Ontario releases new details on private clinic OHIP surgeries

The Ontario government has released new details on how OHIP-covered surgeries will be performed at private clinics.

The proposed regulations, which were posted publicly on June 9, builds on Premier Doug Ford’s plan to allow private clinics to conduct more surgeries covered under the Ontario Health Insurance Plan.

Bill 60, also known as the Your Health Act, passed in early May as part of the government’s pledge to reduce the province’s surgical backlogs.

Under the bill, both for-profit and not-for-profit clinics will be allowed to conduct cataract surgeries, MRI and CT scans, minimally invasive gynecological surgeries and, eventually, knee and hip replacements under the Ontario Health Insurance Plan (OHIP).

Amid criticism about oversight, staffing and upselling, the government stressed that standards for licenced clinics will be made public and that there would be “expert organizations” designated to ensure those standards are met.

The new regulations will repeal the Independent Health Facilities Act and replace it with the Integrated Community Health Centres Act—a nod to the new name the government has given to the clinics they licence.

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Under the changes, private clinics will be required “to post a list of prices for all uninsured services that a patient may choose to purchase” on its website. The facility must post this list at a conspicuous place if it does not have a website.

This will include any costs associated with additional devices, treatments or services not covered by OHIP.

One of the biggest concerns advocates had was of “manipulative upselling,” in which patients are encouraged to pay for medically unnecessary services. Examples previously provided by the Ontario Health Coalition include instances in which patients were urged to get upgraded lenses, told they had to incur the costs of eye measurements, and invoiced for contrast dye needed for imaging.

Each licenced establishment will also, under the proposals, be required to post a phone number for the ministry’s Protecting Access to Public Healthcare program, which reviews instances in which a patient may have been charged for an insured service.

The clinic must also post publicly their complaint process.

ONTARIO NAMES INSPECTING BODIES

As part of Bill 60, the province said it will designate “expert organizations” to work with Ontario Health and the Ministry of Health to ensure quality and safety standards are met at every clinic. The director of this third party or the ministry may issue an inspection of a facility if necessary.

The regulations name two agencies that will act as “inspecting bodies” under the new legislation—the College of Physicians and Surgeons of Ontario and the College of Midwives of Ontario.

A detailed version of the regulations doesn’t provide further details about their responsibilities.

It does say that each clinic has to appoint a “quality assurance advisor” and an advisory committee to ensure quality and safety standards are being met. The committee should consist of health professionals from each specialty, the regulations say.

If a complaint cannot be resolved between the patient and the clinic, the government has said individuals could contact the Patient Ombudsman.

The regulations are open for public commentary until July 9.