Collaborating to better measure physician supply in Ontario: the Ontario Physician Workforce Database (OPWD)

Transcription

1 1 Collaborating to better measure physician supply in Ontario: the Ontario Physician Workforce Database (OPWD) Health Care 2008 Presentation January 21, 2008

2 2 Presenters Anshoo Kamal - Ministry of Health and Long- Term Care (MoHLTC) Neil Johnston - Ontario Physician Human Resources Data Centre (OPHRDC) Sue Schultz - Institute for Clinical Evaluative Sciences (ICES)

3 3 Outline 1. Introductions 2. History and policy framework for PHRP in Ontario 3. Introduction to OPWD collaborating organizations: OPHRDC, ICES, MOHLTC 4. What is the OPWD 5. Benefits from the creation of the OPWD 6. Ongoing challenges 7. Workshop/discussion

4 Physician human resource planning in Canada: a bit of history 4 Hall Commission, 1964 raised concerns about future population growth Judek Report, 1964 consequent need for growth in physician supply Mandatory addition of physician services to provincial public health insurance legislated July 1, 1968

5 5 Physician human resource planning in Canada: the evolving policy framework Early focus (to early 1990s): fiscal implications of continued growth in demand for medical services (eg. Lomas et al., 1985; Barer and Stoddart, 1991) More recent focus: Recognition of pending shortages of physicians (McKendry, 1999; Ontario Expert (Peter George) Panel, 2000; Chan, 2002)

6 6 OPWD Collaborating Organizations Ontario Physician Human Resources Data Centre (OPHRDC) Institute for Clinical Evaluative Sciences (ICES) Ontario Ministry of Health and Long-term Care (MoHLTC)

7 7 OPWD Collaborating Organizations: OPHRDC Original Ontario Physician Manpower Data Centre (OPMD) founded 1977, disbanded 1991 RFP for OPMDC replacement 1991 OPHRDC founded 1992 OPHRDC situated at McMaster present

8 8 OPHRDC Provides a common source of physician human resource data in Ontario to OPHRDC partners MoHLTC, CPSO, OMA, COFM Provide data for physician human resource planning in Ontario by maintaining the Active Physician Registry Coordinate data and report on the postgraduate medical training system in Ontario by maintaining the Postgraduate Registry

9 9 OPHRDC Data: Active Physician Registry Data for all Ontario licensed physicians from multiple sources, CPSO, OHIP, Scott s etc. Ongoing telephone surveys and audits Data for all physicians active in Ontario

10 10 Active Physician Registry: Rules for Inclusion Has an active CPSO licence. 25 years of age or older, 85 or younger. In active practice or at most semi-retired. Primary practice address in Ontario. Has an OHIP number and active status or is identified with an alternative method of payment. Is not engaged in Postgraduate studies. Has not been identified as retired or inactive for disability, leave, sabbatical, or other reason.

11 11 Physician Registry Data Flow Partner/ Providers Data OPHRDC Processing OPHRDC Reporting CPSO CMD PHYSICIAN REGISTRY NEW PHYSICIANS SPECIALTY CERTIFICATIONS MEDICAL SCHOOL PRACTICE ADDRESS ONTARIO PHYSICIAN REGISTRY DATABASE ANNUAL PHYSICIAN REGISTRY PIO APPLICATION OHIP FFS PHYSICIANS ACTIVITY STATUS HOSPITAL APPOINTMENTS PHYSICIANS IN ONTARIO (PIO) DATA TABLES OMA RCPSC CFPC IDENTIFICATION & ACTIVITY INFORMATION SPECIALTY CERTIFICATIONS FAMILY MEDICINE & FAMILY PRACTICE/ EMERGENCY MEDICINE CERTIFICATIONS PHYSICIANS BY: 1. Specialty, County, Sex 2. Age-Sex Distribution 3. Population Ratios 4. Source of Medical Degree 5. Additions and Attritions 6. Migration and Specialty Analysis 7. CPSO Statistics Reports WEB SITE OPHRDC POSTGRADUATE ENROLLMENT AUDIT RESULTS Telephone Surveys Professional & Area Health Organizations Physician Data by Year Midterm Updates Physician Distribution Maps New Patients Survey Wait Times Survey ALT PAY SOURCE PHYS. MOH Reasearch Sol Gen Alt pay plan Hlth Svc Org Comm Hlth Ctr Und Svc Area Publ Svc Lab Paths Soc Svc Contract Ad Rsch Fdtn Coroners Psych Hosp Cancer Ctrs Wkrs Comp SPECIAL STUDIES Ministry of Health District Health Councils Ontario Medical Association Partner Referrals Compusearch POPULATION FIGURES

