On March 11, 2015, France Gélinas, the NDP’s health critic, introduced Bill 78, the Transparent and Accountable Health Care Act, 2015. Bill 78 has since passed second reading in the Ontario legislature and was referred to the Standing Committee on Social Policy on March 26, 2015.
The Bill proposes to promote transparency and accountability in the funding of health care services in Ontario by:
- ensuring that certain persons and entities that receive public funds directly or indirectly are covered by legislative requirements relating to accountabi¬lity and transparency; and
- requiring annual reporting on payments made by the Ontario Health Insurance Plan (OHIP) to certain persons and entities.
Both physicians and major suppliers to Ontario’s public health sector would be particularly impacted by this proposed legislation.
Broadening the Reach of the BPSAA, PSSDA, Ombudsman and Auditor General
Bill 78 proposes to broaden the reach of Part II.1 of the Broader Public Sector Accountability Act, 2010 (BPSAA) and the Public Sector Salary Disclosure Act, 1996 (PSSDA) to major health sector organizations and publicly-funded suppliers – in other words, to all health-sector entities receiving more than $1 million in public funding annually, whether directly or indirectly.
Subject to limited exceptions, Part II.1 of the BPSAA prohibits compensation increases for designated executives and restricts performance pay for designated employers. Currently, the only health-sector entities subject to these prohibitions are public hospitals. The Bill expands the reach of the PSSDA, which established Ontario’s “Sunshine List”, to all major health sector organizations, requiring the publication of the salaries of all employees earning over $100,000 per year.
Additionally, the mandate of the Auditor General is broadened by authorizing its audits of major health organizations and publicly-funded suppliers. Such health-sector entities would also be subject to oversight by the Ontario Ombudsman.
OHIP Payments Publication
Bill 78 would also require the Ministry of Health and Long-Term Care to annually publish a disclosure statement of the total amount paid to a person or entity receiving at least $100,000 through OHIP billings. The disclosure statement would also include “cautionary language”, explaining that the figures do not represent a physician’s net income. The cautionary language proposed by the Bill is as follows: “Readers of this disclosure statement should understand that it provides only a record of gross payments. In some instances, the recorded figure is a payment for the services of a number of physicians. Physicians must pay the expenses of their practice out of this gross amount. No calculation of a physician’s net income can be made from such figures. Conclusions cannot be drawn from these figures about the relative net income of any physician since overhead varies greatly from physician to physician.”
Mary Jane Dykeman interviewed about the new Supreme Court of Canada decision released today in Carter v. Canada (Attorney General)
Also included in this campaign is a new resource document for health care organizations called “Detecting and Deterring Unauthorized Access to Personal Health Information”. This is a must read for all health care Privacy Officers.
The IPC/O’s tips for preventing or reducing the risk of unauthorized access include:
- Develop and implement comprehensive privacy policies and review those policies on an annual basis
- Provide mandatory privacy training for all staff – which includes initial orientation as well as ongoing privacy training and maintain a log of attendance
- Prominently display privacy notices reminding staff of their privacy obligations
- Include privacy warning flags in electronic health records to remind staff of their privacy obligations
- Require all staff and other agents to sign confidentiality agreements on a regular basis
- Have end-user agreements for anyone using your electronic information systems
- Develop and implement a policy to restrict access to health information on a need-to-know basis only
- Log, audit and monitor all accesses to electronic health records
- Follow the IPC’s guidelines on privacy breach management with respect to patient notification and maintain a log of privacy breaches
- Impose consistent, appropriate and proportionate disciplinary action for privacy breaches
DDO provides privacy coaching, breach management advice and on-site privacy training for health care organizations. If you haven’t reviewed your privacy policies lately or engaged your staff in formal privacy training in a number of years, call us to assist you. Mary Jane Dykeman firstname.lastname@example.org 416-967-7100 x 225
On July 22, 2014, the Ontario government introduced Bill 21, the Safeguarding Health Care Integrity Act, 2014. Bill 21 received Royal Assent on December 11, 2014.
