Tag: Members Only News

AFHTO has been working with the Ministry of Health and Long-Term Care and the Ontario Medical Association (OMA) to address concerns regarding the new FHT Funding Agreement templates. FHT Leads should be receiving from the Ministry, prior to the April 29 sign-back date, a revised agreement that addresses our key concerns with these templates. For those FHTs that requested an exemption to the requirement that “all positions funded pursuant to this Agreement shall be employees of the Recipient unless the Ministry has provided its written consent”, you will receive a separate exemption agreement. The Ministry continues to encourage all FHTs to strive to meet this goal; however, the exemption agreement gives greater flexibility regarding FHT staffing arrangements while upholding the Government of Ontario’s risk management needs. Note that the exemption agreement lists a few “as applicable” requirements. If your FHT has a concern with any of these “as applicable” requirements, you may wish to seek clarification from your Ministry consultant to determine whether they are in fact “applicable” in your case. The template agreements for all Physician-Sponsored and Mixed Governance FHTs have been revised to address the concerns regarding governance, liability and communications. AFHTO and the OMA would like to recognize the Ministry’s willingness to make these revisions to address the concerns raised by FHTs. As with any contract, each FHT is advised to carefully review the new agreement and to discuss any ongoing concerns with appropriate legal counsel and their Ministry consultant.

AFHTO has learned the Ministry is working on a framework for granting exceptions to the “employee requirement” that appears in all Funding Agreements. They expect the draft to be completed in the next few weeks. AFHTO was told that, at minimum, we would get advance notice of the content of this framework. AFHTO continues to request the opportunity to review and give feedback on the draft framework for exceptions so that problems can be identified and solved before the Agreements move into implementation. AFHTO has a very successful track record in this regard, given past work in pulling together working groups from member FHTs to give constructive feedback and attempt to solve problems with the Ministry on such issues as the move to 5-year funding, NP-SERT and the new smoking cessation program. AFHTO first notified FHTs about the potential problem with the “employee requirement” clause on March 25, and survey results indicated this would pose significant implementation challenges for many FHTs. As noted in that March 25 e-mail, the “employee requirement” was introduced with the intent to meet a government-wide directive from Ministry of Government Services (MGS) implemented last September for all transfer payment agencies. In the last few days AFHTO has discussed these concerns with the Minister’s Office (MO) and the Ontario Medical Association (OMA). We welcomed news that the MO is working with the FHT Unit and MGS to find reasonable and workable solutions to fulfil the intended purpose of the directive while minimizing the risk of destabilizing staffing arrangements and service delivery in FHTs. The OMA shares AFHTO’s concerns, and our two organizations are working collaboratively in seeking solutions. In the meantime AFHTO has learned that some FHTs have yet to receive an extension date for signing their Agreement.  Other FHTs have received a response to their specific problems in implementing the “employee requirement” with a message that says, “The Ministry realizes that there may be isolated circumstances where exemptions will require consideration. … The ministry is not encouraging exceptions and very rarely will approve unless extreme circumstances.” AFHTO continues to recommend to those FHTs who have not yet signed the Agreement:

• Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation.
• If the “employee requirement” poses problems for your FHT, wait to see the Ministry’s framework for granting exceptions.
• Continue to work with your Ministry consultant to seek clarification on other issues affecting your FHT.
• Seek legal advice as needed to deal with your FHT’s unique situation.
• Please continue to keep AFHTO in the loop. AFHTO remains ready to gather FHT opinions, coordinate discussion, and facilitate resolution of issues that are common among FHTs.

AFHTO has learned that all FHTs who requested an extended deadline to sign their Funding Agreement have received it. For some FHTs the new deadline is Friday, April 8, and others have until Friday, April 15. The FHT Unit has told AFHTO it will work with each FHT individually to resolve the issues the FHT has raised.  While the common issues were reiterated, the Ministry’s view is that each FHT’s needs and issues are unique, and each FHT has been given funding in their budget for legal assistance to help them with this. Each FHT does have unique circumstances. Some are sufficiently satisfied and have signed the agreement. Others have copied AFHTO on their letters to the Ministry specifying their FHT’s concerns. For those FHTs who have not yet signed, AFHTO suggests you:

• Continue to work with your Ministry consultant to seek clarification.
• Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation.
• Seek legal advice as needed to deal with your FHT’s unique situation.

AFHTO is continuing to monitor progress and to seek advice on the unresolved issues. We sincerely hope that all FHTs will find workable solutions; however, if your FHT should find itself reaching an impasse, please keep us informed. AFHTO remains ready to gather FHT opinions, coordinate discussion, and facilitate resolution of issues that are common among FHTs.

