Thanks for stopping by to read my first blog. I am hopeful that you’ll stay long enough to leave a comment and tell me what you think about this issue. The purpose of Shenda’s Blog is to generate discussion around things that matter to patients, the public, physiotherapists and anyone touched by the regulatory world, so don’t be shy.
This summer there’s been lots of conversations about the government’s announced funding changes for physiotherapy. One of the conversation threads in an article that ran in the Toronto Star suggested that the College should take action against those people who had been allegedly billing OHIP excessively up until now.
Here’s how that conversation unfolded. On July 25, the Toronto Star reported, “Letters aimed at recovering $104,600 were couriered to 45 clinics Wednesday after a three-month OHIP audit found more than half of the records did not support claims…”
In the comments section on the Star website, jimmydgp wrote: “I will call the College of Physiotherapist’s [sic] of Ontario today and enquire as to why all of the PT’s who have contributed to this scheme are not suspended…”
And then on July 26, james58 wrote, “Why isn’t the College of Physiotherapists who are supposed to protect the public investigating these bogus clinics?“
On July 27, Dave U. randomly emailed me directly to ask, “Where is the CPO on this? Why are they so quiet?”
Where are we indeed?
Personally, I stand in the ranks of the outraged, if as the Star reported, 58% of billings made by designated OHIP clinics were unsupported. (Please be clear, I don’t know if that’s true, I am only quoting what the paper said).
What do you think?
Were the billings appropriate if the government had created a loophole that permitted them to flow the way they did? Should we accept that individual physiotherapists were merely employees and not responsible for the way the companies for which they worked billed OHIP? Do group exercise classes really equal physiotherapy? Do you think that the OHIP billing allegations, together with the Auto Insurance Anti-Fraud investigation from last year, have irrevocably tarnished the professional reputation of physiotherapists?
It seems to me that many of you are likely uncomfortable with the old funding model and the billing activities it led to. Let me tell you why I think this.
Last fall and winter, I went around the province with John Spirou, College President and a practicing physiotherapist. We spoke with groups of physiotherapists about a day in the life of the College. We presented a couple of real life scenarios of cases where PTs had inappropriately billed insurance companies. John would always ask the assembled group of PTs, “How does this make you feel? Are you embarrassed that a physiotherapist would do this?” The physiotherapists we met with were universally appalled by this conduct. In fact, in many of the examples that we shared, PTs thought the College response was far too lenient.
I formed the impression that the majority of physiotherapists have pretty strict ideas of what’s appropriate in terms of billing. If that’s correct, how are PTs feeling about the newspaper coverage of this issue?
And, back to the question of where is the College on the allegedly inappropriate OHIP billings?
We are not like the police force. We cannot undertake investigations without receiving a formal complaint or having solid evidence that an individual has committed an act of professional misconduct. And we don’t have the power to investigate clinics or businesses, only individuals—but let’s talk about that in a future blog post.
So where is the College on all of this?
We’re watching and waiting—just like you are.
By the way, jimmydgp, you never called!
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when window glass crack and they charge 400 dollar just to replace window people do not mind.
but but when professional like pharmacist charge 12 dollar to read prescription then people think this is too much and they also think this guy making money.
when physio charge 100 dollar per home visit they think same thing.
I think college also think same way.
I will tell my son who is in school that never become health professional to help people but become smart man so people do not mind to pay you 400 dollar to replace glass window.
Come on guys.
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when window glass crack and they charge 400 dollar just to replace window people do not mind.
but but when professional like pharmacist charge 12 dollar to read prescription then people think this is too much and they also think this guy making money.
when physio charge 100 dollar per home visit they think same thing.
I think college also think same way.
I will tell my son who is in school that never become health professional to help people but become smart man so people do not mind to pay you 400 dollar to replace glass window.
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Besides, $104, 000 worth of “fraudulent” billings in over $180 million of total billing doesn’t amount to much more than a rounding error.
I agree with the above that the term “Physiotherapy” should be protected.
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Until we clean up these problem clinics, we are simply part of the problem and are impotent to creating change. Moreover, any other activities were involve ourselves in are tainted by the fact that we can’t police our own. We may not be the police, but we are self regulating, which means self policing, so if we don’t do it, and we “wait and watch”, then there is no point to having an RHPA or any jurisprudence training/testing…
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With all due respect, I would like to know if you have worked in the Long Term Care or Retirement Home. Many of the questions you raised, you shall ask the patients directly in LTC and RH and I believe you will get your answers, because no matter how much i say, you can blame me for my biased views. here are few answers and justifications with my efforts to strive for excellence in the assessment and clinical analysis.
1. Is delivering hotpacks to a nursing home resident physiotherapy?
my patients look forward to have few hours pain relief that hot pack gives them because they are maxed out in medications. mostly all electro-therapeutic treatments are contraindicated given their age, cognitive abilities, combination of medical conditions and complications. besides not all LTCs / RHs have IFT / LASER or other gadgets. it gives them temporary relief and with hot pack, it improved their quality of life.
we have utilized US / TENS to manage pain successfully. i would like to know what would you say to a 90 year old male with arthritic knee pain? how many sessions of PT would you recommend and what interventions would you do? we have utilized UVR for wound management successfully. i have done research review to see how i can utilize those modalities to best treat my patients. am i not striving for excellence in care? yes, if only hotpack is given and no other treatment is offered because PT was trying to be convenient, its wrong. in many cases, it is also patient’s choice just to take hot pack and not do anything else? would you still force him for flexibility exercises and mobility?
2. Is ambulating a patient three metres down a hallway physiotherapy?
Try sitting in a wheelchair (sometimes with flat ROHO cushion or an inappropriate wheelchair because family could not afford to pay $ 1220 for ADP wheelchair) x 8 hours a day without moving and see how it feels. We Physiotherapists are the experts in gait and transfers training. Thats what we do. Who are you going to ask now to ambulate that patient 3 m? Besides, if I am doing gait training and a 90 year old can tolerate only 3 meters, what is wrong with it? what kind of physiotherapy are you expecting? I would certainly like to know what would be your care plan for this individual?
3. i agree with your first point though, saying hi and billing that as a physiotherapy is not physiotherapy and those kind of physiotherapists shall be charged.
Funding dictates the policy and funding dictates the care. no matter how much one sugarcoats the fact, this remains bitter fact. we cannot leave the funding issue aside because its my money, its your money, its our money. one of my friends just said that he would be paid $ 145 to do an ADP in 3 visits, which will cost government $ 360. while ADP was done for free in the past by some DPCA company policy. that could have paid for 3 months of Physiotherapy for that patient x 2 – 3 / week. if nothing else, he would have got hot pack or 3 m walk at least and with same money he is getting 3 ADP visits with no physiotherapy and no follow up.
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I have used LTC in this scenario as I know the system here.
