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Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 

 

 

 

 

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Sunday
May072017

Improving Hospital and Emergency Room Capacity

Of all the telltale signs of mismanagement in Ontario’s health sector by the Provincial Governments of Dalton McGuinty and Kathleen Wynne, perhaps the most glaring is the current, sorry state of Ontario’s hospital and emergency rooms. 

“Gridlock” and “Overcapacity” are terms being used on a regular basis to describe the ongoing overcrowding of hospitals and emergency departments in Ontario. Overcrowding no longer occurs just in a flu season. Hospitals in eastern Ontario are over 100% capacity for most of the year. This lack of capacity has resulted in compromised ability to provide access to care for our most vulnerable citizens at their time of need.

The root of the problem is at the top. Instead of improving access to hospital care to serve our growing population and aging seniors, the Ontario Liberal government chooses to push care to the community and mercilessly underfund those very community health services.

Budget restrictions of the last decade, along with the lack of accessible hospital beds and relative shortage of affordable long term care options, have combined to result in gridlocked hospitals and emergency departments. Today, patients are at risk and it is commonplace to have cancellations of needed elective procedures, longer waits for specialist care, and a myriad of strain and negative health effects on patients and their families.

 

Liberals’ Frozen Budgets Create Chaos

The last five years of austerity funding for Ontario hospitals have been particularly harsh. From 2012-2015, funding for hospital operational costs were frozen. In 2016, hospitals received a 1% increase. Hospital budgets have fallen in real dollars when inflation is considered despite a growing and aging population that requires more services not fewer. It is estimated that hospitals require a 2% increase just to meet inflation, another 2% increase to address aging and population growth, and roughly 1% increase to address higher demand. (I will not broach the subject of the rising hydro and energy costs hospitals must budget for over and above other rising costs.)

The recent Ontario budget included $518 million allocated for hospital operating costs (roughly a 3% increase while the Ontario Hospital Association was asking for more than 5%). The Liberals have called this announcement a “booster shot” but it fails to come anywhere close to addressing the effects of the lack of funding over the past decade. The “boost” would be more aptly referenced in terms of the Wynne Liberals’ re-election efforts.

To address hospital and emergency department overcrowding and their negative effects on patient care, the government must budget responsibly rather than using a stranglehold on patient services in attempts to make up for the billions of tax dollars it has misspent on the eHealth spending scandal, the ORNGE fiasco, a bulging health management bureaucracy, and the one billion dollars a month it is spending on debt servicing charges. This money could have gone a long way to solving the overcapacity problems in Ontario hospitals and emergency departments.

 

There is Lack of Hospital Beds

Evidence shows that minor medical issues do not contribute significantly to ER overcrowding—it is the lack of beds that causes delays in the emergency department. The lack of bed capacity both in the hospital and in the long-term care community limits the ability of the hospital to deal with admissions and important treatment of our most ill patients. If incoming patients who need admission cannot access a hospital bed, the wait times build in the emergency department delaying care and causing waits that can extend from many hours into days. On average, one patient “warehoused” in the ER denies access to approximately four patients per hour to the emergency department.

A surprising fact about how low the last decade of mismanagement has taken our health care system is that Ontario has among the fewest number of hospital beds of countries in the developed world with 2.3 beds per 1,000 people--- ranking close to the bottom behind Turkey.

As part of the 2017 budget, Ontario Liberals are proposing to spend an additional $9 Billion to support the construction of new hospital projects across the province. Older hospitals are being replaced but building new hospitals with fewer hospital beds is not a solution to improving access to care especially when care in the community continues to lag.

Ontario’s growing population and increasing numbers of seniors will need more hospital beds despite the push toward care in the community. The ER overcrowding issue is beyond the point of being managed by doing more with less. Governments must restore additional bed capacity.

 

Alternate Level of Care Patients with No Place to Go

Outside of the hospital, community supports and long term care options also have potential to improve capacity issues within hospitals and emergency departments.

Long term care access is critical to restoring acute care bed capacity within hospitals and to improving waits in emergency departments. Roughly 15% of all hospital beds are occupied by patients who would be better served in a setting outside of hospital.

