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HEALTH POLICY REPORT

A summary of current health legislation and policy developments

by OMA Health Policy Department

 

April 2008

OUT-OF-HOSPITAL PROCEDURES USING LOCAL ANESTHETIC

At its February meeting, the Council of the College of Physicians and Surgeons of Ontario voted to proceed with a proposed regulation change to enable the College to inspect out-of-hospital facilities (e.g., cosmetic surgery clinics).

As a follow-up to this process, the College circulated a document entitled “Procedures Performed Under Local Anesthetic.” The College has stated that only certain procedures performed under local anesthetic will trigger a facility inspection. This document was generated in an effort to have the College clarify the types of out-of-hospital facilities that will be targeted for inspections.

The OMA Health Policy Department is co-ordinating the formal response to the College on this consultation document.

OMA staff contact: Ada Maxwell (ext. 2942)

HPRAC CONSULTATION DISCUSSION ON INTERPROFESSIONAL COLLABORATION

In response to a request for advice from the Minister of Health and Long-Term Care, the Health Professions Regulatory Advisory Council (HPRAC) is seeking comments from members of the health professions on viable approaches to interprofessional collaboration among health college professions.

HPRAC will be submitting its advice on how the colleges and the regulatory environment can support interprofessional care to the Minister later this year. The OMA Health Policy Department is co-ordinating an OMA response to the HPRAC Discussion Guide. Upon referral from the Minister, HPRAC has circulated this Guide, which contains questions that are designed to assist in implementing mechanisms to facilitate and support interprofessional collaboration between health colleges. The OMA response will address issues related to several important areas of interprofessional care, including scope of practice of health professionals, interprofessional relations, quality assurance across professional colleges, liability concerns across professional colleges, joint complaints/investigations bodies for health professionals and discipline processes in a multidisciplinary context.

The Health Policy Department has invited all OMA Sections to forward comments, questions or suggestions regarding the Discussion Guide, to be included in the OMA submission to HPRAC.

MA staff contact: Ada Maxwell (ext. 2942)


March 2008

CPSO PROPOSALS ON COSMETIC FACILITIES, USE OF SPECIALIST TITLES AND MANDATORY PHYSICIAN QUESTIONS

The Council of the College of Physicians and Surgeons of Ontario (CPSO) recently proposed amendments to its bylaws and regulations related to mandatory physician questions, out-of-hospital facilities, and use of specialist titles. The OMA submitted a response to these proposals, voicing strong opposition to many of the changes based on concerns that the amendments were too broad. The OMA engaged the CPSO in active dialogue prior to its Council meeting in an effort to have its concerns understood and the amendments redrafted.

The CPSO Council approved the following amendments: mandatory physician questions will include information about addiction as well as civil lawsuits and specific criminal offences; inspection of out-of-hospital facilities administering anesthesia will take place every five years; and the definition of “change of scope of practice” has been clarified. As a result of discussions with the OMA Executive, the CPSO agreed to defer the issue of specialist titles until further consultation with the Royal College of Physicians and Surgeons.

The CPSO Council also deferred the issue of mandatory disclosure of physicians’ serological status for one year.

OMA staff contact: Ada Maxwell (ext. 2942)

CPSO DRAFT POLICIES ON ESTABLISHING AND ENDING THE PHYSICIAN-PATIENT RELATIONSHIP

The College of Physicians and Surgeons of Ontario recently circulated a draft policy on “Establishing Physician-Patient Relationships,” which set out guidelines for doctors in the process of deciding whether to accept individuals as new patients. Along with this draft policy, the CPSO distributed a revised policy on “Ending the Physician-Patient Relationship.” The College requested general feedback, as well as specific comments on certain aspects of these policies.

The CPSO’s position on patient-physician relationships seems to be, in part, a response to frustrations patients have experienced while seeking out a new physician and securing doctor care. A good deal of the draft policy on establishing a relationship addresses the parameters of the “interview” process many doctors have implemented in deciding whether or not to accept prospective patients. Although the draft policies offer some guidance, one of the CPSO’s objectives is to limit the circumstances under which a physician may refuse patients. The CPSO risks unreasonably limiting a physician’s right to enter into an independent contract with a patient.

