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Tag: Members Only News

  • 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

  • Letter to AFHTO members: Nominations for election to AFHTO Board

    Dear fellow AFHTO members: Are you interested in serving on the AFHTO board of directors? The Governance Committee of AFHTO’s board invites anyone associated with an AFHTO-member FHT to apply.

    The Governance Committee of the AFHTO board will review all applications to assist the AFHTO board to determine the slate of candidates to recommend to the AFHTO membership for election at the AFHTO annual general meeting. Nominees will be informed of their status by the end of September. (NOTE: AFHTO members have the right to make additional nominations at the AGM.) The AGM takes place in conjunction with the AFHTO annual conference. This year it will be held:

    Tuesday, October 16, 2012 4:45 – 5:15 PM Hilton Toronto, 145 Richmond Street

    The AFHTO bylaws call for balanced representation on the board to include the three forms of FHT governance, the regions of the province, and a mix of the professions working within FHTs. Due to existing gaps on the AFHTO board, candidates from eastern Ontario, and from the professions of nursing (RN/RPN), social work/mental health work and registered dietitians are particularly encouraged to apply. FOUR people are to be elected for a 3-year term on the 12-member AFHTO board. To improve the representational balance, the AFHTO membership will be asked to increase the board size by two positions.  If approved, there will be a total of SIX positions to be elected at the October 16 AGM. Click here for information on the role and requirements of AFHTO board members. Sincerely, Dr. Val Rachlis Chair, Governance Committee AFHTO Board of Directors And Past Chair of the North York Family Health Team

     

     

     

  • Letter to AFHTO members: Nominations for election to AFHTO Board

    Dear fellow AFHTO members: Are you interested in serving on the AFHTO board of directors? The Governance Committee of AFHTO’s board invites anyone associated with an AFHTO-member FHT to apply.

    The Governance Committee of the AFHTO board will review all applications to assist the AFHTO board to determine the slate of candidates to recommend to the AFHTO membership for election at the AFHTO annual general meeting. Nominees will be informed of their status by the end of September. (NOTE: AFHTO members have the right to make additional nominations at the AGM.) The AGM takes place in conjunction with the AFHTO annual conference. This year it will be held:

    Tuesday, October 16, 2012 4:45 – 5:15 PM Hilton Toronto, 145 Richmond Street

    The AFHTO bylaws call for balanced representation on the board to include the three forms of FHT governance, the regions of the province, and a mix of the professions working within FHTs. Due to existing gaps on the AFHTO board, candidates from eastern Ontario, and from the professions of nursing (RN/RPN), social work/mental health work and registered dietitians are particularly encouraged to apply. FOUR people are to be elected for a 3-year term on the 12-member AFHTO board. To improve the representational balance, the AFHTO membership will be asked to increase the board size by two positions.  If approved, there will be a total of SIX positions to be elected at the October 16 AGM. Click here for information on the role and requirements of AFHTO board members. Sincerely, Dr. Val Rachlis Chair, Governance Committee AFHTO Board of Directors And Past Chair of the North York Family Health Team

     

     

     

  • FHT Practice Solutions EMR User Group Priorities – June 2012 survey results

    The purpose of this survey was to identify priority issues common to all FHTs using Practice Solutions (PSS). The survey was distributed to all FHTs that had reported through a previous AFHTO survey that they use PSS in their clinics (n=57 FHTs).

    There were 3 elements to the survey:

    • Identify common issues across FHTs
    • Prioritize action items to focus the user group when working on common issues for FHTs
    • Feedback on “Account Manager” proposal

    Please find below the PSS User Group report on FHT PSS Priorities. It presents a list of the 10 most common issues experienced by PSS Users in terms of frequency of the problem and its detrimental impact on FHT operations.

    Following from these, the PSS Users identified the following four items as the priorities for action:

    1. Data Extraction: FHTs are interested in extracting data to inform quality improvement initiatives. Health Quality Ontario is defining data requirements for quality reporting. The user group will seek support from PSS to assist FHTs in accessing usable data.
    2. Interfaces (eg. Lab, e-prescriptions): FHTs are and will be involved in health systems planning and innovation, the EMR should be innovative as well. The user group would work with PSS to determine what works needs to move ahead, and what work needs to wait for province-wide or LHIN-wide rollouts.
    3. Communications: FHTs would like to have a single point of contact within PSS who will have the authority and ability to speak for FHT issues and will coordinate priority issues for FHT clients.
    4. FHT Working Environment: The user group will work with PSS to increase their awareness of and responsiveness to the fact that the FHT working environment is different from that for physicians working in more traditional environments.

    The report also indicates almost unanimous support among the responding PSS Users for an “Account Manager” approach to solving many of these issues.

     

     

  • Priority issues identified by PSS users in Family Health Teams

    Click here to access the PSS User Group report on FHT PSS Priorities. It presents a list of the 10 most common issues experienced by PSS Users in terms of frequency of the problem and its detrimental impact on FHT operations.

