We are very thankful for the hard work and ongoing contributions of Gord Crawford and Rob Gordon, who have chosen to leave the board after several years of service. In the future, as we continue to recruit new members to our board, we will maintain representation from all LHINs and a balance of academic and non academic groups. If you are interested in becoming a board member, keep an eye on the news letters and website as we will be soliciting nominations from our section when space becomes available. For a full list of our Board of Directors, with contact info, please go to www.ooa.ca. This will prove to be an exciting and challenging year as we have recently closed our OOA office and are transitioning into a more ‘virtual’ site with the aid of a management company. As our office lease ended, it was a natural time to make this change. The contact OOA telephone line and email address, will be manned by our board until we reach a final management agreement. We hope to save our members dollars in rental payments and secretarial fees. This being said, we are very thankful to Barb Harper who has served the OOA as Executive Coordinator for over two years with diligence, hard work and enthusiasm! She will be missed.

Website:
Member use of our new website is picking up slowly. We have made changes to the site recommended by our members and will continue to do so. Please go to your new website www.ooa.ca as soon as possible. Although the site is password protected for our members, there will continue to be a public component to the site. Login information is as follows: Your Username will your first name initial (CAPS) followed by your last name in CAPS, (example SGALLAY). Your Password will be your CPSO number ‘five digits’. You may change your password as soon as you have logged in.

To further address your needs, i.e. if there is any content / news article / important event that you would like to add to the site, please email/fax your suggestion(s) to Dafna Strauss at Connect Consulting Solutions dafnas@ccsolutionsgr.com Tel: 416 944- 8555, or Fax: 416 972-5071.

2008 Physician Services Agreement – Follow Up Subsequent to the recent conclusion of the 2008 Physician Services Agreement, the OMA has started to implement the new committee structure outlined in the PSA. One of these committees is the Physician LHIN Tripartite Committee (PLTC). The PLTC will oversee the recommended review of the HOCC program and design and implementation of the LHIN-Physician Collaboration Incentive Fund. The OMA will work with the Ministry and LHINs
to implement a new $100 million incentive program of which $55M is most relevant to Orthopaedic surgeons as it will be used to recognize and reward the local efforts of physician groups who work together and in collaboration with other service providers to support the needs of patients in an MRP Collaboration initiative ($33M) and in an On-Call Coverage Collaboration initiative ($22M).

The PLTC will be made up of three representatives from the LHIN Board of Directors, the MOH and the OMA. The OMA board of directors has chosen their team and this includes two OMA Board Members Dr. Tim Nichols (OMA Co-Chair) and Dr. Chris Jyu (also Family Medicine representative to the Orthopaedic Expert Panel), and myself Dr. Steve Gallay

Government Relations: Since the writing of the Spring/Summer Newsletter the OOA has continued to work with CCSolutions (Ron Gersh and Crystal Colussi) on a monthly basis to maintain and develop new relationships with the MOH, LHINs and the Politicians. In September, the OOA successfully hosted a one day forum on new models of care in Orthopaedic surgery. This day was attended by members of the OMA, MOH and Expert Panel as well as our members. It was a good opportunity to discuss and contrast up-and-coming new models of care which might be relevant to all of us at some point in the future. It also served to strengthen our relationship with the Ministry’s ADM on Health and Human Resources, Dr. Joshua Tepper. The OOA Board has decided to host the next forum at the time of our 2009 AGM. Subsequent to this event, the OOA has met with Dr. Tepper and discussed further our interests in LHINbased musculoskeletal models of care and the specific HHR needs which would be integral in such models. We have also since learned that Dr. Tepper has taken on the diabetes portfolio. The OOA will continue to help previously identified (and new) LHIN-based Orthopaedic surgeon groups with advancing their particular new models of care initiatives.

Two factors affect our fee allocation, the RVIC (relative value income Calculation) and our earnings for the six months ending six months prior to the fee increase. The RVIC is under review due to problems with the calculation that may overweight on-call fees.

