STAFF REPORT TO: FROM: SUBJECT: Committee of the Whole as Budget Committee Jenny Legget, Communications and Special Projects Coordinator Consideration of an After-Hours Medical Clinic as a One Year Pilot Project DATE: October 24, 2017 RECOMMENDATION THAT Committee of the Whole as Budget Committee receive this report for information based on the research completed regarding the establishment of an After-Hours Medical Clinic in Wasaga Beach; FURTHER THAT Committee of the Whole as Budget Committee recommend to Council that it allocate sufficient funds in the 2018 Budget to operate an After-Hours Medical Clinic on a one year pilot basis based on the parameters outlined in the staff report dated October 24, 2017. BACKGROUND Shortly after the current Council was elected, Council established a number of priorities that it wanted to accomplish during this term of Council. One of the priorities is to establish an After-Hours Medical Clinic (AHMC) in Wasaga Beach. The primary reason for the AHMC is due to the fact that residents have commented about the challenges regarding transportation to the After-Hours Medical Clinic in Collingwood, during times where residents felt it necessary to see a physician outside of their family physicians regular office hours. In 2015, an ad-hoc working group was formed for the purpose of exploring the opportunity of establishing an AHMC in Wasaga Beach. The working group was chaired by the Past Board Chair of the South Georgian Bay Community Health Centre (SGBCHC), comprising of a broad spectrum of health care professionals including: physicians, senior staff from the Collingwood General Marine Hospital (CGMH), SGBCHC, Georgian Bay Family Health Team (GBFHT), Georgian Bay Family Health Organization (FHO), members of Wasaga Beach Town Council and Town of Wasaga Beach senior staff. The working group met several times and had thorough discussion regarding the following identified key components surrounding an AHMC in Wasaga Beach: 1. potential practice models; 2. financial considerations; 3. benefits of an AHMC; 4. challenges associated with an AHMC; and 5. potential solutions to address challenges. The Town of Wasaga Beach Age-Friendly Community Plan formed a key part of discussion during the working group meetings. It is important and appropriate to note that the Age-Friendly Community Plan clearly discusses the need for the establishment of an AHMC in Wasaga Beach. The ad-hoc working group concluded their efforts in the summer of 2016 as the group felt that they had taken the initiative as far as they could. Form: WB-SR2010
2 The working group should be commended for their efforts regarding this initiative and are thanked for the expertise, knowledge and guidance they provided. The majority of physicians practicing medicine in Wasaga Beach are part of the Georgian Bay Family Health Team (GBFHT.) Family Health Teams are primary health care organizations that include a team of family physicians, nurse practitioners, registered nurses, social workers, dietitians, and other professionals who work together to provide primary health care for their community. They ensure that people receive the care they need in their communities, as each team is set-up based on local health and community needs. The GBFHT oversees medical care for patients in the Georgian Triangle Area. Physicians within the GBFHT have made their position regarding the establishment of an AHMC in Wasaga Beach clear. The physicians are of the view that the clinic is not warranted for the following reasons: 1. due to the new Health Care funding model, physicians are encouraged to leave a portion of their day free from scheduled appointments and offer evening office hours to accommodate patients that need to see their physician immediately; 2. after reviewing statistical data from the Collingwood General and Marine (CGMH) Emergency Department and the After-Hours Clinic in Collingwood, the physicians do not feel there are enough patient volumes from Wasaga Beach to support an AHMC in Wasaga Beach (average four (4) patients per day)**; 3. physicians are of the opinion that the After-Hours Medical Clinic in Collingwood has demonstrated its ability to handle the volume of patients from Wasaga Beach and the clinic is not facing growth pressures; and 4. from the physician s perspective, it does not make financial sense to invest in an additional AHMC taking into consideration the proximity of the Collingwood After-Hours Medical Clinic to Wasaga Beach. ** Attached are statistics from the Collingwood After-Hours Medical Clinic for the period of January 1, 2014 to June 11, 2015 representing a 517 day period. Please note the postal code pertaining to Wasaga Beach indicated in the chart is L9Z representing approximately four (4) patients per day (2051 patients/517 days = 3.96 per day.) From a physician perspective and taking into consideration the continual growth of the community, some local Wasaga Beach physicians are encouraging the Town to continue with its successful physician recruitment efforts to address any concerns about the proportion of Wasaga Beach residents that do not have a family physician versus focusing attention toward the establishment of an AHMC in Wasaga Beach. The Collingwood After-Hours Medical Clinic is operated under a physician led model staffed by the 47 physicians who form the GBFHT on a rotating basis. The clinic is open 5:00 p.m. to 8:00 p.m. Monday to Friday and 9:00 a.m. until noon on Saturdays and Sundays. Physicians who provide care at the Collingwood After-Hours Medical Clinic pay into a fund which is used to financially support the operating costs associated with the clinic and receive the revenue from the billings received at the clinic. Normally between 25 and 30 patients are seen per shift, which makes the clinic financially viable.
