Physician Payment Review Bard Cmmissin de révisin des paiements effectués aux médecins The Hnurable Deb Matthews Minister f Health and Lng-Term Care Minister s Office Hepburn Blck, 10th Flr 80 Grsvenr Street Trnt, ON M7A 2C4 June 30, 2012 Dear Minister: RE: Physician Payment Review Bard Annual Reprt On behalf f the Physician Payment Review Bard it is my pleasure t submit ur Annual Reprt fr the fiscal year f 2011-2012. The Bard remains cmmitted t the initiatives utlined in the reprt and t ensuring excellence in the service it prvides t the Ontari public. Yurs sincerely, Vivek Ra, MD, PhD, F.R.C.S.(C), F.A.H.A. Chair Physician Payment Review Bard c: Lri Cleman, Chief Operating Officer, Health Bards Secretariat Registrar, Physician Payment Review Bard 151 Blr Street West, 9 th Flr, Tel/Télé 416-327-8512 151, rue Blr uest, 9 e étage Trnt, Ontari M5S 1S4 Tll free/sans frais 1-866-282-2179 Trnt, Ontari M5S 1S4 Facsimile/Télécpieur 416-327-8524
Physician Payment Review Bard Cmmissin de révisin des paiements effectués aux médecins Dr. Vivek Ra Chair Physician Payment Review Bard 151 Blr Street West, 9 th Flr Trnt, ON M5S 1S4 June 30, 2012 Dear Dr. Ra, It is my pleasure t reprt t yu n behalf f the Health Bards Secretariat. The Health Bards Secretariat (Secretariat) prvides cmprehensive administrative, crprate, fiscal and case management supprt t the Physician Payment Review Bard (PPRB). In additin, the Secretariat prvides a similar supprt functin t ther adjudicative tribunals as well as payment prcessing functins fr ther health related services. The Secretariat has wrked t prvide advice and supprt t ensure that the PPRB has the peratinal framewrk in place t prcess appeal files as well as a gvernance structure in line with the requirements set ut in the Health Insurance Act, the Agency Establishment and Accuntability Directive and the Adjudicative Tribunal Accuntability, Gvernance and Appintments Act. Key accmplishments have included management f just under ten appeal files, cmpletin f the reappintments prcess fr members, cnventin f an annual bard meeting and stakehlder utreach. Funding fr the PPRB is directed thrugh the Health Services Branch t the PPRB frm the Cnslidated Revenue Fund. There are sme limitatins in detailing expenditures as they relate specifically t the agencies supprted by the Secretariat. Yu will nte that expenditures such as salaries and facilities are nt included in the financial data n page 9 as many resurces are shared with ther adjudicative tribunals and it wuld be arbitrary t determine what prtin f cst shuld be attributed specifically t the PPRB. These csts are, hwever, incrprated in the fiscal planning cycle by the Secretariat and are reprted t the Ministry. The Secretariat remains cmmitted t wrking with the PPRB and its members in exercising strng cntrllership practices t minimize expenditure while enabling access t justice. I trust that this infrmatin is f assistance t yu, and I lk frward t cntinuing t lead services prviding supprt t the Physician Payment Review Bard. Yurs truly, Lri Cleman Chief Operating Officer, Health Bards Secretariat Registrar, Physician Payment Review Bard 151 Blr Street West, 9 th Flr, Tel/Télé 416-327-8512 151, rue Blr uest, 9 e étage Trnt, Ontari M5S 1S4 Tll free/sans frais 1-866-282-2179 Trnt, Ontari M5S 1S4 Facsimile/Télécpieur 416-327-8524
TABLE OF CONTENTS A. Message frm the Chair 4 B. Physician Payment Review Bard Mandate 5 C. Achievements f the Physician Payment Review Bard 6 D. Physician Payment Review Bard Perfrmance Operatinal 8 Financial 9 E. Membership 10 F. Health Bards Secretariat Staff 11 Physician Payment Review Bard Annual Reprt 2011 2012 3