To avoid hospital gridlock, patients who cannot return home because of cognitive or physical limitations, so-called “Alternate Level of Care” patients, must have timely and respectful transition to more appropriate care. Early in 2017 there were over 3,000 ALC patients waiting in acute care hospital beds. It is estimated that about a third of ALC patients are waiting for a long-term care home. Even for home care in Eastern Ontario alone, there are approximately 3,000 people on a waiting list.

Addressing the home care and long term care needs of seniors including ALC patients is critical to improving capacity of Ontario’s hospitals both rural and urban. For more thoughts on this, please read my previous health priorities article A Way Forward with Accessible Long term Care in Ontario.

Here is something more to think about when considering the need to fund community health services versus hospitals. Over these past years, investments in primary care transformation to community managed services have not resulted in reduced numbers of patients visiting the ER. Statistics show that visits to Ontario hospital emergency departments rose more than 5% between 2012 and 2016. Patient visits are up and the patients are sicker. So, I suggest what the Liberals have failed to properly address is that our aging population means not only more chronic disease but also more acute events such as falls and infection.

 

If Ontario’s health care system were a patient, it would be whisked immediately to the ER

After a decade of mismanagement under McGuinty and Wynne, the Liberal legacy is: cuts to nurses and front line care personnel, ERs empty because hospitals cannot afford to run them, elective surgeries cancelled because of lack of ER beds, sick and elderly having to endure warehousing on gurneys in hospital hallways. These commonplace signs in Ontario’s hospitals are unacceptable. Our provincial government and health minister must do better at managing the health sector - starting with Ontario’s hospitals and emergency rooms.

 

 

 

 

Reader Comments (136)

CICM:

Why June 1?
May 18, 2017 | Unregistered CommenterMovingforwardOntario
CPSO licenses for all physicians expire on May 31 of the calendar year. If you are going to retire that is the last day of work else you pay $2000 for another year.
Canary... CPSO yearly fees are certainly important as are the importance of holding ones patients' medical records for X amount of years and expiration of leases....how about CMPA fees ?

How protected are retirees from malpractice law suits following retirement?

I spoke to a retired lawyer who stated that he could not give any legal advice, no matter how casual and innocent , without peril.
May 18, 2017 | Unregistered CommenterAndris
I see the binding arbitration negotiated by the OMA will take the economic conditions of Ontario into consideration. Hmmm.
May 18, 2017 | Unregistered CommenterMerrilee Fullerton
Merrilee....you got it....the poison pill of the deal? How does one defend such a thing? When is the economic situation ever not going to be dire in the next 20 years?
May 19, 2017 | Unregistered CommenterKsy11
We are a part of the evolving system. MDs are now controlled widgets in the monopoly. Their incomes and work conditions are centrals to manage. Many of the young ones get it, and are not setting up in independent situations with assigned cost to pay.
May 19, 2017 | Unregistered CommenterMovingforwardOntario
"When I first started [as an emergency physician] 20 years ago, if one or two patients were in the department for over 24 hours, that would really have caught our attention. We’d be like, “What’s going on?” Now, there are 30, sometimes more."

Most of us are quietly packing it in convinced that nothing will change. Glad to hear someone speak up. Short term fixes will not solve the problem. Why risk your medical license working in an unsafe, inhumane environment?

Better demographics in Alberta for sure if one still needs an adrenaline rush here and there.
May 19, 2017 | Unregistered Commentererdoc
‘Weekend effect’ isn’t due to hospital staffing issues, study finds
May 18, 2017by Andrew Skelly on
Categories: News
The “weekend effect”—the well-known observation that patients admitted to hospital on the weekend have greater mortality than do patients admitted on weekdays—is often attributed to differences in hospital staffing, but British researchers have uncovered new data that suggest it arises mainly from the fact patients admitted on weekends tend to be sicker.

Unlike previous studies, which mostly relied on administrative data, the new analysis incorporated clinical information such as lab test results from a large EMR database.

