Province gears up for private cataract clinics

Docs concerned about impact on hospitals and patients

Community-based specialty clinics for cataract operations could begin appearing across Ontario in the not too distant future, but the chief of ophthalmology at Health Sciences North has some concerns about how the clinics will impact on hospital services and patients.

The Ministry of Health and Long-Term Care committed to the concept of nonprofit community-based specialty clinics in the Ontario Action Plan for Health Care in January 2012. The objective was to improve access to care and reduce costs to the health-care system.

A call for applications from interested health-care providers is scheduled for early this year, said Pearl Ing, the Ministry official overseeing the rollout.

A second call for applications for non-profit, community-based colonoscopy clinics will follow later this spring.

“There are two eligible models –public hospital-based ambulatory care centres, and non-profit, independent health facilities.

Dr. Stephen Kosar, chief of ophthalmology at Health Sciences North, is aware of some local interest in an independent clinic for Sudbury, but wonders what the impact will be on the hospital.

“It might be a little cheaper to provide the service outside the hospital, but one of the concerns we have is if they’re funding private clinics, will that take away funding from our ability to provide cataract services for difficult patients because there are some cataracts that are really easy to do and others are quite difficult.”

Patients who are mentally challenged or anxious need to be put to sleep and private clinics are only set up to perform the procedure under local anesthetic, he explained.

There are also concerns about patients being charged more for procedures in private clinics.

The Ministry of Health requires applicants to inform patients that charges over and above insured services are optional and to post a notice inviting them to call a Ministry hotline for clarification on extra charges, but Kosar is concerned that patients will end up paying more anyway.

“They’re not allowed to, but it’s still being done (in the few private clinics already performing cataract procedures),” he said. “In Toronto, it has been a real problem because people have been charged $1,000 an eye.”

The extra charge for using a non-insured laser device for accurately measuring a patient’s eyes in advance of the procedure is legitimate, said Kosar. It’s the extra charges for specialized, non-insured lenses that are open to abuse. “Private clinics are allowed to charge for specialized lens implants, but they’re only allowed to charge the difference between the cost of the standard and premium lenses, and some of them are charging more than that.

“Also, some of the premium lenses are no better than the lenses we’re currently using in the hospital because when we set up our lens contract, we made sure our patients were getting superior products. If someone is claiming they’re providing a better lens than what the hospital provides, that’s really not true,” he said. “A lot of people aren’t fully informed about what they’re spending their money on.”

The wait time for cataract procedures in Sudbury is currently 328 days, well above the average provincial wait time of 158 days and wait times as low as 67 and 78 days in Sault Ste. Marie and North Bay, respectively.

“It’s bad,” acknowledged Kosar, “but it’s because we haven’t been getting enough funding to keep up with the needs in our area and the Ministry seems to forget that, compared to North Bay and Sault Ste. Marie, we’re a bigger population centre.”

Sudbury patients could have their cataract procedures performed in low wait time centres, but it isn’t really practical because most patients requiring the procedure are elderly and have difficulty travelling, said Kosar.

“Also, if they have their surgery done there, who’s going to look after any complications?” he asked. “It means travelling back and forth because a surgeon here isn’t going to want to look after another surgeon’s problems.”

An independent community-based clinic could reduce wait times, said Kosar, but so would additional funding for the hospital. With the introduction of the Ministry’s health systems funding reform and qualitybased pricing, hospitals will be paid $547 for an average acuity cataract procedure.

If they can’t do it for that price within an acute care setting, hospitals can apply to set up a satellite clinic offsite or agree to shift volumes to an independent clinic.

It may be possible to perform cataract procedures more efficiently in private clinics by hiring fewer nurses, opting for less expensive non-union staff and not having to cover the higher costs associated with hospital infrastructure.

Health Sciences North has considered setting up an offsite cataract clinic and would have room for it at its Outpatient Centre, but there has been no decision to do so.

Once the call for applications is announced, applicants will have 60 days to make a submission to their Local Health Integration Network (LHIN). The LHIN will then have 60 days to review applications and submit their recommendations to the Ministry. Successful applicants will be notified following a further 45-day review by the Ministry.

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