A. MESSAGE FROM THE CHAIR As Chair f the Physician Payment Review Bard (PPRB), it is my pleasure t reprt n the PPRB s activity fr the perid f 2011 2012. I wuld first like t recgnize the membership f PPRB fr their nging cmmitment t the cntinuus evlvement f this Bard. I wuld als like t thank the staff f the Health Bards Secretariat fr their cntinued supprt. The PPRB is mandated t cnduct hearings regarding payment disputes between physicians and the General Manager f OHIP (the G.M.). During the perid f this Annual Reprt, the PPRB fcused n increasing physician awareness, meeting legislated requirements, managing appeal files and cmpleting the reappintments prcess. Key accmplishments, set ut in detail in the accmplishments sectin, were achieved in the areas f member recruitment and develpment, gvernance, accessibility, and stakehlder utreach. I wuld like t highlight three ntable initiatives: 1. The Memrandum f Understanding (MOU), a cmmunicatin between the Minister f Health and Lng-Term Care and the Chair f the PPRB was negtiated, finalized and apprved n August 26, 2011. The purpse f the MOU is t establish the accuntability relatinships between the Minister f Health and Lng-Term Care and the PPRB thrugh its Chair; t clarify the rles and respnsibilities f the Minister, the Chair, and the Deputy Minister, and t set ut the expectatins fr the peratinal, administrative, financial, auditing and reprting arrangements between the PPRB and the Minister f Health and Lng-Term Care. 2. The Cnflict f Interest Guidelines were apprved by the Cnflict f Interest Cmmissiner n June 15, 2011. The Public Service f Ontari Act, 2006 sets ut cnflict f interest rules that establish standards f ethical cnduct fr public servants. Public servants are in a psitin f trust and are accuntable fr fulfilling their duties with integrity. Cnflict f interest rules assist public servants in acting hnurably and aviding situatins where their private interests may interfere with their public service duties and respnsibilities 3. The Bard has initiated its first public utreach endeavurs since its establishment in 2010. A presentatin was made t the Ontari Medical Assciatin s executive and membership; increasing verall physician awareness f the Bard and its mandate, by prviding an verview f the PPRB s jurisdictin and prcesses I am pleased t wrk with clleagues and staff wh share a cmmitment t prviding high quality service t the Ontari public. In the cming year the PPRB will cntinue t develp plicies and prcesses that will make it fully serviceable, efficient and accessible with a fcus n greening, mdernizatin and key stakehlder utreach initiatives. Physician Payment Review Bard Annual Reprt 2011 2012 4
B. MANDATE The Physician Payment Review Bard (PPRB) is an independent adjudicative agency established in Sectin 5.1 f the Health Insurance Act (HIA). The Bard exercises its pwers and respnsibilities in accrdance with the HIA and Schedule 1 t the HIA, as well as under the Statutry Pwers and Prcedures Act, R.S.O. 1990 and delegated authrity under the Public Service f Ontari Act, R.S.O. 2006. The PPRB cnducts hearings regarding payment disputes between physicians and the General Manager f OHIP (the G.M.). Where a reslutin t a billing dispute between a physician and the G.M. can nt be reslved thrugh the prvisin f educatin and ther assistance, the PPRB prvides an appeal prcess that is at arms length frm the Ministry f Health and Lng-Term Care and the Minister f Health and Lng-Term Care. MISSION STATEMENT The Physician Payment Review Bard is cmmitted t prviding the highest quality service t the public, and t being valued partners in the delivery f health care in Ontari. Physician Payment Review Bard Annual Reprt 2011 2012 5