12 12 OPWD Collaborating Organizations: ICES Created in 1992 to support and promote evidence-based clinical practice and health system planning and management Initially, no in-house physician data data from National Physician Database (first Health Canada and then CIHI)

13 13 ICES Physician Data Sources Data sources in 2003: OHIP billing data Corporate Provider Database (records for providers eligible to bill OHIP) Southam Medical Database (sporadic) Data from OPHRDC (by project only)

14 14 ICES: Physician supply and workload products adjusted FTE functional measures: specialty, community physician-population ratios using physician FTE and population weighted for patient age, sex and flow across geographic boundaries other workload measures days worked, patients seen per day

15 15 Adjusted FTE Measure Adapted form of a measure developed in 1984 by a Working Group comprising representatives from Health Canada, provincial health ministries and academic consultants Original measure based on physician fee-forservice billings

16 16 FTE conceptual model # Physicians + Work characteristics Services X Fees Payments Full-Time Equivalent

17 17 FTE Calculation: A few details calculated by specialty uses benchmarked range of 40 th to 60 th percentiles rather than single cut-off to define 1 FTE to avoid very large values, FTE above 1 plotted on logarithmic scale fees standardized over time initially standardized to a single year

18 18 ICES FTE modifications Adjustment of payments to include shadowbillings (billings submitted by salaried physicians. Includes information of regular billings i.e. fee code, diagnosis, but payment amount=0) Maintenance of CPI-style constant basket of services Development of regression model to estimate FTE for active physicians with very low billings

19 19 Final Algorithm FTE = 1 if total payments falls between 40 th and 60 th percentile for that specialty FTE = P/P 40 if total payments falls below 40 th percentile for specialty FTE = log(p/p 60 ) if total payments falls above 60 th percentile for specialty P=payments

20 20 OPWD Collaborating Organizations - MOHLTC

21 The Health Human Resources Strategy Division 21 Responsible for planning for nurses, physicians and allied health professionals. Physician Planning Objective: To have the right number and mix of appropriately educated physicians available to meet the needs of the people of Ontario both today and in the future.

22 The Health Human Resources Strategy Division 22 Policy Levers/Initiatives Medical Education (medical school spaces & residency positions) (DME, Re-Entry, etc.) International Medical Graduates Recruitment and Retention (HFO Marketing and Recruitment Centre) Incentives (Incentives through the Underserviced Areas Program)

23 23 Physician Human Resource Challenges Reported shortages in physician supply Maldistribution across province Aging population that includes an aging physician workforce Reported reductions in workloads

24 HealthForceOntario HHRSD launched HealthForceOntario, the province s innovative strategy created in partnership with MTCU and MCI. Data & Analytical Capacity 24 Right number and mix; in right place at right time; with the right skills Assessment & Education Practice Environment

25 25 Genesis of the OPWD Initiative At the recommendation of the Expert Panel, MOHLTC initiates collaboration with ICES and OPHRDC to develop the Ontario Physician Workload Database to support modelling exercises Ben Chan creates OPWD combining data from OPHRDC and ICES Expert Panel on Health Human Resources (Peter George) recommends continued refinement, maintenance and use of OPWD

26 26 The right fit to work together OPHRDC: Responsible for monitoring the pool of active physicians and post-grad MOHLTC: Responsible for policy related to education and training positions and practice incentive ICES: Has tools and research capacity for development of physician supply metrics and models

