CE LHIN Hospital Proposals - New Funding for MRI Machines July 20 th, 2010
Operational Funding for MRI Machines Background Wait Times Strategy (WTS) has issued an invitation for hospitals to submit proposals for operational base funding regarding the following: An MRI machine that a hospital intends to purchase or; An MRI machine that has been purchased but is not yet operational or; MRI hours on a MRI machine that is currently operational but unfunded by the ministry (supplemented by other hospital revenue sources) or Other Objective Support the improvement of MRI wait times. Criteria Evaluation will include a needs assessment of funding for operational MRI hours at both a LHIN system level and hospital level. 2
Criteria at LHIN level # of MRI machines in the LHIN # of scans per 1,000 population at the LHIN # of scanners required to achieve 55 scans per 1,000 population 90 th percentile wait time based on a rolling quarter basis Efficiency of existing MRI scanners in the LHIN 3
Criteria at hospital level Estimated anticipated demand for MRI services; Availability of capital to purchase and install an MRI machine Readiness for operation of the MRI machine Operating budget position of the hospital Co-location of machines Anticipated increase in the demand for the performance of specialty MRI scans Human resources availability Where applicable, efficiency of MRI scanners at the hospital 90th percentile wait time based on rolling quarter basis and anticipated impact on regional/local/provincial MRI wait times Other considerations, if outlined by the hospital 4
Timeline June 4 th - WTS Issues Call for Proposals to LHINs June 9 th - CE LHIN Issues Call for Proposals to Hospitals June 25 th - Hospital Proposals Due to LHIN July 20 th - Hospital Proposal Due to WTS Aug. 6 th - All LHIN s submit Formal Recommendations to WTS 5
Operational MRI Hours Business Proposal Submission Status 6
Highlights of RVHS Proposal #1 Operational Funding for a new MRI machine (3.0T) for Ajax/Pickering Site Details of Request: Own capital funds ($5M) available to purchase/install and if able to secure operational base funding, operational date is targeted for March 31 st, 2011. Growing complexity/specialty of scans for diagnosis and interventions (e.g. cancer) required with current machine too old to complete. Patient demand is outstripping capacity/resources, actively engaged in Provincial initiative, Process Improvement Project (PIP)). New magnet will operate at the 3,120 base hours if funding is approved. 7
Highlights of RVHS Proposal #2 Other Additional base funding request to cover hours of operation of existing MRI unit at the Centenary site that has historically been expensed through their hospital global budget Details of Request: Operating hours have now been reduced back to funded levels for fiscal year 2010/11 which will negatively impact RVHS s wait times. Inability to meet needs of patients in Scarborough/Durham based on high referral bases. RVHS s scan volumes (170 scan/week), demand (200+ scan/week), resulting in wait times = 117 days (Durham Region has 2 MRI scanners as compared to greater numbers of MRI s machines in other GTA areas). 8
Highlights of RVHS Proposal # 1 & 2 Benefits: Specialty MRI scans will be performed (e.g. cancer, paeds, cardiac, etc.) HR resources are in place to support estimated hours of operation/volumes (min = 2,080 hours); Provision of MRI base funding will significantly reduce Hospital & LHIN MRI wait times; Aligns with CE LHIN s strategic aim of saving 1M hours of time patients spent in the Emergency Rooms by 2013; Cost efficiency through a reduction in patient transfer expenses; Improvement of ED wait time performance and reduction in conservable days on medical units, service continuity and increased patient satisfaction; 4 new surgeons who specialize in cancer surgery (notably breast surgery) which requires MRI specialty scans for diagnosis and interventions for patient management. Patient access is currently 6 examinations per 1,000 population, well under the provincial average of 55 per 1,000 population. If approved, patient access will increase with better use of resources and level of care is more consistent with CE LHIN & provincial standards. 9
Highlights of RVHS Proposal # 1 & 2 continued Rationale: Population growth in catchment area (5.6% between 2006 to 2010) and requirement to better meet standards/quality of care expectations. Next decade population growth estimates (as per MoF) = 15.8% with highest share over 55 years of age. ED volume at RVAP is 45, 000 per annum and expected to grow to 60,000 with new ED department (22.3% growth from 2001 to 2006 ). Wait Times are typically over 100 days, actual volumes provided is outstripped by patient demand consistently. Magnet at RVHS Centenary site is one of the oldest (2 nd ) in the province and is currently running 17 hours daily to keep up with demand which is in excess of base and one-time funding. Older machine is restricted in types of scans it can process and are not in line with quality and standards of care. The machine is not efficient. RVHS has one of the highest or the highest wait times in CE LHIN (depending on the reporting period). 10
