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Ontario to scrap outdated practices, unnecessary procedures to find OHIP savings

Last Updated Aug 22, 2019 at 7:09 pm EDT

A working group looking to find $460 million in savings for the Ontario government through healthcare coverage has released 11 recommendations to update OHIP.

The Ministry of Health says, as of Oct. 1, OHIP-insured services will be updated to reflect the recommendations given by the group.

All the recommendations have fallen under three categories: improve the quality of patient care, reduce medically unnecessary services and previous appropriateness work.

The ministry says implementing the recommendations will result in savings $83 million a year.

Dr. Joshua Tepper and Dr. Paul Tenenbein, co-chairs of the Appropriateness Working Group, released the recommendations in full on Thursday afternoon.

Dr. Tepper summarized the recommendations and a broad range of changes that result in a better quality of care.

“It’s making more time in people’s day to see the right type of patients and allowing people to move through the system faster and making sure the care they do get in the system is the right care,” said Dr. Tepper.

There will be a second phase of recommendations by the working group to find a further $360 million in the Ontario healthcare system. Tepper said it’s too premature to say where those changes might be.

The recommendations include using more accurate diagnostic imaging for sinus problems, avoiding unnecessary X-rays of sinuses.

Patients with chronic hip and knee pain will be referred to specialized clinics to improve arthritic care. The working group says this will reduce unnecessary hip and knee CT/MRI sans and they will instead be refereed to a “new province-wide system of musculoskeletal rapid access clinics.”

Loop recordings, an ambulatory cardiac monitoring device, will no longer be funded as the group says they are an outdated form of technology, and there will be a new minimum technical requirement for outpatient cardiac monitoring tests.

They have also made it so patients who have already recently seen a specialist won’t have to go back to their primary care provider for a referral letter within a two-year period. The recommendation says hospital-based specialist consults will not be affected by this change.

A method used to diagnose infertility, post-coital testing of the cervical mucous, has been removed from OHIP funding due to it being an “outdated practice.” OHIP will continue to fund “more effective testing to diagnose infertility, including semen analysis to detect male factor infertility, test to rule out tubal blockage and assessing uterine cavity or ovarian function.”

The procedures deemed medically unnecessary by the working group include one to remove ear wax unless it is medically necessary as the softening of ear wax can happen using over-the-counter treatments. It will be covered if the ear wax is causing hearing loss.

Larynx examinations during stomach examinations will not happen if there is no suspicious or evidence of a problem with the patient’s larynx and will only happen if it is medically necessary.

Urine pregnancy tests will not be covered by OHIP anymore in favour of blood pregnancy tests, which according to the working group, provide more information. The dipstick pregnancy tests will still be covered if it’s preformed at a physician’s office when there is an immediate need to determine a pregnancy “to prevent imminent harm to the patient.”

Pre-operative assessments will no longer be preformed by family doctors or specialists as an administrative requirement to surgery. The working group says all patients are already assessed by their surgeon and an anesthesiologist prior to surgery.

Funding for home visits will only be provided for frail, elderly, housebound and palliative patients.

Finally, they will be reducing the amount of knee arthroscopies done on patients with degenerative knee diseases and instead treatment will be focused on pain management and physical therapy. The working group says there will be some exceptions for those whose degenerative knee disease cause loose bones or cartilage.

More details on the recommendations can be found on the province’s website.

Dr. Tepper said they will be able to track the results of their recommendations as well.

“In many of theses cases, we will have data related to the specific activity and, over time, we will be able to look at what’s happening,” said Dr. Tepper. “We’ll also be hearing from front-line physicians and others which is another important source of information.”

The working group was formed in the wake of a four-year contract struck between the province and its doctors in February.

Healthcare is the largest expense in the provincial budget, coming in at close to $60 billion last year, which accounts for 42 per cent of all program spending.

With files from The Canadian Press