C. ACHIEVEMENTS OF THE PPRB Thrughut the perid f this annual reprt, the PPRB has achieved success in a variety f areas, which has served t develp its service delivery t the Ontari public. In line with the PPRB s jurisdictin and mandate and its authrity under the HIA, the fllwing achievements have been made: Member Develpment: Cmpletin f the reappintments prcess fr members whse Order-in- Cuncil appintments expired n April 27, 2012. Gvernance: In accrdance with the mandate prescribed by the Adjudicative Tribunal Accuntability, Gvernance and Appintments Act, 2009 (ATAGAA) the PPRB has engaged a prcess fr member recruitment that ensures appintees will be selected by a cmpetitive merit-based prcess with defined criteria and, that the recruitment prcess will be made public thrugh the Public Appintments Secretariat s website. On Octber 11, 2011, the PPRB cnvened its annual bard meeting. In additin t receiving an administrative update as well as cntinuing educatin cntent, the Bard cnvened an electin regarding the member leadership psitins. Vivek Ra cntinues in his rle as Chair, Rss Male cntinues as a Vice-Chair, and Jacqueline Guimenny was newly elected t a Vice-Chair rle. Peridically, cmmunicatins have been circulated t the PPRB membership t keep them infrmed and educated abut the Bard s prcesses. Adjudicative Tribunal Accuntability, Gvernance and Appintments Act, 2009 (ATAGAA):.aims t increase efficiencies and transparency in the tribunal s peratins while maintaining independence in their decisin-making. In cmpliance with the stipulatins f the Act, the PPRB has develped gvernance and public accuntability dcuments that have been submitted fr the Minister s apprval. Memrandum f Understanding (MOU): a cmmunicatin between the Minister f Health and Lng-Term Care and the Chair f the PPRB was negtiated and finalized n August 26, 2011. The purpse f the MOU is t establish the accuntability relatinships between the Minister f Health and Lng-Term Care and the PPRB thrugh its Chair; t clarify the rles and respnsibilities f the Minister, the Chair, and the Deputy Minister, and t set ut the expectatins fr the peratinal, administrative, financial, auditing and reprting arrangements between the PPRB and the Minister f Health and Lng-Term Care. The MOU is ne f the mandatry gverning dcuments required under the ATAGAA. Cnflict f Interest Guidelines: were apprved by the Cnflict f Interest Cmmissiner n June 15, 2011. The Public Service f Ontari Act, 2006 (PSOA) sets ut cnflict f interest rules that establish standards f ethical cnduct fr public servants. Public servants are in a psitin f trust and are accuntable fr fulfilling their duties with integrity. Cnflict f interest rules assist public servants in acting hnurably and aviding situatins where their private interests may interfere with their public service duties and respnsibilities. Physician Payment Review Bard Annual Reprt 2011 2012 6
Accessibility The PPRB is cmmitted t uphlding the principles utlined in the Accessibility fr Ontarians with Disabilities Act, 2005 by ensuring that peple with disabilities have the same pprtunity t access and benefit frm the PPRBs services as thers. The PPRB has met the requirements set ut in the Accessibility Standards fr Custmer Service. Stakehlder Outreach In the Fall, 2011, Dr. Vivek Ra, Chair delivered infrmatin t the Ontari Medical Assciatin s executive and membership; designed t prvide an verview f the PPRB s jurisdictin and prcesses and t increase verall physician awareness f the Bard and its mandate. Physician Payment Review Bard Annual Reprt 2011 2012 7