From the Medical Post regarding the "Weekend effect".

It turns out patients admitted on the weekend are sicker. No surprises here folks but glad to see a study that doesn't blame the providers yet again.

“Adjustment for routine test results substantially reduced excess mortality associated with emergency admission at weekends and public holidays,” wrote Dr. Sarah Walker (PhD) of John Radcliffe Hospital in Oxford and colleagues in the Lancet. “Adjustment for patient-level factors not available in our study might further reduce the residual excess mortality, particularly as this clustered around midday at weekends. Hospital workload was not associated with mortality. Together, these findings suggest that the weekend effect arises from patient-level differences at admission rather than reduced hospital staffing or services.”
May 19, 2017 | Unregistered CommenterMerrilee Fullerton
Ksy11

Yes, that the economic conditions of the province be a determining factor in binding arbitration means that any arbitration will be toothless.
Come on OMA...this should stick out like a bleeder.
May 19, 2017 | Unregistered CommenterMerrilee Fullerton
" Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients."

http://www.bmj.com/content/357/bmj.j1797

To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.
May 19, 2017 | Unregistered Commentereklimek
erdoc:

Nothing systemically will change. Too much invested in the status quo. However, over 30 years big change in MDs role in health. Now have assumed moral and ethical, and professional responsibility, for MAiNL (abortion - medical assistance in no life) and MAiD (medical assistance in dying). Next will be - is the quality of life, worth the "care" dollars?
May 19, 2017 | Unregistered CommenterMovingforwardOntario
Older doctors have older patients....was that a factor?

The MD frog was comfortably situated in a cold water Medicare pot 30+ years ago, then the various governments started to turn up the heating dial ...the unperceptive profession failed to recognize the significance of the gradually rising temperature of their environment, their leadership rationalized the phenomenon and in fact, aided it....and now the profession is practically cooked.
May 20, 2017 | Unregistered CommenterAndris
Andris

From article

20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.

. Patients’ characteristics were similar across physician ages.
May 20, 2017 | Unregistered Commentereklimek
Do younger physicians or older physicians restrict interventions more?
Interventions within a hospital may increase adverse outcomes measured.
Interventions not done in hospital means more patients return to home or hospice to die where they will not be measured as having an adverse outcome related to any treatment...since they are no longer in hospital.
The "adverse" outcome to no treatment may be death ...but this occurs outside the hospital so not measured.
Are younger MDs restricting access to interventions more often? Don't know, but it's a question worth asking.
May 21, 2017 | Unregistered CommenterMerrilee Fullerton
So, are younger MDs more likely to deny patients lifesaving care? opportunity for life saving care?
Is there a Duty to Try?
May 21, 2017 | Registered CommenterMerrilee Fullerton
R:

The new widgets will do what they are told to,from the good of us all. The old ones just want out.

You will prescribe less opiods because we can track you, you will not consciously object, because we can track you. You will not "disrupt"our health care system. We know what is best.

Soon we will be running the data on gender and ethnic mix, and you will conform. No "specially" constructed practices of "easy care". All will pull their fair weight. We will be watching.

Come to the darkside, and at least take the payments provided for conforming.
May 21, 2017 | Unregistered CommenterMovingforwardOntario
Merrilee the social justice warriors would respond to those questions by stating that the answer to be to design a new society with the 'distribution of the social and economic resources of society to the benefit of all people'.

Of course there has to be a ruling class to dispense out that social justice...Karl Marx and Engels believed that such a revolution would bring about a socially st society which would lead to a classless, stateless, humane society based on common ownership and the principle of " from each according to his/ her ability , to each according to his/ her needs"...the Communist Party became the ruling elite with the Central committee as the elite within the elite and the Politburo as the elite within that elite with the General Secretary ruling all.

In the attempt to create perfect Marxist societies hell is the common result....each hell varying in their hellishness as we saw with the Khmer Rouge's mass slaughter in its Cambodian utopia building and present day North Korean hellish paradise.