After consultation with its members and Sections, the OMA Health Policy Department drafted separate responses to each policy, which have been approved by the OMA Board. The OMA believes that these policies are overly restrictive for physicians who turn away patients and terminate existing relationships. The OMA response to the CPSO emphasizes the importance of protecting every physician’s right to terminate a physician-patient relationship when it is reasonable to do so.

The OMA will continue to assert the importance of preserving each physician’s individual right to begin and end a professional relationship, and will work with the College on these policies.

OMA staff contact: Ada Maxwell (ext. 2942)

PHYSICIAN-EMPLOYED PHYSICIAN ASSISTANTS

The Physician Employed Physician Assistant (PEPA) Demonstration Project will involve up to 11 physician assistants (PAs) working in diabetes care and long-term care. PA candidates are currently being screened, and numerous on-site interviews have taken place. It is antici­pated that all positions will be filled by the March 31 hiring deadline.

A recent orientation session held at the OMA provided physicians who are supervising PAs with an opportunity to raise issues surrounding compensation and liability, recruitment, scope of practice, and the use of medical directives, data collection and evaluation. Further orientation sessions will occur to assist with the integration of PAs into their various practice settings.

OMA staff contact: Carol Jacobson (ext. 2984)
Rachel Bandele (ext. 3330)

WAIT-TIMES INITIATIVE SYSTEM

In order to address surgical wait times, the Ministry of Health and Long-Term Care is in the process of expanding the areas in which participating hospitals must collect data. Beginning in March 2008, three new categories will be added: ophthalmology, orthopedic surgery, and general surgery. With the Ministry’s intention of eventually phasing in all surgical specialties, hospitals may be collecting wait times data on additional areas (e.g., neurological, vascular, thoracic, cardiovascular, pediatric, etc.) by March 2009. In addition, the Ministry is examining the viability of capturing ER wait times.

Recognizing the impact on physicians, the OMA negotiated $3 million (as part of the recent Reassessment of the Master Agreement) to provide for a one-time recognition payment for those physicians who participated in the start-up of the provincial WTIS. This money was dispersed in December 2007; physicians entering into the WTIS between August 2007 and March 2008 will receive a recognition payment in their May 2008 Remittance Advice. The OMA continues to work closely with both the Ministry and the Ontario Hospital Association to acknowledge and address the impact these and future wait-time expansions have on physicians, and to emphasize the need for continuing support.

OMA staff contact: Kristen Gane (ext 2883)

DISRUPTIVE PHYSICIAN BEHAVIOUR

The OMA is working with the CPSO and the Ontario Hospital Association to develop an educational piece for physicians and hospitals on understanding and addressing disruptive physician behaviour. It is anticipated that there will be both videoconferences and a number of in-person sessions during the early spring. More information will be provided as it becomes available.

OMA staff contact: Barb LeBlanc (ext. 2965)


February 2008

CPSO BYLAW AND REGULATION AMENDMENTS

The College of Physicians and Surgeons of Ontario (CPSO) recently circulated proposed changes to regulations and bylaws relating to cosmetic and other high-risk out-of-hospital procedures, physician titles, and expansion of the CPSO mandatory questions.

Most of the amendments have professional misconduct implications, and the OMA is concerned that some of the proposed amendments may result in relatively minor infractions triggering disciplinary proceedings.

Although these proposals arise from the CPSO’s need to deal with high-risk cosmetic procedures, the OMA stresses the broad scope of the proposed amendments, and the latitude it offers the CPSO in imposing new requirements on physicians.

The OMA is preparing a response to the CPSO ahead of the College’s February Council meeting. After consultation with its members and Sections, the OMA takes the position that the CPSO should only implement new regulations and bylaws that respect physicians’ interests while promoting public safety surrounding cosmetic procedures.

OMA staff contact: Ada Maxwell (ext. 2942)

DRUGS AND PHARMACOTHERAPY

On January 15, 2007, the Ministry of Health and Long-Term Care (MOHLTC) made changes to the benefit status of some generic drugs as a result of alleged unauthorized price increases by generic drug manufacturers. Although the Ontario Public Drug Program Division has ensured that there is, at minimum, one generic product available for each strength and dosage form, pharmacies in some regions have experienced difficulty in filling prescriptions, as their inventory did not reflect the recent formulary changes and they were unable to adapt quickly.