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Let me ask you. In a hospital setting, when you dangle a resident at the edge of the bed for 2 mins or if you walk a patient 10 steps, why does that constitute “physiotherapy” BUT NOT when you do it in the LTC setting? Is it not part of your professional assessment to tailor your treatment to resident tolerance and abilities? Whether it is 5 steps or 3 metres or 20 metres, the distance alone should not be the criteria to what constitutes physiotherapy. If this activity keeps the patient weight bearing and able to transfer with @x1 rather than sit stand lift or mechanical hoyer lift, is that not a measure of improving the quality of their life and physical abilities?
When you yourself get to be 80 years old sitting in a wheelchair, perhaps, you may appreciate the little bit of 1:1 exercises, standing, walking you do throughout the week minimizes your risk for skin breakdown, pressure ulcers, pulmonary complications and allows you to toilet transfer rather than wearing an incontinence product. Toileting can also minimize the risk of UTIs which often leads to confusion, falls and fractures. Then you can truly appreciate the importance of LTC “physiotherapy” for these frail residents.
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you mentioned”…without principles of self management or independence in mind.” also shows that you have also never stepped in the LTC / RH. can some one please argue ‘for the system’ who has really worked in LTC / RH? who knows what he/she is talking about? please? i am not sure what kind of self management and independence you are expecting with average age 80 and limited resources. please elaborate on that. i will be seriously glad to know…
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Yes, i agree that those who pay out of pocket are more vocal in terms of what kind of care they want. based on your arguments, it seems that you also never worked in geriatric setting. many do in fact, voice their concerns and try dealing with some of the family members and you would know. besides, the LTC / RH is a responsible sector as well and in fact, it is disrespectful when you mean to say that there is no one for those residents to care for. we do have doctors, nurses, DOCs, administrators, besides PT who are responsible and accountable. we are overseen by MOHLTC; same organization oversees your clinic. i do not wait for referral to go see my resident if i find that he had a fall and c/o pain in the hip, and neither do my colleagues that i know…
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In fact with the new model, virtually all clinics are DPCAs, so now we have opened the doors for more loopholes
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1) College of Physiotherapy needs to have 2 separate distinct divisions – one to protect the public and one to protect physiotherapists. In essence, why are physiotherapists paying their annual dues to the College when they receive NO support whatsoever from its regulatory and disciplinary body. This was especially evident this summer when many physiotherapists needed that support.
2) Yes, I totally support that the title “PHYSIOTHERAPY” should be protected. With delisting physiotherapy and opening up access to anyone and everyone who wants a cut in physiotherapy, we have certainly done a MAJOR disservice to the profession. Instead of ensuring the quality of services, it will no longer be within our control.
3) With all due respect, the College of Physiotherapy was very slow in fulfilling their responsibilities after the April 18th announcement of the delisting of OHIP physiotherapy. It was the DPCA companies who approached the College about the appropriate discharge process and circle of care issues in retirement homes. The College has yet to put forth guidelines to assist the Long Term Care physiotherapists with the difficult task of reducing the caseload to satisfy the MOH episodic care criteria. Physiotherapists are trying to navigate this “using their best professional judgment”. Try being a 90 year old in bed 15 hours a day with no one to stretch your limbs through range because base on the government criteria, you will not show improvement and there are no achievable outcomes so therefore you do not qualify for physiotherapy treatment.
4) It is easy for physiotherapists not working in this sector to misconstrue the comments made in the media. With the exorbitant workload documentation requirements set by the government and the homes with Rai-MDS, care conferences, high risk team meetings, restorative meetings, PAC (Professional Advisory Committee meetings), day to day assessments, progress note documentation, falls prevention, it is literally impossible to accomplish. Now, with the reduction in PT work hours, the task becomes even more daunting and challenging. How can physiotherapists truly provide the services we have been educated to provide? Sadly to say, it is no longer care focus, it is paper focused. It’s the seniors who really lose out. Furthermore, to meet the demands of the homes, many physiotherapists are doing the work free of charge at home. Is that truly an ADVANCEMENT for our profession?
5) Before making any judgments, the College needs to understand the circumstances of fraudulent behavior. Read some of the comments and defamatory statements made by politicians and you realize how ridiculous they are especially if you are working in this sector. The MOH purposely conducted audits to Retirement homes in May-June 2012 because they had already decided to change the funding model and wanted proof to support their agenda. If in fact such atrocious fraudulent claims (58%) were discovered in the middle of 2012 as stated by the government, why did MOH wait till July 24, 2013 to announce this, a day BEFORE the Judicial Review? Isn’t that amazingly coincidental and purposely timed. If there was in fact true fraudulent behavior, it should have been the mandate of the MOH to transparently communicate this to the appropriate DPCAs and to the regulatory and disciplinary body – The College of Physiotherapy. IT WASN’T.
6) Your reference to exercise classes – yes I do consider exercise classes part of physiotherapy. The Ministry emphasized that only exercise classes were being provided and billed. This is farther from the truth. Yes, residents receive exercise classes but many also receive modalities, supervised walking, gait training, standing balance / proprioceptive exercises, fall prevention follow up which the government so conveniently failed to mention.
7) What have really tarnished the profession is NOT THE ACTIONS of physiotherapists but the lack of support for physiotherapist s from their own professional association and their College. Ironically, the OPA supported a plan without knowledge of actual details. According to the OPA Mission Statement, OPA gives Ontario’s registered physiotherapists a united front and a strong professional voice to government, insurance agencies, other health professions, patient advocacy groups and the general public.” “OPA also keeps members up to date on any issues that affect their profession through numerous communication channels in particular; they would provide details of advocacy initiatives that could affect the physiotherapy profession and practice.” Well, OPA certainly did not inform its members of the delisting issue but has silently kept its members in the dark until April 18th. I had doctors and other health professionals approaching me appalled by the lack of support from our College and the strong defamatory comments made by political members. We do not provide “real physiotherapy” now but after August 1, seniors will receive “real physiotherapy” from those very same physiotherapists. What a play on rhetoric and true misrepresentation to the public.
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Can the College do something to the fraudulent billing? If the college can only control the registered staff, then they may not be able to do a lot as those who are involved in the matter are not necessarily registered physiotherapists.
The College may need to start to re-establish their stand point as there are a lot more issues regarding fraudulent billings and claims which will, for sure, affect the profession and also the public.
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Its very sad.
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This is an interesting topic indeed! I’ll start off by saying that many there have been many salient points made by respondents so far. I very much agree with the attitude that we can’t paint all the DPCs with the same brush, nor can we paint our colleagues who operate and/or practice within these organizations in the same way.
Despite the media’s responsibility to report stories fairly and in a balanced manner, there is often an slant towards the bias of the writer. And, so it seems that in the Toronto Star article (which I did not read), physiotherapists were painted in a negative light. Unfortunately, much of the public doesn’t really understand the intricacies of publicly funded physiotherapy outside of the hospital, CHC, or CCAC models, and it’s attitude towards physiotherapy may have been diminished after reading the article.