Current fee allocation (Oct.2009) is 3.7% estimated on total fees for our section of 169 million dollars approximately or 6.25 million dollars.

Current OOA plan for this money after consultation with the CTC is an increase of the A065 to $78.00 with a commensurate increase in the associated fees (A064, A066 etc.).

This is dependent on the dispensation of previously assigned fees by the PSPC, if those fees are assigned to this year there will be insufficient fees for any reasonable change in the A065. The fee allocations for the rest of the contract will be at minimum 1.5% in 2010 and 2.125% in 2011 according to the RVIC formula.

Total for the contract is at minimum $15,387,255.00, further indication of plans for the allocation including the revamped Schedule of benefits we will attempt to indicate in future newsletters.

This is a policy that has been in print since 2005, but most of us know nothing about it. It is VERY important as it may impact on many of us in the future. The OMA has thus far created a draft response which includes the following general principles:

1. A physician performing exposure-prone procedures is ethically obligated to know his/her serologic status with regards to HBV, HIV and HCV.
2. Physicians should not be required to undergo routine mandatory testing.
3. An ‘exposure’ will trigger the appropriate follow up testing for both the patient and the physician (health care worker).
4. A physician who is aware that he/she is infected with a BBP must be under the care of a treating/attending physician who is managing their infection.
5. The health system response and regulatory response to physicians and BBP’s should be in keeping with the magnitude of the problem and the risk posed.
6. Physicians are not under a general duty to share their personal health information and associated infection status with patients unless their condition poses a material
   risk to the provision of patient care.
7. The management of issues relating to BBP and impact on work is best addressed through the creation of a Provincial Expert Review Panel (“Expert Panel”).
8. The Expert Panel should be responsible for providing current information for practitioners and workplaces with respect to best practices, treatment protocols, infection risks/prevention, and educational materials.
9. Appropriate local management of workplace issues relating to BBP should be part of a broad risk management strategy and should include adherence to post-exposure protocols, including post-exposure prophylaxis, for physicians, health care workers, and patients alike.
10. The CPSO should be notified only if it is determined on reasonable grounds that an infected physician’s medical condition poses an unacceptable risk to patients.
11. Ontario physicians should be educated and encouraged to purchase adequate disability insurance which provides necessary support and coverage in the event that they are:
    1. disabled by a Bloodborne disease or
    2. not disabled by the disease but subject to imposed practice restrictions.
12. As a result of infection with a BBP and in the event that physicians are unable to perform exposure prone procedures or are unable to practice in their customary area, the government of Ontario should provide retraining and associated financial support for Ontario physicians for retraining in another field of medicine. It is up to the infected physician to decide whether he or she would like to retrain and continue to practice in any capacity.

As your representative on the Surgical Assembly, I will communicate your concerns/ recommendations, if you feel that something has not been addressed in this document.
This is going to be a very important paper for our group. Please keep an eye out for update and go to the OMA website to read more details.

Over the past year, the OMA Surgical Assembly has been asked to review the CPSO “Policy #6-05: Physicians with Blood Borne Pathogens” (see http://www.cpso.on.ca/Policies/bloodborne.htm).

While none of us at the OOA Board of Directors holds any authority with respect the correct billing of visits and procedures, the sessions have proven informative and potentially financially valuable as options for billing a specific visit or procedure are reviewed. For each clinical scenario several options for billing are offered and audience feedback provides some perspective on the billing experience of OOA members. Below are two procedures that were discussed at the 2007 Annual Meeting.

Note that the examples provided are not always exhaustive and often our discussions reveal additional alternative billing opportunities. Attend the November 2009 Interactive billing session to learn more.

Many LHINs have met their wait time goals for hip and knee arthroplasty and are now treating over 90% of their hip fractures within 2 days of admission, reducing length of stay in acute care facilities, improving access to post op rehabilitation and helping more patients return home post fracture. This is because of YOUR hard work and support implementing these changes for your patients! Issues of decreasing hospital budgets, difficulty accessing CCAC and post op rehab beds, and uncertain funding for ongoing Intake Clinics may impact on wait times in the upcoming year.

