Integration said to be key to partnerships with private medical clinics

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The president and CEO of Kingston Health Sciences Centre says the Ontario government’s plan to expand partnerships with private medical clinics to address surgical waitlists is one immediate way to add capacity to a system that is overloaded.

Dr. David Pichora said the COVID-19 pandemic has exacerbated problems that already existed in the province’s health-care system.

“We knew before the pandemic that we didn’t have enough beds or enough operating rooms or enough staff,” he said. “That has been amplified or exposed very clearly during the pandemic. The problems that we’re seeing are not new, but in many cases are just bigger.”

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The province announced on Jan. 16 that it would invest $300 million this year as part of its surgical recovery strategy to help clear a backlog of surgeries and diagnostic procedures, “prioritizing patients waiting longer than recommended in clinical guidelines,” a news release from the Ontario government stated.

Step 1 of the province’s plan is to add 14,000 cataract surgeries through partnerships with centres in Kitchener-Waterloo, Windsor and Ottawa, and to allocate $18 million to existing Independent Health Facilities across Ontario for diagnostic procedures like MRI and CT scans and for a variety of surgeries, including cataract and other ophthalmic procedures, some gynecological surgeries and plastic surgeries.

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According to the provincial government, there are currently 206,000 people estimated to be waiting for surgeries in Ontario.

There were just over 7,000 individuals waiting for an elective surgery in the Kingston region in January, according to data provided by KHSC. Approximately 4,000 of those patients have waited longer than Ontario Health’s targeted wait times.

“Those wait times have been substantial, even before the pandemic,” Pichora said. “Obviously they took a hit during the pandemic.”

Non-urgent ophthalmology and orthopedic procedures like cataract surgery and hip and knee replacements represent the largest group of patients waiting in the Kingston region.

According to the province, community surgical and diagnostic centres licensed under the Independent Health Facilities Act currently perform approximately 26,000 OHIP-insured surgeries and procedures ever year.

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Pichora says that IHFs have been part of Ontario’s health-care system for some time. He pointed out that pharmacies and physiotherapists are private facilities that work in partnership with the province’s public system.

“It’s not like this is a new thing,” Pichora said. “These IHFs have been around for a long time doing a variety of things.

“This is a way of adding capacity. That’s not a bad thing. From my perspective, it’s more about how’s it done.”

Pichora believes that a “hub and spoke” model utilizing existing IHFs in an integrated fashion will be a positive for Ontario’s health system as an immediate response.

“I think the (Ontario Hospital Association) and virtually all hospitals would agree that it would be far better to do this in an integrated partnership fashion,” he said. “We work really hard to have an integrated health system. This is Ontario Health’s job. This is what the future of (Ontario Health Teams) is about. The idea of setting up a completely independent parallel stream doesn’t really resonate with that very well, but yet we could achieve the same goals if we do it in a more integrated manner.”

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What Pichora doesn’t want to see is patients undergoing surgical procedures at clinics that have no ties to local hospitals.

“We don’t want itinerant surgeons coming into town, who are here today and then gone, who don’t have hospital privileges, who aren’t there to provide any kind of post-operative care or deal with problems or concerns that might arise,” he said.

KHSC maintains existing partnerships with IHFs in the community that were in place before the pandemic, including an ongoing contract with Focus Eye Centre for cataract surgeries.

That contract allows for allocating cases as hospital staff deem appropriate, stipulates that the hospital’s surgeons have “first right” to working at the clinic, as well as allows doctors in training access for teaching purposes.

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“It’s part of the hospital, essentially,” he said.

This kind of partnership and oversight are what Pichora hopes to communicate in his ongoing discussions with the provincial government, which has reached out for advice from hospital organizations across the province.

“They’re certainly seeking our advice, and others, on how to set up the policies and regulations and the application process,” Pichora said. “I suspect the government realizes as well that doing this in a co-ordinated, integrated fashion is better.

“It’s not about saying ‘no.’ It’s about saying, ‘How?’”

The government’s announcement in mid-January has incited mixed responses from medical organizations, many of which believe investing in the public system is a better approach to a long-term fix for staffing shortages and wait times.

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The Registered Nurses’ Association of Ontario believes the provincial government should help bolster hospitals with underutilized resources, such as operating rooms that are closed during evenings and on weekends, The Canadian Press reported in January.

“The premier needs to open the operating rooms, the operating theatres, the recovery rooms in our public hospitals 24-7 like many other countries do,” Doris Grinspun, the association’s CEO, told The Canadian Press.

The OHA is concerned that private clinics will steal staff from public hospitals, where staffing shortages are already a problem.

“We certainly aren’t interested in seeing members of the hospital teams being poached by other employers,” Anthony Dale, the president of the OHA, told The Canadian Press.

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In a news release responding to the province’s announcement on Jan. 16, the Canadian Union of Public Employees (CUPE) said for-profit clinics, long-term care homes and nursing agencies have worsened staffing shortages in Ontario’s public health system.

“This move runs counter to the principles of our public health-care system,” Naureen Rizvi, Unifor Ontario regional director, said in the CUPE release. “Doug Ford is allowing private clinics to profit by performing these essential health procedures, which is not a solution to our health-care crisis. It will simply make this crisis worse by exacerbating the staffing shortages in our public system and diverting funding away from public hospitals and clinics.”

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Ross Sutherland, with the Kingston arm of the Ontario Health Coalition, echoed concerns about investing in private clinics instead of the public system.

“It’s a matter of resources,” Sutherland told the Whig-Standard in an interview. “In a way, it’s no more complicated than that.”

Investing in private clinics will likely make a difference to Ontario’s surgical wait list, he admitted, but at a cost to taxpayers and to the public health system’s future success.

“It’s just going to cost us more, it’s going to fragment the system and it’s going to cost patients more,” he said. “So why wouldn’t we build a strong public health-care system? That’s what I don’t understand, when you get right down to it.

“Where these resources go will determine what we’re going to see 10 years down the road from now.”

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Pichora agreed that while IHFs are “one way to do it,” investing in Ontario’s public hospitals is a needed solution.

“If hospitals had the funding and the staff available, we would be able to run our operating rooms on Saturdays, some in the evenings, and expand capacity with existing resources,” he said. “Looking at the number of (functioning IHFs) today, it’s a very small number. If we were to start building a bunch of new IHFs, why wouldn’t we first extend hours at hospitals that are able to work already?”

Pichora pointed out that locally, while hospitals have returned to full operating room capacity — in fact, running more operating rooms than KHSC did pre-pandemic — there is room to utilize local existing infrastructure more effectively. Hotel Dieu Hospital’s operating rooms do not run in the evenings or on weekends.

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“There’s a potential for expansion there without building anything new,” he said. “It’s just a matter of staffing it so that we can run it.”

Pichora encouraged people who are concerned about the province’s current trajectory with private clinic partnerships to focus on encouraging an integrated model.

“From my perspective, what they should be concerned about is getting improved access to the system, where they know that they’re going to be able to get access to the same quality of care no matter where they go, and that where they’re getting their care is part of the system one way or another,” he said.

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