I believe a role of Government is to create the framework for the systems within which we practice and businesses operate. It is then incumbent on the individuals working within the various systems to act responsibly. Businesses can be viewed as living things, and as such look for ways to survive and prosper. The DPCs, despite partial de-listing, did exactly that. I agree that some of the billing practices were questionable, but one must also consider that the model as laid out by the MOHLTC allowed these practices to occur. There is some duality in where blame can be assigned – some of the DPCs and the Government. Ultimately, the DPC system was old, out-dated, and unresponsive to Ontarians in general. The new system is, most importantly, more accessible. It is also more accountable, more sustainable, more predictable, and more balanced in terms of physiotherapist involvement. Undoubtedly, it will also be flawed but time will be the best remedy.
The founding mission of the Harvard Business School in 1908 was to train leaders who “make decent profits – decently.” Regardless of funding stream or practice setting, whether we spend public dollars through the treatments we provide in places like hospitals or bill our patients directly in private clinics, we can all espouse the spirit of this mission. It is as important for us today as it was over a century ago.
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you agrued “Ultimately, the DPC system was old, out-dated, and unresponsive to Ontarians in general. The new system is, most importantly, more accessible”. how exactly is that?
also you said ” It is also more accountable, more sustainable, more predictable, and more balanced in terms of physiotherapist involvement.” which sounds good in scholarly article. BUT SOME ONE CAN PLEASE EXPLAIN ME HOW? READ THE BLOG PLEASE BEFORE REPLYING TO KNOW WHAT IS GOING ON. it does not seem more accountable, sustainable, predictable and balanced to me…
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Thanks for your reply.
What I meant by the first comment was that the DPC system was established decades ago. OHIP does not cover the cost of assessment. The treatment fee is $12.20 per session – which I assume was the rate that was appropriate when the system was first implemented. Both scenarios often result in some out-of-pocket expense to the individuals that access the system. Also, I understand that there are around 100 active licenses, most of which are in urban areas. So, there are large gaps where publicly-funded community access, specifically to the DPC system, is limited. I’ve attached a link. On a scan of the DPC clinics, it seems that there are none north of Sault Ste. Marie, for example.
http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDIQFjAB&url=http%3A%2F%2Fwww.health.gov.on.ca%2Fen%2Fpublic%2Fpublications%2Fohip%2Fdocs%2Fphysiotherapy_fs_en.pdf&ei=a3UrUqroD8jgrAGF-IHYBg&usg=AFQjCNH5PcR0A6UBHuvTitP0xyLH3ZStjw&bvm=bv.51773540,d.aWM
The application for the new funding included questions about the geographic area the applicant would be serving, using the first 3 characters of the postal code as a criterion. It would therefore seem that the government is making an attempt to provide and distribute services as broadly possible with respect to geography. Hence, my comment about accessibility.
In terms of your second comment, my understanding is that the funding will allow for $300 for each episode of care. In terms of LTC facilities, the funding is based on the number of residents. I believe the plan provides each successful applicant, such as a clinic, a budget to work with which would determine how much service could be provided. In both the community and in facilities then, it’s straight math – services from a global budget or a capitation model. This is compared to the previous model allowing 100 sessions, with the potential for an extension of 50 visits. With a growing number of seniors and an undetermined number of sessions (other than assuming the maximum), a scenario is created in which the ceiling for cost is less predictable. Since partial de-listing, despite there being a more stringent filter in terms of who could access care under the DPC system, costs continued to escalate. A predictable model allows for better planning and extrapolation of cost over time as the numbers are more consistent. Hence, sustainability. On the point of PT involvement, the government is opening up funding to all interested physiotherapists – including the DPC clinics.
It is certainly my intention to understand issues before responding in a public forum. Not sure about your comment about sounding “scholarly”, but I’ll take it as a compliment 🙂
Thanks.
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I understand you are practicing in Ottawa region and I am happy for you that you are not in GTA where physiotherapist as a profession has been decimated by Non Professionals owned clinics and also by big greedy corporations.I recently heard last week one physiotherapist got hired for 24 dollars an hour in North York. That has been the result of these change.
I would like to correct certain facts you have mentioned.
In Clinic the Government is providing 312 dollars of “Unlimited Physiotherapy”. All the patients who have been calling Ministry of health have been told that they will get Unlimited Physiotherapy and as long they want. which on paper looks great.
While physiotherapist have been informed that it is episodic, time limited and discharges to be reported. And as a physiotherapist you have to use professional judgement.!!!!. This new funding is going to create lot of unhappy seniors as they are used to the 50-100 visits.
If you know how this government treated the existing DPCs you will know how they will treat the future DPCS or so called Community clinics.
So let me tell you all the Physiotherapist who are looking at this new policy as a blessing they will face the reality of few funding dollars, many unhappy clients with complex issues and stringent requirements. OPA led by its President were Ignorant or smart to endorse a new legislation without knowing the details. OPA said after 18 April announcement we fully endorse this policy by government and also we are waiting for details. which stupid body will do that?
In long term care the funding is per bed of 750 dollars. It is being funded to Nursing Homes through Lhins. After the money taken by Lhins, Nursing Homes and the same DPC companies who have the contracts what will come to the end provider (Physiotherapist) and Beneficiary (residents of Nursing home) you can imagine how much dollars will end for the real treatment!!.
I anticipate, the next step by ministry will be that very few patients need physiotherapy and cut the funding for physiotherapy in future from 750 dollars to may be less than 400 dollars. Physiotherapist have been advised by their companies to discharge the patients who can be maintained by exercise class. So with this discharges and increased ratio of pt to patients residents will hardly see a physiotherapist. Then Physiotherapist will get a bad name that they are hardly present in the nursing home and they are still getting paid. OPA will be there to applaud and endorse government for further cuts in physiotherapy under the leadership of the OPA President.
In retirement home i have been told that physiotherapist will be given 8 to 16 visits initially and then it will be phased out. I feel bad for the physiotherapist who have run into this new opportunity without understanding the long term consequences. And we all know how efficient is CCAC.
Regarding your comments on cost escalation it is the result of the aging population and it will continue to grow with Baby Boomers. Government will pay more for the increasing falls and skin breakdowns due to delisting physiotherapy from ohip. You pay for physiotherapy to prevent falls or pay for surgery for a Hip fracture post fall. which is the cost effective method ?
I would like to thank you for joining this discussions and showing empathy towards fellow physiotherapist.
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I am happy that you replied. I hear this a lot; expanding and covering population. i work in the hospital and i get a lots of ortho patients from up north; reason – there is no ortho surgeon there. are you going to lobby for the ortho surgeons as well? let me ask you simple question. forget about ontario, what is toronto’s population and what is canada’s population? if you google it, it says toronto’s population is ~ 3 million and canada’s is 35 million. meaning ~ 1/10 of the whole country resides in Toronto. I will not be surprised if 1/10 of all physiotherapy clinics, hospitals, restaurants etc., in general all business are in Toronto! BECAUSE THATS WHERE THE POPULATION IS!!! i am sure you cont want 10 OHIP physio clinics in a town where the total population is 100,000. i am not sure how many OHIP clinics are offered in any city north of SSM.
