Monday, January 16, 2023 – Declaring “the status quo is not working”, Ontario Premier Doug Ford and Minister of Health Sylvia Jones announced sweeping changes to reduce wait times for surgeries and procedures in the province, with a significant expansion of the Independent Health Facility (IHF) model over the next two years.
Using the new term “community surgical and diagnostic centres” rather than Independent Health Facilities, the three-step plan announced today will see the government expand capacity in existing clinics and form new partnerships to create additional surgical volumes.
There are an estimated 206,000 people currently waiting for a hospital operating room-based surgical procedure according to wait time data from Ontario Health. This compares to a wait list of about 200,000 people before the pandemic. The three-step plan aims to provide care for thousands of patients to return to pre-pandemic levels by March 2023, barring operational issues. The expanded surgical volumes will be delivered in private settings and covered by OHIP, with the Premier and Health Minister clear that no patient will pay out of pocket.
The government’s announcement today includes various requirements that community surgical and diagnostic centres must adhere to. Applicants, for example, must collaborate with local hospitals to ensure that added surgical and diagnostic capacity in the community does not divert capacity from the hospital sector. All applicants will be required to submit a detailed staffing plan as part of their proposals for licensing. The applicant will also be required to participate in regional central intake systems and coordinate with hospitals to accept referred patients.
The Three-Step Plan
Step One (Immediate Actions): Addressing the Surgical Backlog
The government announced new partnerships with community surgical and diagnostic centres in Windsor, Kitchener-Waterloo and Ottawa will result in 14,000 additional cataract surgeries performed each year.
The government will also invest $18 million into existing centres to expand MRI and CT scan hours, cataract and other ophthalmic surgeries, and plastic surgeries. This investment will enable:
- More than 49,000 hours of MRI and CT scans;
- 4,800 cataract surgeries;
- 900 other ophthalmic surgeries;
- 1,000 minimally invasive gynecological surgeries; and
- 2,845 plastic surgeries, such as hand soft tissue repair.
Step Two (2023): Expansion of Low-Risk Procedures
This step will expand the scope of community surgical and diagnostic centres to address the regional needs of Ontarians through the provision of more low-risk surgical and diagnostic procedures, including colonoscopies and endoscopies.
Step Three (2023-2024): Expansion Into New Surgeries
The government will introduce legislation in February 2023 that, if passed, will allow existing community diagnostic centres to conduct more MRI and CT scanning. This will allow the government to expand surgeries for hip and knee replacements starting in 2024. These legislative changes are meant to strengthen oversight of community surgical settings to ensure high-quality patient care, while also expanding access to more surgeries and further reducing wait times.
Licensing and Requirements for Clinics
Minister Jones confirmed community surgical and diagnostic centres will continue to apply for licenses through the Ministry of Health to address community needs and health human resources capacity. The government also confirmed that government funding will be contingent on clinics forming partnerships with local hospitals, although what form those partnerships will take is not yet clear. Community surgical and diagnostic centres will also be required to report into the province’s Central Waitlist Management program and participate in regional central intakes.
Criticisms
Concerns have been raised by the NDP and advocates that this move represents a step towards the privatization of health care. The government; however, has been clear that all OHIP-insured surgeries will still be paid for by OHIP, even if delivered in a private clinic.
There is also a concern that health care staff may leave already-stretched hospitals, further exacerbating staffing challenges. For instance, the College of Physicians and Surgeons of Ontario last week criticized the move by stating that “any expansion of private surgical centres would create challenges for hospitals”.
Santis Insights
- The decision to focus on high-waitlist, low-risk procedures such as cataract surgeries, colonoscopies and endoscopies will see a significant shift in how many Ontarians receive care.
- As the Premier and the Health Minister stated, this will align Ontario with other provinces that have greater out-of-hospital surgical capacity, easing the various pressures on hospitals as they continue to face capacity issues.
- Although both not-for-profit and for-profit community surgical and diagnostic centres will be able to apply for new licenses, both the Premier and Health Minister were clear that patients will not have to pay for surgeries or procedures out of pocket. There will still be opportunities for clinics to offer additional procedures for a fee if they are not covered by OHIP (e.g. medications). Questions about privatization will likely continue to be a key issue for stakeholders.
- Although clinics will be required to collaborate with local hospitals in various ways, today’s announcement suggests that these connections may be less strong (and clinics may have more independence) than what the Ontario Medical Association advocated for last year in their call for Integrated Ambulatory Centres. This will likely be a key point for stakeholder discussion as these details are finalized in the coming months.
- While the government has re-committed to a central intake and digital management of surgical waitlists, today’s announcement signaled a continued move towards more regional approaches, rather than province-wide management.
- Staffing shortages remain a significant challenge, with the government expected to announce a major health human resources package in the coming weeks.