3 DISCUSSION Since July 2016 when the GBFHT formally indicated that it could not support an After-Hours medical clinic in Wasaga Beach, staff have been researching and determining alternative staffing models to determine the viability of an AHMC in Wasaga Beach. Through discussion with some of the local Wasaga Beach physicians, it has been determined that if the Town is prepared to assume all operating costs of the clinic as well as the management of the clinic, and pay a guaranteed salary to physicians to staff the clinic, there might be interest among some physicians within the GBFHT to provide medical care at the clinic. Under this model any billings generated by the clinic would be paid to the Town and would lessen the net cost of the clinic. An alternative staffing model to consider is for the Town to undertake recruitment efforts to attract physicians from outside of the GBFHT to provide care within the clinic. However, it is recommended that if Council determines the financial costs associated with establishing an AHMC are feasible, staff should focus recruitment efforts regarding medical staffing of the clinic on physicians forming the GBFHT prior to advertising for physicians to provide care at the clinic outside of the region. Proposed Clinic Location The Executive Director of the South Georgian Bay Community Health Centre (SGBCHC) located in Wasaga Beach has indicated that space is available within the SGBCHC to operate an AHMC on a one year pilot basis rent free. However, the Town will be required to provide approximately $15,000.00 to the SGBCHC for overhead costs associated with running the clinic out of the SBGCHC. Details regarding the necessary funding are discussed further in the financial considerations component of this report. It is important to note that the SGBCHC will not be in a position to permit the Town to begin operation of the clinic until the early part of 2018 (January/February/March 2018.) Proposed Clinic Hours Monday to Friday 5:00 p.m. 8:00 p.m. Saturday and Sunday 9:00 a.m. noon Staffing Requirements in Addition to Physicians If Council determines that the AHMC will move forward, the clinic will require a staffing complement of approximately four (4) medical receptionists working on a rotational basis and a Clinic Manager to handle patient billing and scheduling of reception staff. Staff would be paid out of the budget for the AHMC. Physician Remuneration Regardless of whether care at the AHMC is provided by physicians within the GBFHT or physicians from outside of the local area, physicians will require financial compensation during times when the patient volume is not to a level to support the physicians time at the clinic. Through discussions with experts in the medical field, it has been determined that a reasonable and realistic hourly rate in order to attract physicians to practice at AHMC s is approximately $200.00 per hour. Furthermore, through discussions with the same medical experts, it has been determined that between 25-30 patients per operating clinic is representative of a clinic timeframe where physicians are able to bill OHIP for their time, in turn receiving an acceptable and reasonable level of compensation.