Government is acting on very poor advice. i met a MPP who told me that 95% of residents in LTC / RH can be discharged home. go figure, she is writing the healthcare policies. she does not even know the group exercise class that she saw was from Physiotherapy or from Activation. She does not know what kind of interventions we do. she was only told that Physiotherapy is delivered in groups only and never bothered to see any physio or resident or paperwork.
yes. $ 312 per episode. now let me tell you about a patient who has trapezitis, goes to the doctor who writes OHIP physio referral, after 10 sessions, patient is still there, and because it is not cost effective to see that patient more than 10 sessions (considering $ 30 a session, which seems to be decent outpatient fees), is sent beck to the doctor, who writes another physio order for CS, after 10 treatment, it does not make difference, the doctor writes another referral for shoulder pain. each time, the same patient is treated for same problem, but 3 block funding is accessed. are you going to fight doctor for mis-diagnosing? are you going to fight physio who accessed 3 block funding? are you going to fight patient who is not getting better because he/she is pain focused? but i believe in your view, because its done by private clinic, its fair and not abuse.
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my question to you all here is how did the funding went above budgeted. why did that happen? why was government so lax that gas plants keep on emerging in each and every sector?
if government wanted, there could have been a win-win situation. here is an example…
1. instead of cutting down totally in RH; government could have given block funding – lum-sum to each RH to house full-time or part-time PT. they are paying to CCAC that much anyways. as i mentioned, 6 CCAC visits could have paid for 1 a week physio.
2. in LTC, the visits could be cut to 100. that would have saved them ~ $ 30 millions. that way they would still have decent x 2 / wk PT (at least hot pack and 3 m walk along with group exercises if nothing else).
3. per head maxima for physiotherapy treatment in outpatient as well instead of $ 312 block funding per incident. with that government is giving private clinics a chance to exploit as i mentioned earlier.
remember in the whole equation, we have not yet considered the negative effects of not having physiotherapy in RH / LTC. does that not going to add to the cost? as far as i know, increase in 3% hospitalization of LTC resident because of inadequate physio with 7 day stay, wipes out all saving, we have not considered the $ 312 block funding yet. which will add to the cost. considering baby boomers coming in to equation and misuse makes it even more expensive.
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Why did not CPO question the government when they misled the public by saying they are expanding the physiotherapy services which also includes the exercise class done by non physiotherapy volunteers. If a seniors goes to excercise class in retirement home thinking that it is expanded physiotherapy exercise class then they will see is a volunteer!!!. IF a senior is injured in this class by fall who is responsible??
. I would have imagined the CPO would have been proactive in protecting the title of physiotherapist and protecting seniors who are also under their mandate. Why did they allow government to mislead the public with their message of expanding physiotherapy with exercise class run by non regulated individuals ????
Why has not college of physiotherapist questioned all the clinics where 1000s of patients were treated with Hot Packs and MVA billing was done for 1000$$$ billing done for treatment not required and don’t even start about those housekeeping & false assessments . I have heard stories of 1 dollar shoe horn from ikea billed for 35 dollars. I saw OPP charging some of those MVA clinics what happened to the physiotherapist who worked in those clinics . Did CPO follow on that case?
And in the hospital there has been so much of jobs cut resulting in the physiotherapist in nursing homes helping those patients when they are discharged from hospital. So many resident are discharged post surgeries without any physiotherapy and we end up doing the real treatment.
I will be happy when cpo comes with guidelines on the Physiotherapist to patient ratio in long term care sector .
I will be the happiest person if cpo can regulate and stop all the fraudulent Non-Physiotherapist owned clinics who got the bad name for physiotherapist. Why is CPO just squeezing physiotherapist . please go behind all those non physiotherapist owned clinics to do the real regulation.
I welcome regulations and accountability but do not paint everyone with the same brush. If toronto star is your reference of good news and then please read the demonstration of 100s of physiotherapist who stood in front of OPA to show their displeasure on this regulations forced on them without proper consultation and OPAs unconditional support of endorsing government’s policies. Below is the link of the news article.
http://www.thestar.com/news/queenspark/2013/07/26/physio_clinics_win_first_round_in_court_battle_with_ontario_government.html
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One of our resident came back from hosp 5 days post op following # hip. She was not sent to rehab as “they were short on beds there and bcos there is physio at LTC” . Ours is 250 bed LTC with 1 PT and 2PTAs with the new model. Our PT staff was cut by 30 %. How much time do I have , for me to spend with that resident ?
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I also fully agree with your assessment that hospitals now are shipping post fracture residents back to nursing homes as fast as they can so the in home physiotherapist can provide the rehab services. However, with the cuts in staffing hours, even with streamlining residents and using our “professional judgment” to allocate services, the documentation requirements and committee involvements make time management extremely difficult and challenging.
Furthermore, I take offense in the way this government pushed the agenda forward. One doctor reassured me “it’s not the quality of physiotherapy services, so don’t take it personal. The government just doesn’t have money after all their scandalous waste.” It would have been more honest and ethical if they had openly and transparently informed the public these changes are needed because there are no dollars rather than making defamatory and untrue statements against the profession.
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In LTCs, as per MDS-RAI we can have 1:4 ratio max. for fall prevention group exs class. These so called “exercise classes” are in fact fall prevention group exercise classes where we focus on strengthening and balance training in addition to flexibility exs that are designed and conducted by registered PTs. PTs in LTC s have been seeing those residents for one on one exs on top of the fall prevention group exs class.
Now that other staff members including PSWs, activation aides or practically speaking anyone other than PT can conduct exercise classes, they will magically be “therapeutic”!!
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Look at all the chiropractors owned clinic what is the title some of them have it is physiotherapy? I think CPO and OPA achievement is that they have promoted and participated in degrading the profession and supported the growth of these illegal clinics? I am yet to find one non physiotherapy clinic taken out of buisness by CPO . CPO must get money from government they take money from us in the name of self regulation and then do not support the frontline physiotherapist from non physio clinics and governments vote winning policy’s
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Keep well 🙂
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I feel most strongly that we know need a ” trade union” to protect us. The Chartered Society of Physiotherapy in UK has a system where they act as “College or Licencing body” and “Staff side” who provide representation on behalf of the members. When practicing in UK the CSP represented us against the government when out hours / salaries and jobs were to be cut within the NHS system. The CSP staff side organised the rallies, and marches on parliament and protests throughout the country.
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http://www.theglobeandmail.com/news/politics/er-doctors-under-pressure-as-province-questions-billings/article4597722/
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Under any audit system, “the basis on which doctors or physiotherapists are selected must be clear, the method of auditing must be transparent, and the process must be fair in all respects.” I find it utterly ludicrous that the Minister of Health states that the ministry follows a “very clear, step-by-step audit process.” REALLY!! If that is the case, why are the physiotherapy audit results not shared openly, timely and transparently with the public, with the companies at fault until they need it to push their own agenda through? Yes, I particularly agree with the statement in the Globe and Mail article, “The government is within their rights to ask for patient charts, but not to act as judge and jury.” Perhaps, Premier Wynne should look at her own party’s scandalous behaviour and do some internal audits and recover the FULL EXTENT OF WASTED FUNDS from the coffers of the Liberal party and not depend on taxpayers to pay for their selfish mistakes. If they can audit and judge doctors and physiotherapists, why can’t they audit and judge themselves under the same microscope?