Our own present day Marxist social justice warriors hold the levers of power in Ontario...they declare that they have all the answers to the questions that Merilee posed.
May 22, 2017 | Unregistered CommenterAndris
In the " just " society that the social justice warriors are working hard to impose, the social justice warriors obviously intend to be the leading members of that elite group , the health care nomenklatura , that will be dispensing social justice deciding who will live and who will die.

The choice is whether to cross over to the dark side , to take the shiny shilling, and become a member of the new health care nomenklatura ---or not.

Those who joined the FHNOTs in particular the FHT's etc., and chose to take positions within the LHINs have become , consciously or unconsciously, members of the health care nomenklatura.

Those who refuse , stand to retain their integrity and remain unsullied by what is about to come to pass.
May 22, 2017 | Unregistered CommenterAndris
DrL:

One may maintain one's integrity, but lose all your property. Next step,fairly substantial attacks against "inheritance" which conveys major "steps up" to the children of the "well off". It must be stopped.

O the positive,and humourous side, as all this progresses. On the biological side, in gender, there is male, female, and intersex. However, it seems there are 27 available genders one can pick from, based on personal desire. On the racial side, again there are assigned races (which is wrong, we are the human race), but one can not be transracial (pick the race you want), in that,on its own, is racism.

Too bad, sociologists don't get trained in biology.
May 22, 2017 | Unregistered CommenterMovingforwardOntario
R:

So it is clear,one can support any type of independent lifestyle that has a net negative carbon impact, thus improving our relationship with the global well-being. However, when one demands "privilege rights", make sure you have an argument your "privilege" has a positive value to us all. Whining about the past history of the world doesn't help. Move things ahead by positive action.
May 22, 2017 | Unregistered CommenterMovingforwardOntario
Comments?

https://www.thestar.com/opinion/editorials/2017/05/21/doctors-must-reduce-opioid-prescriptions-editorial.html

We should be asking what systemic factors and what social factors are involved in opioid use and abuse.

It's far more than a prescribing issue.
May 23, 2017 | Unregistered CommenterMerrilee Fullerton
Excerpt from the article:

"For the past several years health experts across the country have been sounding the alarm about the dangers of doctors over-prescribing opioids, a practice that has led to a sharp increase in addicts and overdoses.

Disturbingly, though, the results of a new study from Health Quality Ontario, the provincial adviser on the quality of health care, indicate that the message is falling on deaf ears.

Despite the intense spotlight on the issue, the study found more than 9.1 million opioid prescriptions were filled in the province in 2015-2016, a jump of about 5 per cent from three years earlier.

Worse, the report found there had been a shift to doctors prescribing stronger opioids. For example, the number of people who filled a prescription for hydromorphone increased by nearly 30 per cent over three years. That drug is approximately five times stronger than morphine.

At the same time, the number filling prescriptions for codeine and codeine compounds, which are weaker than morphine, decreased by 7 per cent. "
May 23, 2017 | Unregistered CommenterMerrilee Fullerton
I recall this same pattern 12 years ago in the USA.

Communities were ravaged by opioid addiction. What do you do with a failed back in a 55 year old blue collar worker? He is already on disability and has no marketable skills in an economically depressed area.

The demand for pain relief is persistent. What is the alternative?

The surgeons are done with them. The pain clinics seek to increase function but to what end?

Were the overdosing carfentenil drug users in Vancouver were started by prescription?
May 23, 2017 | Unregistered Commentereklimek
Good points eklimek.
It is also worth pointing out that Canada ranks at the top of the list of countries for marijuana consumption. MDs are not widely prescribing this.
May 23, 2017 | Unregistered CommenterMerrilee Fullerton
R:

You will prescribe, despite your patient issues, at the level we want you to. The data does not lie, and we have the data we collect, and experts whom know how to interpret all issues.

In 10 years, all MDs are complete widgets, with full public support.
May 23, 2017 | Unregistered CommenterMovingforwardOntario
<<The MDs are to blame for all the health care issues.>> - MfO

I smell a good book-burnin' in the near future, too!

