Ministry of Health and Long-Term Care
Presentation to IDCA
Community-Based Specialty Clinics
September 20th, 2013
Presented by Pearl Ing, Director
Why Community-Based Specialty Clinics?
“We will shift more procedures out of hospital and into non-profit community-based
clinics if it will mean offering patients faster access to high-quality care at less cost.” –
MOHLTC Action Plan for Health Care, 2012
• Ontario’s Action Plan for Health Care has three pillars:
1. Keeping Ontario Healthy
2. Faster Access to Stronger Primary Care
3. Providing the Right Care, Right Time, Right Place
• Specialty Clinics will help patients receive timely access to care and improve patient
• This Fall, the Ministry is planning to proceed with a phased strategy to establish Specialty
Clinics, starting with low-risk cataracts.
• Cataract Specialty Clinics are supported by evidence, including:
• Advice from Ontario’s Vision Strategy Task Force, a clinical expert panel group
• The Ministry’s Quality-Based Procedures Clinical Handbook for Cataract Surgery
• Experience funding cataracts/low-risk vision procedures in community-based settings
• Over the course of 2013 and 2014, we are planning calls for proposals for other routine
procedures, including colonoscopies.
What are Community-Based Specialty Clinics?
• Specialty Clinics will be non-profit clinics offering select low-risk procedures.
• A range of low-risk procedures are being considered, including cataract and other
vision care procedures, colonoscopies, MRIs, minor orthopaedics, and dialysis.
• Eligible Specialty Clinics may operate as either:
1. A non-profit Independent Health Facility (IHF) licensed under the
Independent Health Facilities Act (IHFA); or
2. A public hospital-based ambulatory care centre that operates under the
Public Hospitals Act (PHA)
• Existing hospital and IHF legislation will ensure oversight, quality and
• Applicants will be expected to meet price, service volume, and quality
requirements, while improving access, and patient experience.
• Detailed requirements and criteria will be included with the applications process.
Health System Funding Reform
Specialty Clinics are aligned with Ontario’s Health System Funding Reform
• HSFR is changing the way services are funded in Ontario. Ontario is
introducing a patient-based funding model where ‘money follows the patient’
using Quality-based Procedures (QBPs).
• Community-Based Specialty Clinics will be funded using QBPs.
• QBP pricing sets standard and consistent prices for procedures based on best
practices, evidence, and defined clinical pathways.
• QBPs are reimbursed on a ‘price X volume’ basis.
• The Ministry has developed a QBP for cataract procedures, and is working
with Cancer Care Ontario on a QBP for GI Endoscopy (colonoscopies). This
will support the shift of cataract and colonoscopy procedures to Specialty
Funding Specialty Clinics
• There is no new funding for Specialty Clinics. Funding will be reallocated from the hospital where volumes of procedures are
transferred out to Specialty Clinics.
• Physicians working in Specialty Clinics will continue to bill OHIP for
professional fees, as per current practice.
• QBP prices will cover the direct costs, such as nursing care and
medical supplies, and may also cover indirect costs, such as
housekeeping and utility costs, associated with performing a
• For more information on Health System Funding Reform and Qualitybased Procedures, please visit:
Relationship with the Broader Health Community
Shifting services from an acute hospital to another setting requires the
support and readiness of health providers in the local community.
• Successful Specialty Clinic applicants will need to demonstrate the
support of their LHIN for the proposal.
• They will be required to have a formal agreement with the hospital(s)
shifting out procedures, that considers support for procedures that
remain in hospital (e.g. more complex cases, emergency room
• Applicants must work with LHINs to consider broader system integration
to ensure continuity of patient care.
Proposed LHSIA/IHFA Regulatory Changes
• Regulation changes are being proposed to support the strategy to shift lowrisk procedures out of hospitals and into the community.
• Changes will allow overhead costs to be paid by LHINs or Cancer Care
Ontario for services such as colonoscopies performed in a licensed IHF:
1. Changes to the SOB under Reg. 552 made under the Health Insurance
Act (HIA)
• Proposed changes allowing facility fees to be payable in respect of
colonoscopy services may be effective January 1, 2014.
2. A new regulation made under the Independent Health Facilities Act
• Proposed regulation prescribing CCO as an entity that can pay
facility fees may be in place by November 2013.
• Proposed regulation changes have been posted online for public comment
until October 11, 2013 and can be found at:

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