Council Update

November 30 - December 1, 2017

New College President; Dr. Kenneth Fung receives Council Award; Uninsured Services: Billing and Block Fees Policy Approved; 2018 Budget; Registration Pathways Program Evaluation; Bill 160, Schedule 9 Oversight of Health Facilities and Devices Act, 2017 ; Prescribing Drugs – Preliminary Consultation; Find out how your opioid prescribing compares to your peers

Dec 06, 2017

New College President 

Dr. Steven Bodley became the College’s new President December 1.

Dr. Bodley is an anesthesiologist from North Bay, with a practice combining anesthesia and chronic pain management. He is on staff at North Bay Regional Health Centre and is an Associate Professor at the Northern Ontario School of Medicine. Dr. Bodley received his medical degree from the University of Western Ontario and received his Fellowship in Anesthesiology at the University of Toronto.

Dr. Bodley joined Council in 2009 and has served in a leadership role on a number of College Committees.

Dr. Kenneth Fung receives Council Award

Dr. Kenneth Fung, of Toronto, has received the College’s Council Award for his work in developing culturally sensitive mental health programs.

Dr. Fung is an internationally acclaimed psychiatrist with particular expertise in cultural psychiatry. He has worked tirelessly to advance accessible and culturally inclusive mental health services for ethno-racial and marginalized communities in Canada. In so doing, he has helped break down barriers to care and reduce the stigma often associated with mental illness in our communities.

Read more about Dr. Fung in the next issue of Dialogue.

Uninsured Services: Billing and Block Fees Policy Approved

Council approved the Uninsured Services: Billing and Block Fees policy following an external consultation.

Overall, the policy retains the key content and central principles of the earlier policy. However, as a result of feedback – including input from the College’s Inquiries, Complaints and Reports Committee – a number of changes were made. Most notably, new language has been added to emphasize how reliant patients are on the honesty and integrity of physicians when paying for uninsured services. The revised draft policy also includes a new section, requiring physicians to be clear and impartial when proposing uninsured services as an alternative or adjunct to insured services. Council was satisfied that the revisions made to the policy will help to avoid situations where confusion can arise when paying for uninsured services.  

Other requirements of the revised policy include:

  • Charging reasonable fees;
  • Considering the patient’s ability to pay;
  • Communicating fees before uninsured services are provided;
  • When offering a block fee, physicians must comply with a number of policy requirements and offer the option in writing.  

2018 Budget

The College is charged with the responsibility of ensuring that the College can fulfill its statutory duty in a timely manner. This means having the necessary resources in place to operate a robust regulatory system that can continue to govern in the public interest.

The scope of the College’s work is set by legislation and we do not have the option to narrow our focus in response to increasing costs. We continue to face an unprecedented volume of cases and significantly, an increase in the number of complex and time-consuming investigations.  Over the last several years, the number of investigations has been steadily climbing – in the last year alone there was a 13% increase in the total caseload, with a 45% increase in the more complex Registrar’s Investigations. And as of October, there were more than 108 open discipline matters – an unprecedented number.

The College has always been committed to responsibly managing our financial resources, and only modest fee increases have been implemented over the past five years. In fact, one year there was no fee increase at all. We have made process changes and implemented cost-saving efficiencies wherever we can – such as reducing resources to address non-urgent matters. Plans are under development to derive further savings in 2018. This work to find efficiencies, enhance processes and streamline our operations is ongoing.

After reviewing the proposed budget for 2018, Council is recommending a $100 fee increase to renew an independent practice certificate. This increase, if approved, would bring the fee to $1,725.

If the proposed fee is approved by Council next February, the average increase per year for the 2013-2018 period will be 2.25%. For most of the years within the past five, the rate was below inflation.

Council understands the financial challenges currently facing physicians but fulfilling these statutory obligations is not optional – the College must comply with the required programs and, in many cases, prescribed processes and timelines in order to protect the public interest. 

Other external drivers which impact our budget include those numerous issues that arrive at the College and require – based on risk, public safety, stakeholder relationships or direction by government – concentrated work efforts to achieve the optimal outcome. Recent examples include the work necessitated by Bills 87 and 160.

The College is committed to being transparent about its finances and its resource requirements to operate programs. The Finance Committee regularly provides detailed reports to the public Council meetings and all Committees and College programs report regularly on College activities and benchmarks.

