary care sector requires the ability to attract and retain staff in a competitive environment. We’ll keep you posted as we hear more.  Please keep us informed as well if you hear any developments. For more information and analysis on the proposed Protecting Public Service Act, 2012, go to:

  • Report from quarterly meeting with MOHLTC FHT Unit, September 20, 2012

    Representatives from AFHTO’s Operational Issues Working Group and the AOHC’s CFHT Executive met with the MOHLTC FHT Unit on September 20.The main objectives were to receive updates from the FHT Unit on budgets and other operational matters and to highlight “good news” from FHTs.  The following is a summary of the discussions. a) Recovery of unspent funds

    • Recovery of unspent funds currently applies only to vacant position salaries and benefits. The focus is currently on surplus HR funding from the Q1 time period.
    • Background: a significant amount of surplus funds are recovered each year from FHTs.  Due to the timing of audited statements, these funds have been recovered in the following fiscal year.  By reconciling on a quarterly basis, it provides more in-year flexibility, either to re-invest funds or to contribute to the government’s deficit reduction commitments.
    • Process: based on review of hiring reports and Q1 financials, FHT Unit and FHT will come to agreement on amount to be recovered; following monthly payments will be adjusted accordingly.  Amount recovered is salary + 20% for benefits. This will have no impact on the approved budget for the FHT.
    • FHT Unit is open to discussions about re-profiling positions that remain vacant for long periods (as long as the interdisciplinary nature of the team remains intact and the re-profiling is revenue neutral) or addressing in-year pressures. These issues need to be discussed with ministry contact.

    b) Plans for funding existing/new Physician Assistants (PAs)

    • Existing PAs (funding ends Mar 2013): Health Human Resources Strategy Division manages the PA program, but work is underway on a long-term strategy to support the integration of PAs into targeted areas of Ontario’s health care system.
    • Regarding FHTs specifically, although PAs are not currently included in the list of approved interdisciplinary health providers in FHTs, there appears to be a strong case for making this happen. The permanent integration of PAs into FHT’s is one of the areas of focus for the long-term work currently underway.
    • The FHT unit is currently working with the Health Human Resources Strategy Division on how this could work. The goal is to communicate this before March 2013.
    • It was noted that support from the MOHLTC for a FHT-PA Community of Practice would be appreciated.
    • Approvals to hire New PAs: Deadline for hiring is Oct 31. The FHT Unit is in process of finalizing approvals for recruitment.  FHTs should be notified in the next couple of weeks about the status of their application.

    ACTION: FHT Unit to send AFHTO & AOHC list of FHTs with existing Physician Assistants. c) Funding for Relief positions

    • Lack of relief funding, in particular for reception and RNs, continues to pose significant problems for some FHTs, including patient services, impacting workload and health and safety of providers when an absence creates a scenario where someone is left to work alone.
    • Smaller FHTs, rural/remote, and community FHTs may be more greatly impacted by this.
    • The FHT Unit will consider a number of options for addressing this issue, including a standard percentage increase for relief funding on a per-request basis, reallocation of unspent salary dollars or 3rd party revenue to offset cost of relief.  FHTs are encouraged to discuss this problem with their primary consultant.
    • Any change in relief funding would not be in effect until 2013/14 fiscal year.
    • The question of BSM physician job-sharing was raised. The FHT Unit identifies this as an issue for FHT management to address/implement as appropriate.

    d) Association Membership Fees

    • The group thanked the FHT Unit for support for association membership fees.
    • The FHT Unit confirmed that these funds are specifically earmarked for association fees, and cannot be reallocated if not used for that purpose.
    • The expense needs to be reported as a separate line item under general overhead and will be monitored to ensure it is going towards AOHC or AFHTO dues.

    e) Preparing for next budget cycle / annual planning

    • The earlier start to the budget cycle was noted as a positive change for FHTs.  FHT Unit would like to start 2013/14 budgeting process even earlier.
    • FHT Unit analyzed 2012/13 annual plans and will be issuing a provincial snapshot in the next FHT To Print newsletter.  FHT Unit will follow up with each FHT individually about how they compare with other FHTs in their LHINs.
    • FHT Unit is reviewing reporting requirements with the eye to streamlining and reducing the burden of reporting.  May include new quality improvement measurements (see (f) Quality  Improvement Planning in FHTs)
    • Process: FHT Unit will aim to have a draft revised annual plan template by end of Nov 2012, for input from a small working group of FHTs gathered by AOHC and AFHTO.  The goal is to have the revised plans to FHTs by mid-Dec 2012, with a submission deadline of Feb 28, 2013.
    • A request was noted that the measurements related to HealthCare Connect be reviewed with feedback from FHTs, with an eye to improving program processes and related measurements.