A brief memorandum addressing the formulary amendments, entitled “Tool to Educate Physicians,” posted on the Ontario Pharmacists’ Association (OPA) website, contained incorrect information and resulted in some consternation to the physicians who received it from their local pharmacist. Nevertheless, supply uncertainties have the potential to seriously jeopardize patient care and impede physician practice; therefore the OMA will continue to be in frequent contact with the Ministry, both to monitor the supply issue, and to communicate the Association’s concerns regarding the potential impact on patient care.

OMA Staff Contact: Kristen Gane (ext. 2883)

CPSO POLICIES ON ESTABLISHING AND ENDING PHYSICIAN-PATIENT RELATIONSHIPS

In early December, the CPSO circulated a draft policy entitled “Establishing a Physician-Patient Relationship,” which set out guidelines for doctors in the process of deciding whether to accept individuals as new patients. Along with this draft policy, the CPSO distributed a revised policy entitled “Ending the Physician-Patient Relationship.” The CPSO requested general feedback, as well as specific comments on certain aspects of these policies.

The CPSO’s firmer position on patient-physician relationships seems to be, in part, a response to frustrations patients have experienced while seeking out a new physician and securing doctor care.

A good deal of the draft policy addresses the parameters of the “interview” process that some doctors have implemented in deciding whether or not to accept prospective patients. Although it offers some guidance, the CPSO’s objective seems to be to limit the circumstances under which a physician may refuse patients. While the CPSO acknowledges that physicians should be allowed to exercise discretion in accepting new patients, it risks unreasonably limiting a physician’s right to enter into an independent contract with a patient.

After consultation with its members and Sections, the OMA has drafted separate responses to each policy. The OMA has expressed concerns that the policy on establishing relationships may be overly restrictive for physicians turning away patients. In the case of ending physician-patient relationships, the OMA response emphasizes the importance of protecting every physician’s right to terminate a physician-patient relationship when it is reasonable to do so.

OMA staff contact: Ada Maxwell (ext. 2942)


January 2008

ESTABLISHING AND ENDING THE PHYSICIAN-PATIENT RELATIONSHIP

The College of Physicians and Surgeons of Ontario (CPSO) recently circulated two new policy documents for input by stakeholders. The first document involves policy outlining principles related to establishing a physician-patient relationship, with an emphasis on screening/ interviewing prospective patients. The second document is an updated version of an existing policy on terminating the physician-patient relationship.

The OMA will be reviewing and responding to each of these proposed policies.

OMA staff contact: Ada Maxwell (ext. 2942)

PHYSICIAN BEHAVIOUR IN THE WORKPLACE

The CPSO is concluding a lengthy project related to physician behaviour in the workplace. This initiative has involved many stakeholders and is designed to provide the information and education necessary to help physicians and institutions deal with behaviour that is generally viewed as “disruptive.”

There are two parts to this issue that will be of interest to physicians:

  1. A new CPSO policy on appropriate physician behaviour in the work environment has been developed. The policy is posted on the CPSO website (http://cpso.on.ca/Policies/behaviour.htm).

  2. A toolkit that provides a framework for dealing with physician behaviour — including a sample code of conduct — is being developed and will be posted on the CPSO website at the conclusion of the project.

The OMA will be working with the CPSO and the Ontario Hospital Association (OHA) on a communications strategy to ensure that physicians and hospitals understand that the toolkit has been developed as a constructive and educational device, and is not intended as a means to stifle physician advocacy, or to impose arbitrary rules and regulations.

More information on this issue will be forthcoming in the weeks ahead.

OMA staff contact: Kristen Gane (ext. 3131)

REGULATIONS RELATED TO COSMETIC SURGERY

The CPSO is undertaking a significant review of the regulation related to high-risk cosmetic procedures. As part of that review, input is being sought on a proposed new regulation under the Medicine Act. The OMA will be reviewing the regulation and responding to the College.

OMA staff contact: Ada Maxwell (ext. 2942)


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