AFHTO has just received a copy of a review by OMA legal counsel of the FHT Funding Agreement – Physician Sponsored template.  This is posted on the OMA’s members-only website or click here to view. Some comments in the review apply to the Mixed Governance and Community Sponsored templates as well, and so this is being forwarded as a service to all FHT leaders.  The assessment of risk and liability issues may be the most pertinent for other models. AFHTO’s ED has followed up with the Ministry regarding the “employee” and the “governance” issues outlined in the March 28 e-mail below. The fact that these are issues for a large number of FHTs has been acknowledged, as has the need for a collective approach to finding workable solutions in the best interest of all. Thank you to the 62 FHTs who responded to the survey – the results were instrumental in getting the Ministry’s attention.   Please remember to e-mail a copy of your response letter to the Ministry to angie.heydon@afhto.ca , and thank you the FHTs who have done so already. These are very valuable to have for reference in our follow-up with the Ministry on the Funding Agreement.

This is a review of the what the Ontario provincial budget means for FHTs, prepared for the benefit of AFHTO members. The good news for FHTs is government’s commitment to “protect education and health care”. In documenting its record in office, creation of 200 FHTs are once again mentioned as one of the key achievements in “Better Access to Primary Care” (pages 97-98). New investments are announced to invest in a Mental Health and Addiction Strategy – starting with children and youth, enhancing the MedsCheck program, expanding breast screening for high-risk women aged 30-49, increasing funding for long-term care and community-based support to free up hospital beds, and a 1.5% increase to hospital base funding. There was no announcement of additional funding for delivery of primary care services.  There is simply the statement “More than $300 million is invested annually to support Ontario’s FHTs” (page 98). The “Managing Responsibly” section of the budget lists measures to reduce waste, eliminate duplication, strengthen oversight and find more savings. While the measures mostly focus on the public service and government agencies, as transfer payment agencies, FHTs could expect to see tightening of controls. (FHTs are already beginning to experience this with the current Funding Agreement templates.) Pages 107 – 110 point to action to manage health care costs. It states, “The government’s focus now is to manage the rate of growth in health spending to a sustainable level, while protecting front-line service delivery of quality care. In the 2010 Budget, the government set a goal of holding annual health sector spending increases to three per cent by 2012–13.The government is on track to meet this target and to maintain this rate of growth into 2013–14 after accounting for time-limited investments. It is doing so by introducing reforms that focus on providing services supported by evidence, improving quality and accountability in the sector, and increasing the value of investments in the health care system.” Government will also establish the Commission on Broader Public Sector Reform, chaired by economist Don Drummond, to examine long-term, fundamental changes to the way government works. The Commission is to report “in time to inform the development of the 2012 Budget. The Commission will not make recommendations that would increase taxes or lead to the privatization of health care or education”. Given that Mr. Drummond was co-author of a highly-publicized report called “Charting A Path To Sustainable Health Care In Ontario”, the recommendations could touch on how publicly-funded health care is organized. Full text of the budget is available at – http://www.fin.gov.on.ca/en/budget/ontariobudgets/2011/papers_all.pdf

The Ministry template for FHT Funding Agreements has serious implications for FHTs, therefore this message is being sent to all FHT leaders, AFHTO members and non-members alike.  This message follows up on an e-mail sent to all AFHTO members on March 25 and a related message sent to non-members on March 26. The AFHTO board of directors met this evening (March 27) to review the results of the membership survey on the Funding Agreement (53 responses since Saturday) and outcome of discussions today with Phil Graham, with two different lawyers working with FHTs on this issue, and with various FHT leaders. The key messages for all FHT leaders are: 1. Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation. Our survey results tell us over 60% of responding FHTs cannot meet the deadline. The Ministry’s FHT Unit has said it is looking for “best efforts for sign-back” and will consider requests for extensions, as long as the FHT is specific in identifying the additional issues that need to be addressed. 2. Review the problems with the template agreements listed below, and seek legal advice as needed to deal with your FHT’s unique situation. Our survey results show that the “all funded positions shall be employees” clause will create significant hardship for the majority of FHTs. Additional issues identified to date in the three template agreements (one for each of the three governance models) are identified below. 3. In a letter to your Ministry consultant, indicate very clearly the clauses in the Agreement that are of concern. In sending the letter, your FHT could append the signed Agreement, having first struck out and initialled all of the problematic clauses in the agreement. 4. E-mail a copy of your cover letter to AFHTO — angie.heydon@afhto.ca. AFHTO is ready to gather FHT opinions and coordinate discussion. Our goal is to facilitate resolution of issues that are common among FHTs. Concerns with the template agreements ·         “All funded positions shall be employees” clause: From the survey response, this is a problem affecting pharmacists in about 1/3 of responding FHTs, admin staff and social workers in about 1/4 of these FHTs, RNs and dieticians in 15% of these FHTS, and NPs in just under 10%. Among the 19 FHTs who reporting having psychologists, 11 FHTs would be challenged in converting them to employees.  Twenty-eight FHTs reported having mental health workers; 9 of these FHTs would have the same conversion challenge. AFHTO acknowledges that a government-wide directive on “transfer payment accountability” has led to inclusion of this clause, and that the clause allows for exceptions. From discussions Friday and today, it is clear that each requesting FHT will have to go to inordinate lengths to prove they cannot fill these positions with employees, and very few exceptions would be granted in the end.  While AFHTO believes it will be possible to find solutions that uphold government’s principles for transfer payment accountability, without jeopardizing patient care, the FHT Unit has indicated they are not prepared to discuss it further. ·         Governance problems in “Mixed Governance” and “Provider-led” templates: For Mixed Governance FHTs:  the requirements are highly prescriptive (and include some errors, e.g. a FHT cannot be a member of itself) and will generate costs to amend and implement the resulting bylaw changes. For Provider-led FHTs: their governance is undermined by the lack of any reference to the FHT board as the governors, and gives authority for the contract to the “Lead Physician and Associate Lead Physician as designated or redesignated under its Physician Services Contract”. ·         Other concerns to note: AFHTO members have also flagged concerns about: –          the process by which payment could be reduced or suspended –          the restrictive bands on compensation levels –          liabilities for the physician group if the FHT is wound up –          the requirement to consult with the Ministry before participating in media communications and publications. AFHTO will continue to work on behalf of members to identify and work to resolve common issues.  We will provide updates and share solutions with AFHTO members as they emerge. For those who are not yet members of AFHTO, this is an excellent time to join. Go to www.afhto.ca for more information.