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Toronto sun articles below
http://www.torontosun.com/2013/08/25/physio-changes-mishandled-by-province
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University of Waterloo research supporting benefit of ongoing physiotherapy for seniors
http://www.inforehab.uwaterloo.ca/
Recent medicare changes in USA supporting maintenance treatments.
http://blog.aarp.org/2013/02/06/amy-goyer-medicare-pays-for-skilled-therapy-for-maintenance-with-chronic-illness/
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University of Waterloo research supporting benefit of ongoing physiotherapy for seniors
http://www.inforehab.uwaterloo.ca/
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I appreciate your candid analysis and opinion on the situation. I have worked in almost all areas, private practice, hospital, and CCAC. The CCACs have been tasked to take on the PT in these settings due to the legislative change. The CCACs also have a finite budget to serve a growing number of seniors and they have attempted to put guidelines in place to be able to serve as many people as possible. There is no open purse for the future for any healthcare profession. I think the reality is that we need to look at what tasks are required in these settings and make sure that the most capable and least expensive provider can be utilized to do those tasks. Just like different levels of RN, RPN, PSW ect. In the physiotherapy profession we are undergoing changes in how service will be delivered to these millions of seniors so that the quality and expertise of the PT can be utilized on as many people as possible. The maintenance programs however for these seniors should be carried out by support personal either PTAs, PSW or other support type personal depending on the situation. Every sector complains that there isn’t enough money and it will not get better. We need to do more better. We have to step outside of our singular thinking and look at the system and see how it can be managed better. The LHINs are putting more money into the community support sector because they can provide so much more for lower needs clients and fulfil many prevention models. The CCACs are taking on more complex patients. There are a lot of very dedicated and conscientious people who are trying to look at models and how to serve more clients better. It is evolving and everyone was tasked to do this in such a short period of time. It is very unfortunate how quickly my colleagues lost their jobs and hopefully with the changes there will be others that will start to emerge. Physiotherapy was once seen as the “nice to have service” but with more research in home care and other settings it is now seen as the needed profession to maintain clients and improve outcomes. We should all come together and try to come up with models for Ontario that can be sustainable. In the end, everyone wants to make a living and do the best for their clients.
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It is sad to see physiotherapists at each others throats dure to an intolerance and misunderstanding of the professional diversities among us.
As a physiotherapist of 34yrs experience, I am abhorred by some of your lack of knowledge and understanding what is actually provided by OHIP physiotherapists in LTC and Retirement. I personally have worked in the hospital system, private sector, CCAC and for a DPCA. One is not more important in the other but as Physiotherapists working in the field, we should recognise the different areas of expertise in which our colleagues work.
Please note that our Physiotherapists assess each and every senior in both Retirement Homes and LTC Homes with re: to their fall risk; pain; mobility; strength, continence; skin integrity, chest; cardiac and more, using multiple objective measurements. Once assessed, treatment is based on these outcomes and goals are set. Most treatments are one on one therapy, in fact in LTC, this is the norm. Some classes are specifically designed to address, strength; balance; flexibility-it would depend on the outcome of the assessment. Exercise is and always will be an integrated part of physiotherapy.There were speciality groups for Parkinson’s; MS; stroke and other neurological diseases. Painful wounds are treated effectively using ultrasound and or UVR providing relief of excruciating pain. We treat continence; chest care; responsive behaviours; vestibular issues as well as mobility. All these seniors are reassessed every three months or earlier if required to ensure their treatment is effective. We address both acute and chronic pain using “hands on” or modalities as needed. (Not just hot packs). We have outcome measurements that we provided every quarter that show the effectiveness of our treatments. I take offense that you consider this not real therapy and that we only do group exercises and throw on hotpacks. Setting goals for immobile seniors in their 80’s, 90’s and 100’s are very different from those in a clinic or hospital who are functioning well in society. It does not mean these seniors should be disregarded due to the fact they can only manage small goals and achievements. Yes these seniors may need help to hold a theraband due to severe arthritic changes in their hands or cognitive difficulties – children require help and “play therapy” in paediatrics but this is considered acceptable. These are vulnarable people who, yes, need help more than others, yes need reminders to carry out their programmes but are nevertheless important and needy members of society.. We have outcome measurements to show positive results. We have used the University of Toronto to assist with designing our programmes and interpreting our results to ensure we are effective. I have worked CCAC and know personally that this is not their area of expertise nor should it be.They are very effective in their area of homecare. We train our PTs in all these areas of Eldercare and provide ongoing education to update our staff on the most recent intervention and studies relating to seniors. We support our homes in providing regular inservicing and ongoing education to staff, residents and families. We assist on committees in our homes for Falls, wounds, continence, care conferences; interdisciplanary meetings and professional advisory committees. We provide ADP assessments and seating modifications to those needing care in this area. We provide placements and mentoring for students-
CCAC will now provide real therapy 1:1 for 1 visit/month to these seniors. Please note , these are often the same therapists that provided care in the Eldercare setting-did they suddenly become smarter and more effective. Most seniors need help, cannot remember or follow a programme from month to month on their own, so this approach appears to display a lack of understanding of the client you are following and their needs. I question this “plan of care”.
There is much going on other than “walks and a hot pack” and those of you unaware of this should educate yourselves before critising all DPCA therapists.
Yes, changes were needed and no-one was in agreement more than the DPCA who had presented cost effective solutions more than once that were ignored.
Yes, there are “bad apples” in every profession and every faction of the workplace but don’t dare tar us all with the same brush!
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and thats exacetly what i meant that we need to respect each other. today, you stand beside me in my tough time, and i will stand beside you when you are in tough time. tables can turn anytime. never saw this disrespect in other professionals, why in Physiotherapy?
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See when u open Alberta college physio site http://www.physiotherapyalberta.ca/ you will see how college acting to support physio and same time regulating.This college just scar physios to restrict their abilities.
They have set standard so high so physios job in Ontario is to keep writing patient chart and spend less time with patient.college wants quality time to spend on writing and less on patient.
Days are not too far that physios will move to alberta or Australia to work.
When handy man charge 100 dollar for only 5 min to fix microwave switch then people do not mind.
when window glass crack and they charge 400 dollar just to replace window people do not mind.
but but when professional like pharmacist charge 12 dollar to read prescription then people think this is too much and they also think this guy making money.
when physio charge 100 dollar per home visit they think same thing.
I think college also think same way.
I will tell my son who is in school that never become health professional to help people but become smart man so people do not mind to pay you 400 dollar to replace glass window.
Come on guys.
Expecting reply from the college for above concerns on blog.
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http://blog.aarp.org/2013/02/06/amy-goyer-medicare-pays-for-skilled-therapy-for-maintenance-with-chronic-illness/ease read a blog below about recent medicare changes in USA
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o yes, i remember. it was in aurora about 2 months ago if i am not wrong. i went through twice to know if its weekly pay or monthly. also checked for typo – PT or PTA.
