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Funding Changes to Physiotherapy—Where’s CPO in all of this?

Sep 04, 2013

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!

Leave a comment
  1. Anonymous | Apr 08, 2014

    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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  2. Anonymous | Mar 06, 2014

    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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  3. Anonymous | Jan 29, 2014

    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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  4. Anonymous | Jan 16, 2014

    \ \ \

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  5. Anonymous | Dec 23, 2013

    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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  6. benchmarkphysiotherapyau | Nov 26, 2013

    Excellent Post…you information provides better management of your pain. It’s really appreciating.

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  7. Dear Private Clinic PT | Shenda’s Blog | Nov 13, 2013

    […] of you who have been here before may remember that my first blog was about whether the College should take action against those people who had allegedly been […]

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  8. Anonymous | Oct 17, 2013

    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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  9. Cindy | Oct 15, 2013

    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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  10. Paul Stackhouse P.T. | Sep 29, 2013

    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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  11. Anonymous | Sep 24, 2013

    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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  12. Anonymous | Sep 24, 2013

    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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  13. Anonymous | Sep 12, 2013
    As a PT who worked in an OHIP funded outpatient clinic and gave the best care possible, treating all OHIP, private, WSIB and MVA clients the exact same way, I am still in disbelief that I was “let go” because of the funding changes. I guess doing a good job just doesn’t matter anymore. Where is the OPA/CPA when I need them? Many thanks for nothing!

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  14. PT | Sep 11, 2013

    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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  15. Anonymous | Sep 10, 2013
    The physio programs should also include courses to teach the students business skills. Chiro clinics are run by chiros in most cases. Physio clinics? majority of them are by businessmen. Obviously, the quality of the treatment or ethical billing is not the first priority for them. I strongly believe that PT clinics should be run by PT’s more. That WILL improve the quality of PT services in general. I had worked for clinics run by non PTs for 7 years and, after that, 12 years on my own now, running my private practice. I can control the billing, work load, and the quality of service. It is much better. Much better. The way it should be! Why didn’t I do this in the first 7 years? No knowledge of running the clinic.

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  16. Anonymous | Sep 10, 2013
    It seems that most of us, PT’s are offended about the chiropractors and others (but mainly chiropractors) saying that they offer physiotherapy. Please, everyone, what they mean by “physiotherapy” is just “electrotherapy”. What we do as PT’s is just electrotherapy, then? The Chiro program, to my knowledge, offer one course in their curriculum, named “physiotherapy” and it is all about running IFC and ultrasound. Well, if electrotherapy is what they think all that we offer and they say they offer physiotherapy, then, since many of us do offer Gr V manipulation, shouldn’t we say we offer chiropractic? I am sure they will file a lawsuit against us if we do that. Please, everyone, what are we? Why can’t our association and the college do something about this non-sense? Everyone complains about it, but no one does anything about it. we are just very nice bunch of people, allowing anyone to say they offer what we are educated to offer.

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  17. Anonymous | Sep 10, 2013
    Again You need to ask this questions to OPA. They are the one made this deal with MOH

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  18. PT | Sep 10, 2013
    Why are the DPC’s required. Cannot the LTC facilities directly deal with the physio’s who are actually going to do the work! When you have a DCP inbetween(, They were needed in the past for their OHIP billing previlages,)
    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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  19. Anonymous | Sep 10, 2013
    But most substantially cut their staff

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  20. PT | Sep 09, 2013
    yes, it seems CPO and OPA is all happy seeing falls prevention classes run by PSWs, volunteers, activation or for that matter any body. god knows if any of them know THR / TKR / Back Sx or for that matter any other contraindications. but i guess for CPO public is safe and for OPA, PT is jobless is fine.

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  21. PT | Sep 09, 2013
    totally agree. the mendate is different. there is no way, pushing CPO to do something about this. it is a regulatory body – to protect public as simple as that. CPO has nothing to do with government policies, in fact it polices the government policies.

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  22. PT | Sep 09, 2013
    as i mentioned in earlier post, the MPP we met, told us “95% of residents can be discharged home anyways”. she also said that she had visited 3 homes. would you agree Joseph?

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  23. PT | Sep 09, 2013
    Wow, well said.

    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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  24. PT | Sep 09, 2013
    hi there, their time will come too; wait and watch…

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  25. PT | Sep 09, 2013
    Shame that neither OPA or CPO stands to unify the profession.

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  26. PT | Sep 09, 2013
    hi joseph,
    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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  27. PT | Sep 09, 2013
    hi Joseph,
    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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  28. PT | Sep 09, 2013
    well said. ask them to work in LTC and see how many days they survive. we passed the same exam you did, we are also governed by the same college that governs you, so why there is no respect? you are killing your own profession! or is it more than that? is it because many LTC PTs are foreign trained? racism? personal financial gain? ask your self…my apologies if i hurt anybody’s feelings here, but there has to be something that we are fighting with someone who shall be standing in unity; beside us. once we respect each other and stop fighting in-between, the profession will grow. we are not focusing on the right issue and i can understand why.

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  29. PT | Sep 09, 2013
    ya, and i guess college is okay with that. college wants PTs to supervise eveything, considering their experience and when something goes wrong, are behind PTs.

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  30. Anonymous | Sep 09, 2013
    Most of the LTC homes kept their previous service providers (DPC).

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  31. PT | Sep 09, 2013
    I have worked in Ontario as a registered PT for past 30+ years. Currently I am away and have been getting regular updates about the changes that have taken place with regards to physio funding. unfortunately the writing was on the wall for a change. OHIP could not sustain the rate at which the physio billing was rising. In my work in LTC (for last 12 years) it saddened me that my time as a physio using hands on treatment was severely challenged due to increasing administrative demands, but that is the way the whole system is moving.
    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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  32. PT who left public sector completely due to chaos | Sep 09, 2013
    I am confused how one becomes “outraged” by information that one understands may not be true.
    Clearly, you bought into this.

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  33. Lost everything | Sep 09, 2013
    I lost my house after loosing my Job. Moving to small 2 bed apartment with my 3 young children :(. Thanks for refrom. A BIG THANK YOU to OPA.

    Like

  34. Joseph Federico | Sep 08, 2013
    Ha! Just realized I didn’t sign off. The last entry is mine.

    Apologies for some misspells in past posts 🙂

    Like

  35. Anonymous | Sep 08, 2013
    Just seeing some comments in response to mine. Thanks for the discussion so far. Not to sure how to take some of them …

    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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