The College is required to set fees in the form of by-laws, and to circulate all by-laws to the membership. Below is the proposed amendment.

By-law No. 116
Subsection 4(a) of By-Law No. 2 (the Fees and Remuneration By-Law) is revoked and the following is substituted:

Annual Fees
4. Annual fees for the year beginning June 1, 2018, are as follows:
(a) $1725 for holders of a certificate of registration other than a certificate of registration authorizing postgraduate education and other than a certificate of registration authorizing supervised practice of a short duration; and

Registration Pathways Program Evaluation 

Council was provided with an overview of key findings from the College’s multi-year evaluation of the Registration Pathways Program.

Overall, the evaluation findings support the effectiveness of the College’s alternative registration pathways and policies, based on three performance measures – peer assessments; primary care quality indicators; and multisource feedback. The primary care quality indicators were developed and analyzed by the Institute for Clinical Evaluative Sciences.

The evaluation sought to determine if performance differences exist between practising physicians who were registered through alternative routes to registration (ARPs) and those who were registered through the traditional route (TRPs – i.e., physicians fully trained in Canadian residency and qualified in Canadian examinations).

The findings suggest that there are few performance differences between ARPs and TRPs on most validated primary care quality indicators and in multisource (360) feedback assessments. There are some differences noted on peer re-assessments ordered by the Quality Assurance Committee, however, the re-assessments reflected record-keeping and/or minor quality concerns that are not a risk to patient safety.  

We will have an article about the evaluation’s findings in an upcoming issue of Dialogue.

Bill 160, Schedule 9 Oversight of Health Facilities and Devices Act, 2017 

Council received an update on a bill that, if passed, will enhance and consolidate oversight for Ontario’s out-of-hospital facilities and services, better ensure patient safety, and take important steps to increase transparency and public reporting.

Bill 160 is a significant Bill containing ten schedules. The focus of the College’s attention is on Schedule 9, Oversight of Health Facilities and Devices Act, 2017 (OHFDA) as it creates a new legislative framework for health facilities.

The OHFDA seeks to establish a single legislative framework for:

  • community health facilities (including Independent Health Facilities (IHFs), Out-of-Hospital Premises (OHPs), private hospitals, and other facilities prescribed in regulation, and
  • energy applying and detecting medical devices (e.g., conventional X-rays, CTs and fluoroscopy, MRIs, ultrasounds, nuclear or molecular imaging devices).  

The OHDFA’s focus on patient safety, transparency, and public reporting are vital changes to a new regulatory system of oversight for community health facilities in Ontario. Inspection bodies – of which the College will be one – will be provided with the tools to take action to protect the public where quality and safety issues are identified.

The Bill is expected to pass by December 14, but will not be proclaimed until a later date. Recently, the College made a submission to the Standing Committee on General Government regarding the College’s support for the Bill and suggested amendments to Schedule 9 to ensure clarity and alignment with the objectives of the legislation. 

Prescribing Drugs – Preliminary Consultation

The College asks for your feedback as it begins reviewing the Prescribing Drugs policy in accordance with our regular policy review cycle. This policy sets out the College’s expectations for all physicians who prescribe drugs or provide drug samples to patients. The policy also includes guidelines for preventing medication errors and appropriately prescribing narcotics and controlled substances, including opioids.

Find out how your opioid prescribing compares to your peers

We bring you an early look at an article from the upcoming issue of Dialogue that describes Health Quality Ontario’s initiative to encourage appropriate opioid prescribing.

Halth Quality Ontario uses Patient Care Practice Reports to provide family doctors with confidential information about their own practice relative to peers across the province. The reports – which have covered diabetes management, cancer screening and the use of other health services like emergency departments – now include opioid prescribing patterns.

“The College encourages physicians to access their PCPR reports and use the information provided to better understand the care they provide to patients,” said College Registrar, Dr. Rocco Gerace. “Physicians then have an opportunity to access resources to improve their care, if necessary,” he added.

For Ontario doctors, accessing the reports and following up with recommended actions or suggested resources in a PCPR is entirely voluntary. Physicians can sign up for MyPractice at hqontario.ca. The reports go only to the email address provided upon registration, to help physicians understand their patients and how to support them.