The cover letter for all of the funding agreements MOHLTC has sent to FHTs contains a paragraph called “Requirement that all funded positions be employees”.  This post: ·         Summarizes specific issues AFHTO has collected to date, from e-mails and phone calls with EDs & lead physicians over March 24-25, 2011. ·         Reports on outcome of an initial conversation with Phil Graham, Manager of the FHT Unit (i.e. this requirement results from a government-wide directive) ·         Asks you to complete a brief survey so AFHTO can identify the depth and breadth of these issues, found at http://www.surveymonkey.com/s/MCCLLMZ . ·         Asks for potential volunteers who can be called on to form an AFHTO working group to find workable solutions on behalf of all FHTs, if needed. Requirement, as stated in the letter: 3 Requirement that all funded positions be employees To ensure consistency and alignment with enhanced accountability requirements, the following clause has been incorporated into the new Funding Agreement: “The Recipient acknowledges and agrees that all positions funded pursuant to this Agreement shall be employees of the Recipient unless the Ministry has provided its written consent for the use of an independent contractor. In no case, shall any portion of the Funds be transferred by the Recipient to any other person, corporation or entity for the purpose of paying for a position Funded pursuant to this Agreement, unless otherwise agreed to in writing by the Ministry.” Why has this requirement been introduced? This is to meet an Ontario government-wide directive implemented last September that applies to all government-funded transfer payment agencies. I requested a copy to get clarity on the scope and intent of this directive, and the criteria for the Ministry to determine exceptions. Apparently the document cannot be shared, but further background may be forthcoming in another week. Key problem areas identified by FHT leaders: ·         Barriers to recruiting community pharmacists, psychologists, dieticians who generally working in private practice and are contracted to work x hours per week in the FHT. Prescribed pay rates are below what they earn in their other roles. They appear to meet Canada Revenue Agency’s test for “independent contractor”. Conversion to an employment contract means payroll taxes will reduce their income further. ·         Contracts with outside agencies to provide services, e.g. mental health: in a number of communities, this was found to be the most cost-effective way to provide quality services to FHT patients. ·         Contracts for physician staff to fill part-time roles: where some roles are less than .5 FTE, some FHTs have found it more efficient to combine the role with one in the physician organization to create a full FTE position. Other issues raised by FHTs regarding the Funding Agreements: ·         The specific content of the schedules. These are unique to each FHT – each FHT will need to make sure they are accurate and negotiate the content with your MOHLTC consultant individually.  Keep in mind that this is your FHT’s “base” funding and activity for the next 5 years. Each year your FHT can apply for additions to your base or for one-time funding required to meet specific objectives in your annual operating plan. ·         Amount of time needed for full review with board and legal counsel. MOHLTC’s letter says “This Agreement must be signed and returned to the ministry by March 31, 2011 in order for the ministry to process the April 2011 payment.” Some FHTs received their Funding Agreements yesterday. ·         Time needed to implement changes to comply with the agreement. MOHLTC consultants have said FHTs would be allowed 6 – 8 months to transition to the new requirements (e.g. ensuring equal access to IHPs, implementing public complaints process, ensuring the FHT comprises all physicians contracted under a Physician Services Agreement). Next steps: Please click here to complete the brief survey – http://www.surveymonkey.com/s/MCCLLMZ . AFHTO’s Executive Director will continue to work on getting clarity regarding the scope and criteria for granting exceptions to the employee requirement. Your response to the survey will help in this matter. AFHTO will continue to keep you informed, and we appreciate your help in keeping the AFHTO board and me informed of developments as well.

Click here to access AFHTO’s notes on the questions and answers discussed during the two teleconferences on NP-SERT hosted by MOHLTC on March 11, 2011. Click here to to access the Q&A document e-mailed by MOHLTC on February 1, 2011.

Click here to access the February 2011 edition of “FHT to Print”, the Ministry of Health and Long-Term Care’s newsletter for family health teams.