Highlights of TSH s Proposal #1 Operational Funding for an MRI Machine To Be Purchased For The Birchmount Site. Details of Request: TSH does not have the capital funds to purchase and install an MRI machine which will require infrastructure/building/capital renovations (intends to purchase). Foundation approves and will be initiating a traditional capital campaign with 5 phases and several divisions to target gift requests to reach goal of $5M. If approved, expectation is to be operational as of June 2011. Has the resources in place to operate the machine for a minimum of 2,080 to 3,120 hours. Their one MRI operates 16 hours a day, seven days a week and actual volumes delivered outstrips funded volumes as well as patient demand. Currently delivering approximately 15.5 examinations per 1,000 population, well below the provincial benchmark = 55 exams per 1,000 population. In 2009/10, 227 patients were transferred from Birchmount to the General site for MRI investigations (32% increase in patient transfers in the past 4 years). 11
Highlights of TSH s Proposal #1 continued Benefits: Locating the MRI at the Birchmount site will allow them to perform specialty MRI scans (e.g. Cardiac, Cancer, Paeds, Bariatric,). The new MRI will significantly reduce their wait times at the hospital level as well as at the LHIN level. Rationale: TSH s catchment area have one of the most diverse ethnic groups (over 25) with the highest immigration rate in Canada, many of the ethnic groups have a higher incidence of certain medical conditions (e.g. cancer, tuberculosis, cardiac disease, etc.) than the provincial average. TSH general medicine patients are 65+ years (this age group utilizes more DI services than age groups 64 years or less). Currently involved in MRI Process Improvement Project (PIP) as of June 2010. New magnet will operate at the 3,120 base hours if funding is approved. 12
Highlights of TSH s 2nd Proposal MRI Business Proposal For Additional Base Funding to Cover Hours of Operation of the Existing MRI Unit Located at The General Campus Site Details of Request: Historically expanded operations by 1,456 hours annually prior to implementation of WTS funding and these hours were not funded by Ministry; Request is for funding support for 1,456 hours historically funded by TSH over and above the base 3,120 & one-time WTS incremental funded hours. Rationale:. Operating at 16 hours a day, seven days a week for a total of 6,122 hours which includes base = 3,120 hours, 2,537 incremental WTS one-time funded hours and 285 unfunded hours (additional 180 hours used to complete WSIB cases); No guarantee that they will receive same amount of one-time incremental WTS funding. Patient demand is increasing year over year (60% increase in wait times for Priority 4 patients). 13
Highlights of LHC Proposal Replacement Of Existing MRI Details of Request: Intent for LHC is to purchase a new machine to continue to improve their wait times. The new machine will be purchased with previously secured funds and operate with previously approved base hours = 3,120 hours and any one-time incremental wait time strategy funding. Operates at base hours of 3,120 and is currently the oldest magnet in the province (operational since 1997). Funding to operate this replacement MRI is coming from their own budget and no other funding is required. As of 2006, LHC was informed that their 1st machine parts will no longer be made available and will have to second source parts or replacements (will fail overall shortly). Still operating but downtime has increased due to frequent repairs. This is a limitation to patients for certain types of scans required like breast imaging and biopsies for patient management. 14
Highlights of LHC s Proposal continued Benefits: Co-location of 2 magnets will increase staffing efficiencies and reduce redundancy to ensure minimal downtime; Operating hours are extended and the hospital forecasts that they will meet their performance wait time targets in the future; Consistent with wait time strategy, improvement to access, and increase in efficiency; Rationale: 2nd magnet opened in May 2009 and operates at 2,080 hours base annually; Wait time funding is divided between both machines = 4,596 hours; Their new 3.0 magnet works with a shared magnet with MDRCC for 2 hours daily for cancer planning so cannot function with only one magnet; 15