[I know this is tongue-in-cheek from your side, MfO...but some people may take you too seriously].
ELB

Things are changing and governments are going to have to become more authoritarian to control cost, as the public demand more services. In doing so, central needs to find groups to blame. That's why tax the rich, blame the MDs., plays so well. Almost every group likes those slogans.
May 24, 2017 | Unregistered CommenterMovingforwardOntario
Must be that "New Math" taught in schools.?

"Facing public anger over soaring power bills, Premier Kathleen Wynne’s government has pledged to cut electrical rates by 25 per cent this year and to cap bill increases at the rate of inflation for the next four years.

...

Due to interest and other financial costs, Ontario taxpayers will need to repay $21-billion more by 2045 than they’ll save on power bills. The FAO warned that those costs could increase rapidly if the government can’t keep its budget balanced over the next three decades. If Ontario needs to borrow money to finance the plan, the cost could increase to as much as $93-billion due to higher borrowing costs."

https://www.theglobeandmail.com/news/national/hydro-plan-will-cost-45-billion-to-save-ontarians-24-billion-fao/article35096250/
May 24, 2017 | Unregistered Commentereklimek
Back to "improving patient care" with EHR in British Coliumbia



"Following complaints from doctors, provincial health minister Terry Lake ordered a review of IHealth in July, 2016, by Dr. Doug Cochrane, B.C.’s patient safety and qualify officer.

The Cochrane Report, released in November, noted 34 Canadian health-care sites with more than 3,800 “physician partners” are using systems from the same supplier for computerized provider order entry.

The experience of these Canadian organizations is that the “implementation process is highly disruptive, particularly in the first number of months following activation,” the report said.

The Cochrane Report made 26 recommendations, including that medical staff and VIHA “revalidate” the order entry capabilities of the IHealth system.

That process hasn’t cleared glitches flagged more than a year ago, Dr. Forrest maintains."

....

"We also know from the experience of other places that have done this, it takes several years to work through this. Particularly for doctors who are looking after very complicated patients, like the internal medicine physicians are – the impact on their practice is huge,” ...

https://www.theglobeandmail.com/news/british-columbia/vancouver-island-health-record-battle-persists-one-doctor-suspended/article35081934/?reqid=6bdd8257-cb43-4439-bf15-4d1a5c2b6ad4
May 24, 2017 | Unregistered Commentereklimek
So it is clearly stated:

MDs must deal all requests for abortion (MAiNL) and all requests for death (MAiD). NO other group stepped up to "own" this.

The only legislated jurisdiction in the world (that I'm aware of) with such an authouritarian control. Can't get walked back.


Be careful with that "binding" arbitration. May have strings attached, such as new medically required OHIP codes. Imagine a "funded" team meeting, where the decision of the "team" must be enacted by the MD service provider.

Hopefully, someone is looking at the long term consequences.
May 24, 2017 | Unregistered CommenterMovingforwardOntario
<<Hopefully, someone is looking at the long term consequences.>> - MfO

I know that your comment is intended only to apply for the binding arbitration discussion, MfO, but sadly, the simple and plain answer is that no one in Ontario ever looks at the long term consequences.

Of anything.

Ever.

Ontario's underpinning "go-to" move on practically everything is to kick the can down the road only as far as necessary. Not a centimeter short. Not a centimeter long.

Just get us past whatever it is that is getting in our immediate RIGHT NOW way and expect everything to be fine and dandy later.

It is the Ontario way.
ELB

It needs to change. This oppression by the dominant force, is not going to get us ahead. It seems to be pulling us backwards.
May 25, 2017 | Unregistered CommenterMovingforwardOntario
mfO,
Having equal rights is important. In that sense we are all "equal". Some people require more support and services than others. This ought to be recognized as the reality that we are not the same.

So, mfO...although we may be "equal", we are not the "same".

Each of us is unique, living in circumstances and with experiences unique to each one of us. There ought to be recognition of this.
May 25, 2017 | Unregistered CommenterMerrilee Fullerton
Then it is not Liberal government...it is something very different, Прав, товарищ? (prav, tovarishch)?

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