D. PPRB BOARD PERFORMANCE OPERATIONAL PERFORMANCE The PPRB is an independent adjudicative tribunal that cnducts hearings and renders decisins n payment disputes that arise between Ontari physicians and the General Manager f OHIP. INTAKE Apr 1, 2010 Mar 31, 2011 Apr 1, 2011 Mar 31, 2012 Ttal Intake 9 5 The infrmatin belw details the caselad and activity f matters befre the PPRB. CASELOAD SUMMARY Apr 1, 2010 Mar 31, 2011 Apr 1, 2011 Mar 31, 2012 Active Caselad at beginning f perid 0 4 Intake 9 5 Ttal Case Lad 9 9 Ttal Matters Cnducted 0 0 Ttal Matters Reslved* 5 7 Active Caselad at End f Perid 4 2 *Includes thse matters administratively clsed r reslved prir t hearing. CASE CONFERENCES (CCs) CONDUCTED Apr 1, 2010 Mar 31, 2011 Apr 1, 2011 Mar 31, 2012 Ttal CCs Cnducted 1 18 Physician Payment Review Bard Annual Reprt 2011 2012 8
FINANCIAL PERFORMANCE DESCRIPTION 1 Apr 1, 2010 Mar 31, 2011 Apr 1, 2011 Mar 31, 2012 Per Diem Hnraria 2 & 3 23, 280 2,888 Independent Legal Services 37, 557 4,320 Cmmunicatins 84 1,868 Travel 4 2, 295 0 Cnference Registratin 350 0 TOTAL $63, 568 $9,076 1 All figures in Canadian dllars. 2 Fr the perid f April 1, 2011 March 31, 2012: Public member = $398; Vice-Chair = $491; Physician Member = $664 3 Includes educatin, administratin, and travel time. 4 Includes cst f travel expenses, and accmmdatin. Physician Payment Review Bard Annual Reprt 2011 2012 9
LAST NAME E. PPRB MEMBERSHIP AS OF MARCH 31, 2012 FIRST NAME CITY OCCUPATION START DATE EXPIRY DATE Balitsky Tammy Trnt Public - Scial Wrk 28-Apr-10 27-Apr-12 Barrn Philip Kanata Physician - General Surgen 28-Apr-10 27-Apr-12 Beatn Melanie Lndn Physician - Internal Medicine, Gastrenterlgy 28-Apr-10 27-Apr-12 Bested Alisn Trnt Physician - Clinical Haematlgy 28-Apr-10 27-Apr-12 Blunt Marie Elizabeth Sarnia Physician - Obstetrics & Gynaeclgy 28-Apr-10 27-Apr-12 Bltman Marilyn Trnt Public - Human Service Cunselling 28-Apr-10 27-Apr-12 Bridge David Windsr Physician - Family Physician 28-Apr-10 27-Apr-12 Dias Csta Fernand Trnt Physician - Plastic Surgery 28-Apr-10 27-Apr-12 Davidsn Jhn Kingstn Physician - Psychiatry 28-Apr-10 27-Apr-12 Dev David A. Wdbridge Public - Law 28-Apr-10 27-Apr-12 Egertn Catherine E. Lndn Public - Financial accunt manager 28-Apr-10 27-Apr-12 Gldberg Rnn Thrnhill Physician - Diagnstic Radilgy 28-Apr-10 27-Apr-12 Gldstein Sandra Ottawa Public - Alternative Dispute Reslutin 28-Apr-10 27-Apr-12 Gumienny** Jacqueline Kingstn Public - Law 28-Apr-10 27-Apr-12 Gupta Samir Trnt Physician - Dermatlgy 28-Apr-10 27-Apr-12 Hectr Ian Thrnbury Physician - Psychiatry 28-Apr-10 27-Apr-12 Ka Shawn Etbicke Physician - Pediatric Medicine 28-Apr-10 27-Apr-12 Lau Helena Oakville Physician - Gastrenterlgy 28-Apr-10 27-Apr-12 Male** Rss Paris Physician - Family Physician 28-Apr-10 27-Apr-12 Mitchell Marianna K. Whitby Physician - Pediatric Medicine 28-Apr-10 27-Apr-12 Mhammad Naveed Mississauga Physician - Emergency Medicine, Trauma 28-Apr-10 27-Apr-12 Niclle Michael Lndn Physician - Neurmuscular & Electrdiagnstic Medicine 28-Apr-10 27-Apr-12 O Brien Simn Kingstn Physician - Psychiatry 28-Apr-10 27-Apr-12 Ra* Vivek Trnt Physician - Cardithracic Surgery 28-Apr-10 27-Apr-12 Varty Christpher Trnt Physician - Anesthesia 28-Apr-10 27-Apr-12 Waddell James Trnt Physician - Orthpaedic Surgery 28-Apr-10 27-Apr-12 * Chair f the PPRB ** Vice-Chair f the PPRB Physician Payment Review Bard Annual Reprt 2011 2012 10
F. HEALTH BOARDS SECRETARIAT STAFF LIST AS OF MARCH 31, 2012 STAFF MEMBER Lri Cleman Sara van der Vliet Sandra Evra Chris Ppvich Natalya Demyanenk Alpha Aberra Maureen Baker Andrew Cliffrd Anna Dunscmbe Kate Franklin Shanti Persaud Glenn Sequeira Christine Nieckarz Margaret Blinas Jada Fung Mallry Hyde Sarah Oliver Mathanan Kailas Aravinth Ramalingam Gui Dickie POSITION Registrar Deputy Registrar Executive Assistant/Researcher Executive Assistant/Researcher Case Management Crdinatr Administratin Crdinatr Administrative Assistant Administrative Assistant Administrative Assistant Administrative Assistant Senir Technlgy/Business Systems Administratr Systems Supprt Analyst Systems Officer Physician Payment Review Bard Annual Reprt 2011 2012 11