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http://blog.aarp.org/2013/02/06/amy-goyer-medicare-pays-for-skilled-therapy-for-maintenance-with-chronic-illness/
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Excellent job summarizing what really goes on in LTC and RHs.
As a fellow physiotherapist with over 24 years of experience in various sectors, I am also saddened at the plight of our profession. Besides our professional colleagues who perhaps lack knowledge and understanding in our working sector, it is utterly inexcusable that even the OPA and CPO are totally deficient is this aspect and has not shown true leadership in standing up for and uniting all members of the physiotherapy profession during this very stressful & difficult time.
The workload you described – assessments, quarterly reassessments, RAI-MDS, ongoing referrals, falls assessments, numerous committees, care conferences is exactly the complexity of the workload in LTC. It is extremely different and in some ways far exceeds the demands in hospitals and private sectors because of the constant patient-family-staff-management dynamics involved. It is extremely challenging, time demanding and stressful. Any physiotherapists who have worked in this sector will truly & fully understand what I am alluding to. There is no such thing as slacking off – there is absolutely no time for that.
In my home, we have reduced falls by over 50% since 2012. The MOH scoffs at this data and states they are not true outcome measures. They dare to question the quality of our services. By reducing falls to this level, we have minimized exorbitant costs to the health care systems in terms of hospital stays, resource utilizations and improved the quality of life of these seniors.
From my understanding, DPCAs have made ongoing proposals to MOH to support a more sustainable, cost effective method to deliver care but all these suggestions fell to deaf ears. OPA purposely did not consult the appropriate stakeholders liked DPCA during the negotiation process with MOH. How can OPA make any informed recommendations without the input of those who actually operate and work in the sector?
The OPA President WILL NOT BE REMEMBERED as the President advocating for the physiotherapy profession but as the President who got 1,500 + physiotherapists TERMINATED WITHOUT NOTICE. That will be her legacy. Under her leadership, the profession and the morale of its members have spiraled downhill and ebbed to its lowest levels.
It is a sad time for the profession! Yes, I agree when one door closes, another will open. It will take some time, perhaps a very long time to claw our way up again…. I look with sadness and regret at how we have made great strides forward as a profession but I see where we are now. We’ve taken huge strides backward. Sadly, we have handed our profession to non-physiotherapists and large diversified health care companies who may not be interested in quality but the bottom line – big profits and big bucks. Small physiotherapy owned clinics will be swallowed up. We aren’t our own bosses any more. Large LTC corporations through RFPs will dictate our service levels but at fixed funding levels. Who will lose out but the front line physiotherapists who are caught in the middle with little or no choice? Who will lose out but our vulnerable seniors? It’s demoralizing how much the profession has lost. All for what – to increase geographic access and to be part of the family health networks. NO THANK YOU!! The goal SHOULD NOT BE to decrease services for seniors in the GTA in exchange for increase services in rural areas. No, the OPA goal should have been to consistently raise the level of care in ALL PARTS OF ONTARIO rather than shifting resources. Yes, I acknowledge a need to change the funding model to make health care sustainable. However, there are much easier and smarter ways to accomplish the same goals without destroying the physiotherapy profession, uprooting the entire system and wiping out the morale of its members. What a fiasco!!! What a gong show!!! What poor leadership!!!
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The OPA President did not lay off the PTs. She is not responsible. The MOH changed the legislation. She supported it and so do many others. The details are really the issue here. Change was inevitable. It is short sighted to blame her.
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Really interesting discussion, so far – that’s for sure!
There are so many challenges, and unfortunately no perfect solution. I’m sure if we ask people working in other sectors funded by the government, we would find that they too have challenges and that there are no perfect solutions.
A challenge we face as physiotherapists is that we are one of the few, and maybe the only health profession that has a significant visibility in both the private and public realms. As such, it creates some division in attitudes and emotions within our profession. I’m a believer in standing strong together.
Clearly, there were issues with the past funding and anticipated issues moving forward. It’s great that people feel so passionately about these things – as do I. But, like some of intonated, we bring ourselves down and become weaker as a group (bearing in mind that we have considerably fewer members than the nurses and physicians, and a much smaller treasure chest) when we put down some of what our colleagues do.
I’ve had personal success cold-calling my local MPP, and developing a working relationship with him. I can tell you that physiotherapy is on his radar. In fact, I ran into him just a few days ago in a coffee shop and he brought up the new funding. I would strongly encourage each of you to bring your facts and well-formulated thoughts, and constructive commentary to your MPP. In the end, they are the ones that develop and pass the legislation that impacts all of us.
Thanks.
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You can make a good politician ! Wow what a speech !
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Regarding abuse of the system, let us look outward as well as inward. We should also ask why many doctors continued to refer patients back to physio for chronic conditions, even after treatment had already been provided and even after the patients had been advised on how to maintain themselves following physiotherapy. There also seemed to be a problematic sense of entitlement by the patients, themselves. They were aware that OHIP provided a certain number of physiotherapy visits annually and would often become upset if treatment was concluded earlier.
Change was long overdue, but the “baby should not have been thrown out with the bathwater”. Many employees will be left jobless and many patients will feel abandoned. Now is not the time to point fingers.
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Has anyone really thought about this???????. And the news came about as the court case started. I never thought the politicians can bend to this Low level to hit on a group of educated professionals. I have lost the tiny little bit of respect i had for this elected Modern Media spin doctors (MPPs and Ministers)
Now i understand that CPO gets their first hand information by reading Toronto star and following Jimmy DGP . I would recommend them to read Sun, National Post and Globe & mail to complete their knowledge.
I feel bad that i had to do Masters in physiotherapy and clear two parts of exam conducted by Alliance . Where as my regulatory body’s Registrar is reading Toronto star to get outraged.
(Quote from the Blog- “Personally, I stand in the ranks of the outraged, if as the Star reported, 58% of billings made by designated OHIP clinics were unsupported”. ). She has only mentioned the comments of Jimmy DGP and not the other outraged physiotherapist who have also tried to defend their work and ethics with their comments.
This looks like how George Bush picked the intelligence to find WMD in Iraq. And you know what was the consequence of the War in Iraq. They went for OIl and had to beat a hasty retreat..
If CPO starts to pick intelligence which suits them then they will have the same legacy like George W Bush. I hope that they will change the course of their thinking and have evidence based Approach. I would like every official in the college to study what is the role of physiotherapist.
Why is exercise therapy not part of physiotherapy and has any evidence based studies research done on group settings vs one to one exercise therapy.
If we follow this trend, then manipulation is only for chiropractors, soft tissue is only for Massage therapist, exercise is for Kinesiologist, Restorative care & Nursing rehab under Nurses, Physiatrist , Podiatrist for foot and acupuncture is only for TCM doctors.
What is left in physiotherapy ?
It looks in the name of protection what’s happening is destruction of this wonderful profession by the OPA President . Who can only destroy fellow physiotherapist and not create any jobs. I feel funny that OPA is happy that physiotherapist will join NP and MD led teams. Why cannot a Registered Physiotherapist led team be created.