    ACTION: AFHTO & AOHC to identify working group for Annual Plan review. f) Quality Improvement Planning in FHTs

    • Primary care has been identified as the next sector to which the principles of the government’s Excellent Care for All strategy will apply. Family Health Teams will feature strongly in this.
    • Although work is underway, this at a minimum will include a requirement for FHTs to undertake quality improvement processes, including the development and implementation of a Quality Improvement Plan.
    • The Quality Improvement Plan for primary care is likely to include the following three Quality attributes: Accessible, Integrated and Patient-Centred. The specific quality indicators are currently under development.
    • Planning is underway to ensure supports are in place for an enhanced focus on quality improvement, including templates, guidance documents, governance training and other assistance provided by the ministry and Health Quality Ontario.
    • The details of the roll-out are still in the planning phase, but more details will be communicated through AFHTO and AOHC shortly.
    • Work is underway by the ministry to streamline the reporting burden on FHTs in anticipation of new expectations for quality improvement. The ministry’s intent is to reduce administrative reporting on a quarterly and annual basis so as to free-up capacity to focus on quality improvement planning and implementation.
    • The first year of implementation will be a transition year to support FHTs in embedding quality improvement in their on-going activities, with the intent to progressively advance the program in out-years.

    ACTIONS

    • Kavita Mehta and Ruth Kitson to send FHT Unit sample patient satisfaction surveys.
    • AFHTO & AOHC to identify working group for review of draft QI plans.

    g) Data Management Support in  FHTs

    • The need for data management/analysis support in FHTs was reiterated, especially given the planning for QI.
    • FHT Unit is investigating the possibility of implementing a regional data support model. This may be feasible to implement under the umbrella of NPAR (see (k) NPAR: update on evaluation and roll-out plans for more information).

    h) Update on plans to integrate primary care with LHINs

    • The MOHLTC continues to assess a number of proposals/models that were submitted on restructuring primary care.
    • There are legislative barriers that may prevent moving primary care into the LHINs, and other alternative models are being considered that do not require legislative reform.
    • In the meantime, FHTs should continue fostering and building local partnerships to enhance service integration and collaboration.

    i) Compensation

    • The AOHC/AFHTO/NPAO compensation review being developed by the Hay group is scheduled for release at the end of October.
    • The FHT Unit regrets that with continued austerity measures in place, there is no news on addressing funding inequities within FHTs and lack of parity across FHTs for similar positions funded through different funding streams.

    j) Adding Physicians to Existing FHTs (Patient Enrollment Models)

    • There has been managed registration of new physicians in certain patient enrolment models (including those eligible to affiliate with FHTs) to 25/month while a review of the registration process takes place.
    • The current interim process is to register 25/month through a needs-based assessment and consultation with LHINs.
    • The ministry will consult with relevant stakeholders before finalizing the process.

    k) NPAR: update on evaluation and roll-out plans

    • The MOHLTC has committed to removing the $1 per service encounter. In order to do this a consent form will be developed to allow interdisciplinary health providers (IHPs) and FHTs to share service-level information with the ministry.
    • FHT Unit is looking at options to roll out NPAR to other IHPs.  This will take time, as support for additional NPAR licenses was also identified as a need if it is rolled out to other IHPs.
    • Included in this work will be options to re-profile the $1/encounter allocation to support data management and analysis support.
    • It was emphasized that different skill sets are required for data entry and data management/analysis.
    • FHT Unit will issue a communication to FHTs on the status and evaluation of the program in the next few weeks.

    l) Point of Care Testing

    • The group shared how point of care testing (eg INR) can be done more cost-efficiently through FHTs than by other providers in the system, such as hospitals or labs, using existing provider resources in the FHT. While the FHT Unit has already approved the one-time equipment costs, there is an ongoing funding need to cover the cost of additional supplies.
    • This is an innovative way of reallocating health system funds to enhance services to clients and client experience.
    • The FHT Unit affirmed that FHTs can use General Overhead funds to cover the cost of supplies.  Requests for additional funding for supplies will be considered, but individual FHTs need to first demonstrate or estimate the volume of testing being / that will be performed, and the financial need, before additional funding will be approved.
    • The FHT Unit will also consider requests to reallocate unspent operating line items (outside of General Overhead) to cover these costs.

    m) FHT Good News Stories: areas of priority to showcase

    • AFHTO will be issuing awards to 16 FHTs at their upcoming conference, and will share details with the FHT Unit after the event.
    • For FHT to Print, the FHT Unit is particularly interested in stories pertaining to quality, access, integration, peer modelling, and the patient experience.

    Meeting participants

    • MOHLTC: Phil Graham, Acting Manager of the FHT Unit and Richard Yampolsky, Program Manager, FHT Implementation.
    • FHT EDs: Randy Belair (Sunset Country FHT in Kenora), Mark Ferrari (Windsor FHT), Ruth Kitson (Community & Primary Health Care FHT, Lanark, Leeds & Grenville) Kavita Mehta (South East Toronto FHT).
    • Association staff: Sophie Bart (Association of Ontario Health Centres) and Angie Heydon (Association of Family Health Teams of Ontario).

    Do you have input on operational issues for the next quarterly meeting? Please contact:

    • For FHT EDs in LHINs 1-4 and 12 (Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant,North Simcoe Muskoka) and all CFHTs across the province:
    • For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
    • For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
    • For FHT EDs in LHINs 13-14 (North East,North West)
      • Randy Belair, ED Sunset Country FHT,  AFHTO Secretary
      • E-mail:  rbelair@kfht.ca
    • For FHT Clinical Leads:
      • John McDonald, Lead Physician PrimaCare Community FHT, AFHTO Past President
      • E-mail:  john.mcd1@sympatico.ca