    Following from these, the PSS Users identified the following four items as the priorities for action:

    1. Data Extraction: FHTs are interested in extracting data to inform quality improvement initiatives. Health Quality Ontario is defining data requirements for quality reporting. The user group will seek support from PSS to assist FHTs in accessing usable data.
    2. Interfaces (eg. Lab, e-prescriptions): FHTs are and will be involved in health systems planning and innovation, the EMR should be innovative as well. The user group would work with PSS to determine what works needs to move ahead, and what work needs to wait for province-wide or LHIN-wide rollouts.
    3. Communications: FHTs would like to have a single point of contact within PSS who will have the authority and ability to speak for FHT issues and will coordinate priority issues for FHT clients.
    4. FHT Working Environment: The user group will work with PSS to increase their awareness of and responsiveness to the fact that the FHT working environment is different from that for physicians working in more traditional environments.

    This report was sent as the “Prioritized list” to OntarioMD CEO Brian Forster, as he requested, and to Dennis Ferencz (OMD’s head for change management and the peer leader program) whom Brian identified as AFHTO’s key contact.  Brian and Dennis will go through the list. OntarioMD has identified the following tactics for moving forward with the results:

    • For issues that indicate PSS is failing to meet any of the standards for the latest spec, OMD can send them a “cure letter”. If they don’t meet the spec, then their status is suspended and the vendor can’t proceed with any further installations.
    • If the issue is not related to the current specs, OMD could potentially add requirements to future specs to deal with it.
    • For other issues – e.g. finding solutions to common operational needs, addressing overall poor communications – OMD can use its relationship to add more pressure to get problems solved.
    • At the same time, OMD + the user group could go through staff of CMA + CMA Holdings (Brian Peter is President) to apply pressure.  (Apparently some PSS physicians have threatened to drop their CMA membership over this issue. If the other avenues fail, perhaps this threat could be organized more widely and escalated if needed.)

    The FHT PSS User Group will receive all updates on developments with OntarioMD and PSS.

     

  • Post-Drummond Report and Budget: Moving Forward with Implementation of Health Care Reforms

    Monday, June 11, 2012

    This conference explored recommendations made in both the Drummond Report and the Action Plan that proposed a new local integrated health model. This model sets out primary care as the focal point, with access to health services shifted away from emergency rooms towards community care and alternative forms of care.

    AFHTO’s Executive Director, Angie Heydon participated in a panel discussion, Moving Forward with Integrating Primary Care.

    Panelists:

    • Melissa Farrell, Director, Primary Health Care, Ministry of Health and Long-Term Care
    • Jan Kasperski, President and CEO, Ontario College of Family Physicians
    • Angie Heydon, Executive Director, Association of Family Health Teams of Ontario
    • Paul Huras, CEO, South East LHIN
    • Matthew Anderson, President and CEO, William Osler Health System- Brampton
    • Sandra Coleman, CEO, South West CCAC; Board Member, Ontario Hospital Association

    Please find Angie’s presentation for the conference here.

     

     

  • Article in June 9 National Post

    On June 9, 2012, the National Post ran a full-page spread on page A6 under the large headline “Unhealthy conflicts” and smaller headline – “Numerous irregularities found at Ontario’s Family Health Teams.” The online version is at — http://fullcomment.nationalpost.com/2012/06/08/ontario-government-faces-lawsuits-over-troubled-family-health-teams/

    In response, AFHTO has sent the following letter to the editor:

    Family Health Teams are all about improving care for patients.  Christie Blatchford said it herself — “Early evidence is that FHTs do result in better outcomes for patients, particularly those with complex medical problems such as diabetes.” Teams also work with specialists, hospitals and community agencies to make more efficient use of Ontario’s health resources.

    It is sad to see this progress overshadowed by the isolated allegations in Christie’s story. Improvement is based on evidence.   Family Health Teams continue to combine evidence, innovation, collaboration and learning to improve access to care, help patients achieve better health, and use the precious resources of our health system wisely.

    As the evidence of their value expands, let us hope these Teams can also expand so that all Ontarians can access high quality interdisciplinary primary health care.

    There is some good news in the article. In addition to Ms. Blatchford’s positive comments about FHTs in paragraphs 2-5, quotes from Minister Matthews and Phil Graham are highly supportive of our teams.  Unfortunately, the rest of the article uses allegations about two FHTs – one community-led and one physician-led – to “suggest there may be widespread gaps with oversight and real potential for abuse and even wrongdoing.”  The criticism is directed toward “conflict of interest” and at government processes for funding and oversight.

    AFHTO continues to champion all that FHTs have accomplished, and advocate for the support they need to improve and deliver optimal interprofessional care. On behalf of members, AFHTO has advocated for Ministry support to strengthen many aspects of FHT operations, including governance.

    AFHTO members want to govern their FHTs wisely. Members identified governance development as a priority at AFHTO’s November 2009 leadership retreat. This was followed up with a member survey in May 2010, then a proposal to government in January 2011. Participants in the October 2011 leadership program at the AFHTO Conference concluded that FHT governance has been improving, but still needs further development.

    Within our resources – two staff plus FHT volunteers – AFHTO will once again present a Leadership and Governance program for the 2012 conference in October. Board resources submitted by FHTs are posted on AFHTO’s members-only website. We also continue to seek external support to be able to ensure all FHT boards have access to the education and tools they need to support sound leadership and governance for their FHTs.

    Family Health Teams have so much to offer to patients and Ontario’s health system. AFHTO applauds you for all you have accomplished so far, and is here to support you in your work to provide high quality interdisciplinary primary health care to Ontarians.