The OPA President’s Legacy is killing 1500 jobs in this profession and the rest of physiotherapist who are retained to work in the ratio of 1 to 250-300 residents will have early stroke or heart attack due to their stress levels.
I will like to quote one of the famous words from George W Bush
“You know, one of the hardest parts of my job is to connect Iraq to the war on terror.” –interview with CBS News’ Katie Couric, Sept. 6, 2006
I will follow this blog for further information from all the newspapers regarding physiotherapy.It is very enligthening and entertaining.
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Thank you for your post. You make some excellent points that I would like to highlight:
1) College needs to be unbiased and open minded in their approach. Their veiled judgmental, biased and accusatory tone in the blog does not lend them credibility and does not lead to solidarity in the profession. Research your facts from credible sources before making statements one way or the other. You are a regulatory and disciplinary body.
2) Yes – why is group exercise class not within the realm of physiotherapy especially if that is only one component of their overall Rx? Yes, I highly endorse your suggestion that College members themselves study the role of a physiotherapist.
3) Yes – we need to protect our Title. With OHIP delisting, we’ve opened up the profession to non physiotherapists. I cannot see that as a good thing. Small clinics can’t survive on the cap that is set by the government when you factor in rent, office expenses, administrative costs, salaries (PT, PTA, secretary), there isn’t much left especially at the fixed rate of $312 episodic care. Many have already closed. Big companies will buy up small clinics and apply for the government funding. Nursing homes can directly hire PTs and dictate their workload. PTs will have no DPCAs to support them.
4) Yes, I agree that PT profession has given everything away to various professional disciplines. We won’t have a foot to stand in the future.
5) Yes – fully agree. Why does OPA endorse MD and NP led family units? WHY NOT physiotherapy led family units? Do we not have enough confidence in our profession? That would have been the smart forward move for our profession. If OPA’s mandate is job creation, why has 1,500 jobs been lost and the new jobs that come around are below standard hourly rates – $24 per hour and going further down I hear. Wow!! We make as much as the PSWs but they have no legal responsibilities.
Thanks for your support! Your insight is excellent!!
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Thank you both for your interest in the new funding model issue.
I would like to enlighten you to what many LTC, RH, clinic PT colleagues have gone through the past 5 months. It has been mentally straining and stressful to say the least.
Many PTs have had to engage in activities they normally would not dream of doing. Since the announcement of the delisting of physiotherapy on April 18th, many if not all DPCA physiotherapists and PTAs have done the following:
1) Several Friday lunch periods rallies in front of all MPP offices across Ontario (Liberals, PCs and NDPs)
2) Meeting with MPPs at constituent offices
3) Writing letters and emails to all MPPs – often without responses from Liberal MPPs
4) Attending webinars and town hall meetings.
We too are constituents in ridings across Ontario and we have a right to have our voices and our concerns heard.
Liberal MPPs pretend to listen but have been scripted by their party in their responses.
5) Writing to media outlets across Ontario with numerous supportive articles published.
6) In June, we had two Queens Park Rallies – one organized by Physiotherapists / PTAs (more than 400 staff in attendance) and another rally organized by seniors.
Over 200 seniors went to Queens Park to have their voices heard and to tell the Health Minister, Deb Matthews directly to her face what they thought about her plan.
7) Over 144 OPA and non OPA members collectively wrote and signed letters to the OPA President demanding a meeting with the OPA Executive team, requestiong copies of minutes to meetings between MOH and OPA and OPA’s involvement in the delisting issue.
8) OPA Rally in front of OPA headquarters in Toronto (July 26 – same day we won the 1st judicial review)
Over 200 PTs and PTAs flooded the streets with placards demanding transparency and accountability from OPA.
Did anyone from OPA show leadership and come out to speak to their members? A resounding NO.
9) Many PTs also participated in election rallies, All candidates meetings and door to door canvassing in the 5 by-election areas.
The Liberals lost several seats in the elections because we made the physiotherapy issue front and center to the public. We garnered support from the other 2 political parties despite staying party neutral.
Although we lost in round 2 in Divisional Court, we should be proud that as caring health professionals, we stood our ground against this insensitive government, made the physiotherapy issue heard loud and clear and fought diligently for a better solution for our vulnerable seniors in LTC/RH/Community and most importantly for our profession.
It is sad that we have a Health Minister who does “battle” with its professional bodies. Matthews states, “she has taken on the doctors and the pharmacist and she is going after the physiotherapists.” Is that the way we want our government to function? Should it not be a collaborative effort of all stakeholders to come out with a viable, effective and sustainable plan? Besides OPA – should DPCAs, OLTCA and ORCA not be included on the discussion table. Why were they purposely excluded? No organization were involved except OPA who really have no working knowledge in this sector. Time and time again, Deb Matthews uses the OPA to justify support of her plan.In honesty, none of the OPA physiotherapy members working in this sector (LTC and RH) were consulted.If it was a “majority” that supported this plan, then OPA consulted the wrong members. What professional organization would have the stupidity to endorse a plan without knowing the specifics? What gullible leadership!!!
What frustrates me more is that Premier Wynne brags about consultation, dialogue, transparency and accountability. None of these essential components took place in the process leading up to the delisting of OHIP funded physiotherapy. All they did was spin lies to gain public support -pretense of increase physiotherapy expenditure when in fact there is a significant cut. The numbers don’t lie. I think Ontarians deserve to hear the truth.
My heart goes out to the PTs and PTAs in RHs who were terminated that very night (Aug 21). Aren’t physiotherapists, like any other workers in Ontario – don’t we have the right to have proper termination notice? Don’t we deserve the 45 days posting with the regulation change? Not according to the Liberal government. The courts decided the regulatory policies they make are not legally binding. I guess labor laws and regulation changes don’t apply to those working in the physiotherapy profession!!?? What a degrading way to treat educated professionals!!! Is that what OPA is doing to advance our profession in public eyes? I don’t think any other province have seen the likes of this – 1,500 PTs receiving termination letters. This is a first…..It will take a long time for our profession to heal from these deep scars?
Peter – I have to agree. The CPO has not been open minded, unbiased and has NOT fulfilled their mandate to protect the public (misrepresentation by govt). To highlight the Star article and not present both sides of the argument and to not include other newspaper viewpoints don’t do justice to the issue. They too have wilted under government pressures as evident in bending the rules to facilitate the government plan to discharge all residents to CCAC.
I was especially disgusted with the veiled threat of disciplinary action to PTs, as if PTs were not stressed enough, the College had to hammer it in.
The OMA would certainly not treat its members the way we’ve been treated.
Thank you both for taking an interest and your ongoing support. Your fellow colleagues do appreciate.
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It is not my intention to sound cynical, but here it goes:
First off, I will say that I have the strength of conviction to put my name to my posts.
Secondly, in terms of being enlightened I’ve heard much about the problems and little about solutions. That would be enlightenment for us all.