4 If Council wishes to move forward with the establishment of an AHMC in Wasaga Beach, it is important to be cognisant of the fact that there will very likely be a need for the Town to provide financial remuneration for physicians providing care at the clinic if the patient volumes are not within the 25-30 patient range. Current statistics from the After-Hours Clinic in Collingwood indicate that there are approximately four (4) patients from Wasaga Beach per shift. In addition to the funding model described earlier in this report, it may be possible to implement a combination of OHIP billing and Town funded physician remuneration during clinic operating hours in order to compensate physicians. For example, if there is an evening where a total of ten (10) registered patients visit the AHMC in Wasaga Beach for care, the ten (10) patients will be billed through OHIP with the Town being responsible to compensate the attending physician for the remaining time of the evening/day. Taking this into consideration and for budgetary purposes, Town funded physician remuneration could be considered to be handled on a sliding scale basis. Further details regarding physician remuneration are discussed in the financial considerations component of this report. Electronic Medical Records System (EMR) One of the most crucial components of any medical practice is the system in place to handle and manage patient medical records. The physicians forming the GBFHT are very fortunate to be part of the Georgian Bay Family Health Organization (FHO.) FHO s are an initiative of the Ontario Medical Association and the Ontario Ministry of Health and Long Term Care, providing a platform for a group of family physicians working together to provide better access to quality primary services. In partnership, the GBFHT and the FHO have established a seamless Electronic Medical Records (EMR) system allowing all FHO patients who visit the Collingwood After-Hours Clinic or the CGMH Emergency Department the ability to have their medical records available. The EMR system leads to significantly safer and better care for patients requiring After-Hours medical care. In order to ensure the continued success of the FHO and GBFHT s EMR system which directly impacts patients, it is important that the same EMR system be in place if the Wasaga Beach AHMC moves forward. The writer has made a request to the Lead Physician of the FHO to determine if it is possible to connect to the already established EMR system. The Lead Physician has indicated that he is prepared to take the request to the FHO Privacy Committee for approval. However, it is important to note that there will be fees associated with the EMR system which are further discussed in the financial considerations component of this report. Financial Considerations Taking into consideration the information presented above, the estimated Town assumed costs associated with establishing an After-Hours Medical Clinic in Wasaga Beach on an annual basis are: Overhead Costs $15,000.00 Administrative Staffing $24,960.00 Physician Remuneration $218,400.00 Patient Electronic Medical Record System $12,312.00 Advertising for Physician Recruitment $3,500.00 Marketing and Advertising the Clinic $2,000.00 Total $276,172.00
5 Breakdown of Costs: 1. Operating overhead costs of $15,000.00 payable to the SGBCHC: 1. medical supplies; 2. shared maintenance costs of medical equipment; 3. cleaning; 4. toiletries; 5. laptop(s); 6. printer; and 7. paper (printer and prescription). *the SGBCHC will track all costs and provide a quarterly report to the Town. 2. Administrative staffing costs - $24,960.00: 1. Clinic Manager - $3,120.00 (based on 2 hours per week at $30.00/hour) 2. Medical Receptionist - $21,840.00 (based on 21 hours per week at $20.00/hour) 3. Physician Remuneration - $218,400.00 (based on staffing the clinic with one physician per day at 21 hours per week at $200.00/hour) *it is important to note and understand that remuneration for one physician is based on a sliding scale model taking into consideration that patient billing through OHIP will account for a portion of physician remuneration. $218,400.00 represents physician remuneration without any billings through OHIP and is based on a worst case scenario with zero patients visiting the AHMC. It is difficult to estimate the number of patients that will visit the AHMC. Therefore, in order to provide a maximum physician remuneration value for Council s consideration, one full physician salary is included with the overall AHMC budget. 4. Electronic Medical System $12,312.00 Based on the following fees: 1. $400.00 per month payable to the FHO covering the necessity of being part of a secure fiber optic network, fiber optic lines, privacy, security, internet access, system maintenance, backups and software/hardware support - $4,800.00 2. $7,512.00 payable to Telus representing the following fees: a) $126.00 per month for the site license at the SGBCHC ($1,512.00); b) $4,500.00 site implementation fee; and c) $1,500.00 representing a one-time site activation fee for the EMR software at the SBGCHC. *it is important to note that the patient EMR system is owned by Telus and all licensing is awarded through Telus. 5. Advertising for physician recruitment - $3,500.00 6. Marketing and advertising the clinic - $2,000.00 Total Estimate - $276,172.00 for a 12 month pilot.