Highlights of PRHC Proposal The Peterborough Regional Health Centre is requesting an additional 1,000 base funding hours of operation for the MRI machine that is operational Details of Request: Wait time performance has been increasing quarter to quarter, currently at 60 days as of 2009/10Q4 from 21 days in 2009/10Q1. Wait time estimated to increase based on current referral rates of 400 referrals per month and recruitment of Medical Radiation technologists continues to be a challenge. One-time incremental funding reduction in 2010/11 from 2009/10 = 124 hours. Request additional base funded hours = 1,000 of operation for total base funded hours = 4,120. At this time, approximately 600 patients are waiting up to 90 days for an MRI scan. Currently 86% efficient (above 80% benchmark as per WTIS Target); Specialty exams delivered include musculoskeletal studies, breast imaging, abdominal, thoracic, head and spine. 16
Highlights of PRHC s Proposal continued Benefits: HR resources needed to support additional base funded hours if approved would be part of the current DI staff compliment. Forecasted number of patient s waiting would decrease significantly, - 200 patients per month. Current staffing and hours of operation are 15 hours per day, 3 times per week. 10 hours per day, 2 days a week with weekend up to 8 hours per day, 2 days a week = 4,212 hours. Scan rate increase to provincial scan rate = 38.8 scans per 1,000 population from PRHC s 21 scans per 1,000 population in 2009/10. Expansion of hours of operation to facilitate PRHC s regional responsibilities. 17
Highlights of PRHC s Proposal continued Rationale: Due to reduced staffing levels and vacations, approximately 600 patients are waiting up to 90 days and the DI Unit is operational for 225 hours per month. With a full compliment of staff, PRHC can deliver 500 patients per month with 350 hours per month. Peterborough has the 2 nd highest elderly population in Canada and the increasing comorbidities (medical conditions) requires more exams. Facilitate ED patients having more timely access to MRI scans in alignment with CE LHIN s strategic aim of reducing ED wait times. Recruit and retain certified MRT s and Diagnostic Radiologists in Northern clusters. Meet and exceed standards of care in accordance with Wait Time Strategy standards and appropriate specialist referrals. 18
Staff Recommendation MOTION: Be it resolved that the CE LHIN Board of Directors direct staff to submit a letter of support endorsing the following proposals for MRI funding to the Wait Time Strategy/Ministry: Rouge Valley Health System s proposal requesting MRI base funding for 3,120 hours to operate a new MRI machine at the Ajax/Pickering site (new machine to be purchased through own funds); Rouge Valley Health System s proposal requesting for additional base operational funding for a minimum of 3,085 (incremental + unfunded +additional hrs, to be added to base funding). Lakeridge Health Corporation s proposal to replace the outdated MRI machine with a new machine to be purchased with previously secured funds and operate with previously approved base hours (3,120 hours) and any one-time incremental wait time strategy funding; The Scarborough Hospital s proposal to purchase a new MRI machine (own funds campaign) for the Birchmount site and obtain operational funding for a minimum of 2,080 to 3,120 hours. And; The Scarborough Hospital s proposal for additional base operating funds of 1,456 hours for the MRI located at the General campus. Peterborough Regional Health Centre s proposal requesting additional base operational funding of 1,000 hours for a total = 4,120 (3,120 + 1,000). 19
Appendix
Current CE LHIN MRI Status HSP Base Hour WT Funded Incremental Hour Volume Non Funded Incremental Hour Total Actual Working Hours for 2009/10 Actual Wait Time (CE LHIN Target 65 Days) 2009/10 Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 NHH 2,080 1,503 107 3,690 49 57 26 29 CMH N/A N/A N/A N/A N/A N/A N/A N/A LHC 3,120 2,843 0 5,963 1,560 1,872 0 3,432 85 88 96 33 RMH N/A, but new MRI machine will be in operation starting on Jan 2011 N/A N/A N/A N/A TSH 3,120 1,442 1,561 6,123 99 103 118 133 RVHS 3,120 2,825 5,945 94 123 136 116 PRHC 3,120 1,206 0 4,326 21 36 45 60 Note: Actual Wait Time above CE LHIN target is highlighted in red. 21
Action Items Clarify with Ministry/Wait Time Strategy whether LHC s proposal to replace existing MRI machine requires Ministry approval. Compose a letter for Debby Hammons, CEO of Central East LHIN as below: CE LHIN board reviewed the business case on July 20 th. Endorses all submitted MRI business proposals as attached. To improve healthcare requirements by Hospitals and local communities within CE LHIN. 22