Thirdly, I’d like to remind everyone that this is a public blog for anyone and everyone to read. Let’s be conscious of tone and how we present to the outside world.
And finally, I set out attempting to respond to the original questions in the post. My main point was to suggest that businesses should make decent profits decently. That’s how I feel about the alleged improper billings, and I’m proud to put my name that.
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Apologies for some misspells in past posts 🙂
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Clearly, you bought into this.
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anyway to get to my question, I understand that OHIP is to pay $720 per resident directly to the LTC facility. Are they to recieve the funding irrespective of the residents physitherapy needs? Most physios working in LTC have had their hours cut and are to be paid on hourly basis. Thus it is natural that their number of residents seen will go down. Are the DPC till involved in this as middlemen?
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but not anymore. Physios dont need them for hand holding! that way more Monies can be directed to the Physio involved in doing the actual work.
BTW, LTC facilities are used to dealing with consultants, like dieticians, so working directly with the physio should not be a problem.
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If you read the scope of practise of a Chiropractor and of a Physiotherapist they are virtually identical at this point in time! Chiropractors are taught mobilization, gait analysis, orthopaedics, extremity adjusting and treatment, adjustments, soft tissue therapy, Graston, ART, x-ray/MRI reading, diagnosis and much more. There is so much overlap! Chiropractors have 4 years of schooling whereas Physiotherapists have two years of training. I personally would rather go to a Chiropractor as they have more education and clinical experience.
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Thank you for the post about possible dishonest billing to OHIP by physiotherapists. Such behaviour sadly is to be expected in our society. Over the last 30 years I have observed that many physiotherapists are only interested in the business aspect of physiotherapy. They will do anything to grow profits and have no regard for the profession or their patients. This is the expected result as physiotherapy moved from a publicly funded institutions, hospitals and rehab centres, and into the private sphere.
It is time for the College to partner with the OPA to lobby for public funding for evidence based physiotherapy. The College needs to work with the OPA and the university physiotherapy programs to establish clear criteria for evidence based physiotherapy. Interventions which are found to lack any evidence base would then be prohibited. This would eliminate the fast buck artists who employ support personnel to churn people through interventions of no therapeutic value but high financial reward.
As a profession we need to eliminate the rubbish, especially as there are interventions which are effective. The effective interventions require direct patient interaction and are time consuming and revenue reducing. Ultimately these are more rewarding to the patient and the physiotherapist.
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PT
OPA was a main role in changing funding model,cause they don’t know how we treat the patients for 12.20
barber shop person is getting 15 dollars plus tips for 15 min hair cut (no paper work no registration fee)
OPA is against Physiotherapist
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Pingback: Dear Private Clinic PT | Shenda’s Blog
Excellent Post…you information provides better management of your pain. It’s really appreciating.
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I have worked in a hospital OHIP funded out-patient setting for two decades. I am paid an hourly wage under the hospitals global budget. I work in a small rural community with a population who for the most part can not afford private care. Approximately 40 % of my case load are seniors. I’ve been in the fortunate position of being able to to provide one on one ethical care for our community and I know that that care has had a positive impact — not only in terms of improved function and decreased suffering but also is real savings to our hospital through prevention of unplanned admissions. All around me, I have seen rural communities lose their hospital out patient departments. We can thank the MOH for this pattern for allowing CEOs to target Physiotherapy as an easy fix for budget issues. Over the years I have observed the gradual ‘privatization’ of Physiotherapy and the problems that have developed out of that change. Profit motive and care are not a good mix and we shouldn’t be surprised at the ethical failures that result in systems based on greed. I believe most Physiotherapist are honest and ethical but there is a segment that are strictly motivated by profit and have little time for ethical considerations. That segment is growing.
I was encouraged when Deb Matthews announced changes to OHIP funding for private clinics. The case model seemed more appropriate for preventing increasing cost and the redistribution of funds to under serviced areas in the province was good news for seniors. I was also encouraged when Deb Matthews stated that this redistribution of funding was not to have an impact on already established hospital departments.
But now that the OPA and MOH has stopped congratulating themselves, let’s look at what happens in the real world. Our hospital, as a result of austerity measures, is facing a sizable deficit in the coming fiscal period. The new funding announced by Deb Matthews was also offered to hospital out patient departments and I was involved in submitting an application for this funding. This would have made it more likely for our department to continue providing service to our community. It seemed like good news after years of bad. A short time after submitting, we were notified by the MOH that we would not be receiving the funding. I assumed this was because our community was not considered under-serviced.
There is a private physiotherapy clinic in our town. It has been opened for quiet a few years and to this point has had no OHIP funding. We have always respected the communities right to choose the type of care they wished to receive and those who could afford it choose to use this clinic.
It was quite a surprise then when it was announced last week that the private clinic would be receiving the new OHIP funding and in addition would be occupying our space in the hospital in the new year. I would love to have been in the room at our LHIN when that decision was made.
So what has the MOH accomplished. Seniors will receive very limited care (I believe the new funding allows for an average of 5 visits) and the other 60% of our population will have to find the resources or simply go without. I am confident that most will go without.
I have no idea what this new private/hospital clinic will look like but I am sure my position will be eliminated, contrary to what Deb Matthews stated. A significant savings for the hospital – how could a CEO resist.
Privatization marches on, service is lost and ethical dilemmas present themselves every day.
Early in my career, I spent some time in the States. I know what the end of this story looks like – not good.
Too bad the College can not broaden it’s mandate to protect the public and the OPA make the MOH comment on broken promises. And too bad our LHIN is unaccountable. That is what needs to happen if we really believe in creating an ethical and cost effective way of providing Physiotherapy care for our population. Public funding of Physiotherapy is the best ways to create a sustainable system moving forward. What motivation would any private business have for teaching someone to take care of their own health – that’s the difference. That’s why private equals decreasing quality and ever increasing cost and unethical behaviour.
Merry Christmas.
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Word is that The Big Four DPC’s as identified in the Toronto Star last Summer continue to be under investigation and no doubt the other shoe is about to drop. In Ottawa, the major DPC operator who tried to control the DPC market is closing clinics and the damaged reputation of this DPC is negatively affecting other reputable physiotherapy companies that are being painted with the same brush as this company. To think that millions of dollars were billed as one on one care with a physiotherapist when in fact seniors were corralled into fitness classes with the class facilitation being carried out by unsupervised PTA’s. In fact, there are strong suggestions that the former DPC in Ottawa is still taking advantage of seniors by charging for physiotherapy services that are delivered by unsupervised PTA’s. Imagine how accurate the charting is and how much effort is put into treating these seniors based on actual episodes of care! Senior’s Program of Care as defined by DPC’s = Heat Packs/IcePacks/ Walking/Chatting and no outcomes and no discharge. Licence to print money.
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Incredible! No doubt that the Ministry is dealing with this and will fiercely look to get refunded for all this out of control billing.
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I think I worked for this company in 2009! They paid bonuses for seeing as many seniors as we could. The owner was adamant about every PTA and Physiotherapist having to bill OHIP for no less than 4 treatments per hour.
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