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Rapid Recap: Ontario Introduces New Community Surgical and Diagnostic Centre Legislation

Tuesday, February 21, 2023 – Ontario’s Minister of Health Sylvia Jones introduced the Your Health Act, 2023 to the legislature this afternoon. The legislation creates the framework to apply for and operate new Community Surgical and Diagnostic Centres (CSDCs) as well as codifying new “As of Right” rules and expanding pharmacists’ scope of practice.

The Your Health Act is designed to simultaneously give the province the ability to establish new CSDCs, while also introducing requirements to address the concerns that have been raised relating to health human resource challenges, quality of care, patient access and fee-for-service. CSDCs will be required to follow new rules around integrating with local hospitals, staffing, quality oversight and monitoring procedures, and pricing transparency.

The legislation does not immediately create a set number of new centres, nor does it immediately establish a new quality and oversight framework. Instead, it lays the groundwork for the province to steadily expand the number of CSDCs over time and shift more care out of hospitals and into alternative community settings.

The Details

Community Surgical and Diagnostic Centres

Quality and Safety

  • The legislation will introduce new requirements for Community Surgical and Diagnostic Centres (CSDCs) to develop and provide details of all quality assurance and quality improvement programming.
  • CSDCs will be required to share details of infection prevention and control measures.
  • They will also be required to develop a patient complaints process, as well as keep records of all complaints received through the process and what steps were taken to address them.
  • Under the legislation, patients will also be given the right to raise concerns with CSDCs to the Ontario Patient Ombudsman.
  • The government has not yet decided which organizations will be responsible for inspections, but the legislation enables the government to appoint as many inspection bodies as appropriate.

Hospital and Health System Integration

  • The legislation will require all applicants to detail their proposals for integrating with and supporting local hospitals.
  • CSDCs will be responsible for reporting into wait times information systems, participating in regional central intake programs and coordinating with local hospitals to accept referrals.
  • These requirements are aimed at ensuring effective care pathways and reducing wait times for patients, regardless of where they receive care.

Health Human Resources

  • To address concerns that private clinics will take staff from hospitals, the legislation includes a requirement that all physicians employed at a CSDC must also have privileges to perform that same work at a hospital.
  • CSDCs will be required to report on their compliance.

Fees and Charges

  • CSDCs will be prevented from refusing service to those who do not accept more costly non-OHIP funded services.
  • They will also be required to ensure all pricing information is transparent and provided in an upfront manner.
  • As part of the application process, they will be required to provide a description of any charges for uninsured services and how they will provide information and obtain consent for these services.

“As of Right” Rules

As another step in the government’s response to the health human resource (HHR) crisis and to ease barriers to recruitment, the legislation will enshrine the right of certain regulated health professionals who have been registered in another province to work in Ontario without first registering with an Ontario body.

Pharmacist Scope of Practice

The legislation adds “the assessment of conditions for the purposes of providing medication therapies” to pharmacists’ scope of practice, enshrining in legislation the government’s earlier announcement providing them with the power to prescribe for 13 minor ailments.

Santis Insights

  • This new legislation represents the next step in Ontario’s health reform strategy, which began earlier this year with initial announcements regarding surgical expansion and health care licensure.
  • In their recently released “Your Health” plan, the province outlined a series of reforms to bolster system capacity, and with this legislation, they are developing the legal framework required to implement these reforms.
  • These reforms are targeted at addressing Ontario’s HHR challenges and the consequent surgical backlog and ER wait times that have had significant impacts on Ontario’s health system. Over the past year, Ontario’s surgical backlogs have exceeded 200,000 people, vacancy rates in hospitals for nursing roles have been as high as 12%, and the average time spent in ERs has exceeded 20 hours. The province is looking to make a significant dent in all of these indicators.
  • Establishing new Community Surgical and Diagnostic Centres will take time. In the coming months, Ontario will begin to approve new licenses, greatly expanding the capacity for private delivery of surgical and diagnostic care.
  • The government will continue to emphasize the important role of CSDCs in reducing waitlists and improving access to care, while ensuring users are not paying out of pocket for OHIP-funded services.