This legislation intends to safeguard health care integrity by enacting the Voluntary Blood Donations Act, 2014. In relation to Ontario’s voluntary blood donor model, the legislation prohibits payments or offers of payment to individuals for their blood, including any forms of compensation or reimbursement of expenses. Inspection and enforcement provisions are also provided for, including compliance orders.
The Drug and Pharmacies Regulation Act will be mended to give the Ontario College of Pharmacists the authority to regulate hospital pharmacies in the same way it currently regulates community pharmacies. This change has not yet been proclaimed. We will let you know when it is in force.
Mandatory Reports to Regulatory Colleges for Restrictions of Practice:
In addition, the Regulated Health Professions Act, 1991 and the Public Hospitals Act will be amended, intending to enhance communication among health system partners and enable health regulatory colleges to more readily share information with hospitals and public health authorities. Existing mandatory reporting requirements will be strengthened in order to respond more quickly and effectively to issues regarding a health professional’s practice. In particular, when they come into force, the amendments to the Public Hospitals Act will make it mandatory for hospital administrators to report to the College of Physicians and Surgeons where a physician restricts his or her practice and there is reason to believe the restriction is related to the physician’s competence, negligence or conduct, or if the restriction takes place during the course of, or as a result of, an investigation into the physician’s behaviour. This is an important change for hospital Chiefs of Staff and Medical Advisory Committees to know. We are waiting for these changes to be proclaimed before they come into effect – we will let you know.
On July 8, 2014, the former Minister of Health and Long-Term Care, Deb Matthews (now the President of the Treasury Board), introduced Bill 8, the Public Sector and MPP Accountability and Transparency Act, 2014, which proposes changes to several statutes including the Excellent Care for All Act, 2010 (ECFAA). The ECFAA provisions of Bill 8 are a restatement of those found in Bill 179. Clients may remember that Bill 179 had been introduced and carried at first reading during the former session of the Legislature but died on the Order Paper with the call for the provincial election.
Proposed amendments to ECFAA (Schedule 5)
Bill 8 outlines to following key amendments to ECFAA:
- Expands the definition of “health sector organization” to include community care access centres (CCACs) and long-term care (LTC) homes.
- Expands the functions of Health Quality Ontario (HQO) under the Act to include the area of patient relations. This appears to a formalization of initiatives already being undertaken by HQO. See here, for example.
- Creates the position of patient ombudsman. The patient ombudsman shall be appointed by the Lieutenant Governor in Council and employed by HQO.
- Enumerates the functions of the patient ombudsman as:
o receiving and responding to complaints from patients and former patients of a health sector organization, and other persons if prescribed;
o facilitating the resolution of complaints made by patients and former patients of a health sector organization, and other persons if prescribed;
o undertaking investigations of complaints made by patients and former patients of a health sector organization, and other persons if prescribed, and to undertake investigations of health sector organizations on the patient ombudsman’s own initiative;
o making recommendations to health sector organizations following the conclusion of investigations; and
o doing anything else provided for in the regulations.
- Introduces provisions concerning complaint facilitation, investigations, reports and other matters are included.
Should the Bill be passed into law, CCACs and LTC homes will be most impacted, at least initially. In addition to the Bill’s increased oversight mechanisms (applicable to all health care organizations), an amended ECFAA will statutorily require CCACs and LTC home clients to adopt and implement (to the extent they have not done so already) additional and more formal quality improvement obligations – including the establishment of a Board quality committee, regular patient/provider surveying and public reporting. Quality Improvement Plan (QIP) development may be less of an issue since many in the LTC sector adopted it on a voluntary basis through the HQO Residents First initiative; and CCACs began submitting QIPs as of April 1 this year.
The Bill passed first reading on July 8, 2014. A full text of the Bill can be found here.