6 2018 Budgetary Considerations Based on a March 1, 2018 Opening For budgetary purposes, if Council determines that it is appropriate to support a Town facilitated AHMC in Wasaga Beach, the earliest a clinic could open would be March 1, 2018. Therefore, the maximum budget projection for 2018 to establish the clinic is $238,732.00. Alternative Models One option that exists and has been implemented primarily in larger urban centres, with the exception of one example in a small urban centre that the Town is aware of that has insufficient family physicians, is the establishment of a privately operated physician led medical clinic. These clinics operate outside of the FHO governance and accountability structure and do not have access to the medical records of local patients. The model that was reviewed by staff consists of a clinic staffed by individuals trained as physicians from another country or jurisdiction who are waiting for their Ontario license under the supervision of a licensed Ontario physician either directly or over the telephone. One particular privately operated physician led medical clinic company that was explored has had discussions with the landlord who owns the newly constructed plaza located near 45 th Street. As with the AHMC, any urgent medical issues would be referred to the Collingwood General and Marine Hospital. This model was discussed with representatives from the North Simcoe Muskoka Local Health Integration Network (LHIN) and was not recommended with the primary reason being that patients do not receive the benefit of continuum of care through a consistent physician and enabled by access to comprehensive patient records. Staff have given consideration to this model as a potential option for Council s consideration and are not recommending a privately operated physician led clinic at this time for the following reasons: 1. the model is not recommended by the North Simcoe Muskoka LHIN; 2. physicians working under this model would not have access to medical records of local patients through an EMR system. The importance of physicians having access to patient medical records though an EMR system have been discussed earlier in this report; and 3. the clinic would operate as a private clinic outside of the local 47 member FHO. CONCLUSION It is appropriate to note that the Collingwood General Marine hospital (CGMH) and the South Georgian Bay Community Health Centre (SGBCHC) are both supportive of the establishment of an After-Hours Medical Clinic (AHMC) in Wasaga Beach. The primary reason for this is due to the fact that the AHMC may reduce some of the patient volume from the Emergency Department at CGMH and the volumes at the SGBCHC, where there are some patients who visit the health centre assuming the SGBCHC is an AHMC. From a physician perspective, taking into account current family practice approaches and the reasons cited in this report, including the low volume of patients that might be seen, the establishment of an AHMC in Wasaga Beach is not supported. Local Wasaga Beach physicians are encouraging the Town to continue with physician recruitment efforts to address the concerns surrounding the proportion of Wasaga Beach residents that do not have a family physician, versus focusing attention toward the establishment of an AHMC in Wasaga Beach. This would provide the full continuum of primary care; primary care is the element within primary health care that focusses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury needs. Additionally, it is appropriate to give consideration to the population increase that is experienced in Wasaga Beach during the peak summer tourism season (late June, July and August) while contemplating
7 the establishment of an AHMC. Establishment of the clinic would provide a service for visitors to Wasaga Beach while also addressing the After-Hours medical care needs of Wasaga Beach residents when necessary. Regardless of Council s decision pertaining to the establishment of an AHMC on a one year (12 month) pilot basis, staff are very appreciative of the assistance provided by senior staff at the GBFHT, FHO, SGBCHC, CGMH, North Simcoe Muskoka LHIN and Wasaga Beach physicians over the past year while researching the necessary information required to prepare this report. The Town is very fortunate to have positive and effective relationships established within the medical profession; staff looks forward to continuing to work with these key individuals who offer a great deal of knowledge, expertise and support to the Town. Respectively Submitted, Jenny Legget Jenny Legget Communications and Special Projects Coordinator George Vadeboncoeur George Vadeboncoeur Chief Administrative Officer