27 27 What is the OPWD? OPWD -- Ontario Physician Workforce Database is a database of approximately 40 variables, OPHRDC Physicians in Ontario (PIO) database, 9 -- ICES physician database

28 28 Benefits from OPWD OPHRDC a workload measure (FTE) enabling enhanced estimates of physician supply in Ontario information about physicians functional location, based on where patients reside ICES more accurate, reliable information about physician specialty, activity status and location, which enables better research into physician practice patterns in Ontario

29 29 MOHLTC Aim is to use evidence-based planning to ensure an appropriate supply of physicians for Ontario. Goes beyond headcounts to understand how much clinical activities physicians are providing in what specialty areas Base projection models such as Assessing Doctor Inventories and Netflows on the FTE to better forecast future supply Attempt to capture trends in physician workload patterns in order to implement appropriate incentives Reporting geographic distribution by FTE to capture physician resource mobility

30 OPWD: Still some challenges 30

31 1. When is a Physician not a Physician? Comparison of the 2005 ICES File to OPHRDC 31 Under 85 Deceased Rule Inactive license status Not a postgrad trainee Ontario address Retired Maternity/other leave No OHIP or OHIP inactive Effect 36 fewer in OPHRDC 39 fewer in OPHRDC 129 fewer in OPHRDC 242 fewer in OPHRDC 367 fewer in OPHRDC 507 fewer in OPHRDC 44 fewer in OPHRDC 48 fewer in OPHRDC

32 Ongoing challenges to FTE methodology 32 Increasing % physicians who are not FFS Questions about completeness of shadow billings Emergence of new primary care group models and compensation structures Implications for FTE: Unable to maintain consistent basket of services, Concerns about relevance of base year

33 Testing solutions to the FTE challenges: number of GP/FP FTEs 33 BY99, lat.price, man adj No BY, lat. price, man adj Total actual payment Yrly prices, No BY, lat. price, no man adj Head counts

34 34 OPWD continuing challenges Trend for some specialties to conduct significant practice in non-insured services Increased mobility of physicians and practice at multiple sites Growth in health research and time spent in activities other than clinical practice Data availability

35 35 OPWD How do we use it? How would YOU like to use it?

36 36 OPWD What can/do we do with it? Answer questions such as: How many physicians are there? What is their sex/age demographics? What is their specialty? Where are they? What are they doing? How much clinical work are they doing?

37 For example: How many General Paediatricians are there in Ontario? 37 What criteria should we use? Self-report Certification OHIP billing eligibility OHIP billing pattern Patient population A combination of the above

38 How many General Paediatricians ARE THERE in Ontario? 38 Self-report: Certification: Eligible to bill OHIP as paed: Self-report + certification: Self report, no certification: Certification, self-report other: No cert. or self-report, but >75% patients 19 or under:

39 39 The bottom line on specialties The number of physicians in a given specialty depends on how you define that specialty.

40 Example 2: Geographic assignment and issues in calculation of physician supply by LHIN 40 LHIN boundaries do not coincide with municipalities Postal codes do not uniquely fit into municipal boundaries in rural areas Catchment areas vary in size by specialty A growing number of physicians practice in an itinerant fashion or may reside outside Ontario Distance image reading or robotic surgery

41 Example 2: How many Obstetrician/ Gynecologists are there in a given LHIN? 41 Waterloo Wellington, for example Headcount 35 OBGYNs (using mainspecialty variable from OPWD) But: Several with fewer than 50% of patients from WW Others with patients from 3 or more LHINs You decide

42 42 Discussion Questions How could you use OPWD? How should we assign physicians to LHINs? Should specialty be assigned fractionally or categorically? Should specialty be by RCPSC/CFPC or based on actual practice? How do we determine future need for those specialties with significant activity outside of insured clinical practice (eg. plastic surgery)?

43 43 Other OPWD committee members MOHLTC: Caroline Abrahams Yoka Macfarlane OPHRDC: Lyn Chrysler ICES: Doug Manuel Deva Thiruchelvam Karey Iron Hussein Lalani Greg Harrington Barbara Reid Therese Stukel Kinwah Fung