Recently, Drs Mahomed and Gross have left the panel, and will be replaced by Dr Tim Daniels as lead of the Foot and Ankle project, and Aileen Davis as lead in Data Management. The expert panel has had access to T1 (wait from referral to consult) in the Central Toronto LHIN through a pilot project.

It has also reviewed preliminary data on T2 waits in all areas of Orthopaedics. Despite our suspicion that T1 data and nonarthroplasty wait data would demonstrate significant wait increases due to cannibalization of OR time by current WTIS priority surgeries, this has not been revealed. It did, however, reveal Foot and Ankle as an area with significant untreated volumes, with few being treated within the target of 182 days. This has resulted in Foot and Ankle becoming a new targeted area for the Wait times agenda. Unfortunately, additional volume funding has not been made available to these cases. It remains to be seen, how changes in this area will be implemented, but many LHINs are already showing interest in the Foot and Ankle Program being developed by Tim Daniels in collaboration with the MOH, the expert panel, the Chiropody/Podiatry groups and the OOA/COA.

A process of implications for wait times data entry noncompliance has been developed with graded actions, from reporting on the public website, reporting to local wait times coordinators, and speaking to local hospital CIOs and CEOs, to sending a letter to the hospital’s board of directors. This would ultimately affect funding.

Ongoing work in the areas of osteoporosis, dementia/delirium care and technical hip fracture treatment recommendations continues in order to improve hip fracture patient outcomes. As this is very important to most of our practices, the OOA plans on hosting a Hip fracture symposium at our next AGM , in Nov 09. We will work collaboratively with the Expert panel and PROOF Ontario on this initiative.

This was undertaken under the Chairmanship of Dr. John Tracey of the OMA. At the end of November, a meeting was set up with senior representatives of the WSIB including Dr. M. Bridge, Associate Medical Director – Clinical Services Branch, Ms. Cheryl Dear, Manager of WSIB Specialty Programs and Dr. D. Bain, VP of Health Services Division.

Numerous issues and concerns were presented on our member’s behalf. It is hoped this initiative will provide an opportunity to liaise with WSIB when issues arise within the Ontario Orthopaedic Association.

Issues that pertain to the WSIB, it can be now directed to the OOA and myself. It is hoped these concerns will now be addressed more effectively once these contacts are formalized.

The program is being created to address access due to the long wait times that the subspecialty surgeons are currently experiencing. It is a multidimensional program and builds on the knowledge gained from the wait times hip and knee replacement programs which have been developed over the last 2 years across the province. The program includes: data collection, best practice in referral management practices (triaging), standardization in administrative and clinical processes where appropriate, standardization in access, independent clinicians to assess and manage non surgical candidates, formal linking to local community resources for patients across the province and a communication strategy. Current data demonstrates variations in access to foot and ankle care within the LHINs and local communities so a significant part of the program through the first year will be to collect data on patient flow and to link with LHINs across Ontario to maximize patient access to local resources where it is appropriate for the patient including surgery and medical programs such as diabetes and wound management clinics.

With respect to the assessment and triage components of the programs it is anticipated that through a phased in approach a number of pilot sites will become operational through the 2009/10 fiscal year with staff to assess and triage patients. There are a number of clinicians that have the qualifications, potential interest and can develop the necessary assessment skills to be considered as independent assessors at these sites including Family Physicians, Sports Physicians, chiropodists, podiatrists, physiotherapists and occupational therapists. The decision, as to which assessor is chosen, will be made by the local surgeons, based on their case mix and the human resources available within their community/ LHIN.

It is anticipated that the program will take place through a ‘phase in’ approach which will include ‘Phase 1’ data collection, pilot triage and assessment projects and linking services provincially. In ‘Phase 2’ the focus will be analysis of the data to identify patient needs, wait times issues and expansion of the assessment to all sub specialty foot and ankle surgeons that want to participate. Establishing these defined parameters will be the initial step in obtaining focused funding that will help increase patient access to foot and ankle care and decrease surgical wait times.