Ontario’s Appropriateness Working Group Submits First Phase Recommendations

In February of 2019, Ontario Doctors were awarded a new four-year contract in an arbitrated settlement. As part of this contract, a joint committee was created between the OMA and the Government of Ontario called the Appropriateness Working Group (AWG). The AWG is tasked with discussing and establishing evidence-informed amendments to payments by eliminating or restricting inappropriate or overused physician services and payments.

The AWG was tasked with making recommendations in two phases: the first phase was tasked to find $100 million in savings and the second phase was tasked to find a further $360 million.

Today, the first phase recommendations were announced and included 11 recommendations, making changes to OHIP-insured services, tests and procedures for patients in Ontario. Phase two is ongoing and an announcement on those recommendations are expected in the Spring. These recommendations have already been accepted by the Government of Ontario and the Ontario Medical Association (OMA).

The recommendations will officially take effect beginning October 1st, 2019.

AWG’s 11 Recommendations:

Improve the Quality of Patient Care

  1.  Use More Accurate Diagnostic Imaging for Sinus Problems
  2. Refer Patients to Specialized Clinics for Chronic Hip and Knee Pain to Improve Arthritic Care
  3. Update the use of Ambulatory Cardiac Monitoring Devices (Loop and Holter Monitors)
  4. Improve Access to Primary and Specialty Care by Simplifying Referrals to Specialists
  5. Use More Effective Testing to Diagnose Infertility

Reduce Medically Unnecessary Services

  1. Perform Procedure to Remove Ear Wax Only When Medically Necessary
  2. Conduct Larynx Examinations During Stomach Examinations Only When Medically Necessary
  3. Continue Access to Urine Pregnancy Tests When Medically Necessary
  4. Improve Primary Care Access by Streamlining Pre-Operative Assessments
  5. Improve Access to Knee Arthroscopies for Patients with Degenerative Knee Disease
  6. Fund Physician Premiums for House Calls Only for Frail Elderly and Housebound Patients

The Appropriateness Working Group (AWG) was first established by the Kaplan Board of Arbitration and is binding on both the OMA and Ministry of Health. Its purpose is to provide recommendations based on evidence and best practices to ensure the most effective care for patients by reducing the provision of medically unnecessary services. 

Read the Government of Ontario’s news release here. 

Read the Appropriateness Working Group’s recommendations here.