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As a policy under the workers' compensation insurance system, expedited fees were effective in reducing wait time to surgery. While a difference of only two weeks may not improve longer-term clinical outcomes post-surgery, it represents a reduction in the total disability duration (i.e., pain, suffering, quality of life) for the injured worker and increases the worker's likelihood of successfully returning to work; the reduced disability duration also represents a cost saving to the workers' compensation system for time-loss benefits and to employers who pay compensation premiums based on the frequency and duration of their claims experience.

the provision of surgeries "after hours" or within private clinics may result in a redistribution of finite resources (e.g., surgeons, surgeon time, surgical staff) from one insurance provider to another, favouring those associated with higher fees, thus creating inequities. An evaluation of the effect of workers' compensation policies on inequity in the provincial healthcare system was not part of this study and warrants future investigation.

the time leading up to surgery may be confounded by co-morbidities and that individuals with complications may be directed to the public system

A difference of approximately two weeks in surgery wait time associated with the expedited fee policy may have meaningful clinical and quality-of-life implications for injured workers, in addition to being cost-effective policy for workers' compensation insurance systems, but did not affect the return-to-work time post-surgery as part of total disability duration. Minimal (and not statistically significant) differences in disability duration were observed for surgeries performed in private clinics versus public hospitals.

However, according to Jain, it was SteriPro who initiated the proceedings to bring the contract to a close. "It was SteriPro that took Trillium to task," says Jain. "We filed a change inquiry notice, and according to our agreement, the next step would have been arbitration, and we would have won a very, very large compensation from Trillium if we had gone to arbitration." Rather than going through arbitration, SteriPro opted to begin negotiations to terminate the contract. "We got compensated a significant amount of money by Trillium to enter into this termination agreement. So, it's not that they terminated the contract. We terminated it."

Jain explains that rather than being dissatisfied with SteriPro's service, the hospital instead had carried on along a trajectory of increasing demand for those services, but neglected to honour the contract elements that mandated further talks about increasing compensation along the same lines. "There were some issue in the contract that enabled us to increase our compensation with increased volume," says Jain. "When a hospital's surgical case volume goes up by 70 per cent, you would expect that our compensation would increase by 70 per cent, but it went up by zero per cent over the last four years, and that's because Trillium did not engage in the discussions that were dictated in the agreement to enable us to increase our compensation for the extra work and the extra labour force that we needed to employ the work that needed to be done."

For Jain, the notion that it was the hospital who terminated the SteriPro contract is factually incorrect, but the added idea that that decision would have been made because of lapses in quality runs counter to the high mark that he sets for his company, and which is attested by the level of accreditation they've received.

"We are the first private facility accredited by Accreditation Canada, which looks at all your work. We've been accredited strictly for reprocessing, Which is a very stringent and highly controlled and monitored service that meets all the standards set by the CSA." With regards to the company's contract with Pembroke Regional Hospital, two main concerns were raised by CUPE representatives during their March media event: that prolonged turnaround time on instruments needing cleaning could lead to shortages at critical times, and that the 400-plus kilometre one-way trip to Pembroke from the SteriPro facility could result in compromises to the sterilization of the equipment. On the topic of instrument inventory, Jain points out that the issue was raised during the preliminary portion of contract talks with the hospital, and to mitigate that concern, SteriPro agreed to cover the cost of an augmentation to the hospital's existing inventory with brand new equipment so that they would always be sufficiently well-stocked to deal with routine and unforeseen situations.

When it comes to the notion that distance presents an insurmountable hurdle to assuring the sterilization of treated instruments, Jain points to his company's provision of service to a trauma centre in Newfoundland, and their various other contracts, as his main response. "If we can service a major trauma centre on the East Coast, we can service anyone from coast to coast. We consider ourselves the experts in sterile transport, because we have developed the methodologies and the techniques, and we've tested them out, to ensure that instruments can be transported safely by road or by air. We currently transport instruments to major hospitals throughout the GTA, and we transport them safely."

In addition, Jain says that SteriPro has a number of detailed tracking and data systems to ensure that every step in the process is wellsupervised and documented. "We have temperature and humidity-controlled and monitored trucks, which have GPS monitoring on them as well. If there was a particular case that had an infection, we can pull out all the records on that particular tray of instruments and provide the data to show when it was sterilized, by whom, and under what conditions that sterilized set was kept. So the chain of sterility from the time that it comes out of the sterilizer to the time when it goes on the shelf in the storage room in Pembroke is completely documented, and we are practically the only ones in Canada who can do that, and we maintain all that data in our database forever. If there was a case that was done 10 years ago where, say, an orthopaedic implant which became infected 10 years ago, we can provide the hospital all the records they need to prove that sterility was not the issue." Over the past few months, SteriPro officials have been working to get the necessary underpinnings of their service to PRH in place, and they are expecting to be fully operational for surgical equipment reprocessing by the end of April. rpaulsen@postmedia.com Twitter.com/PRyanPaulsen

The current model for paying physicians is “expensive, outdated and doesn’t support the efforts of doctors to provide the best care possible,” said Health Minister Sarah Hoffman at a Feb. 8 policy forum in Edmonton on the health system’s fiscal sustainability.

In 2014, Alberta spent $1060 per capita on physician services — the third highest in the country. More than 80% of payments are through fee-for-service, where doctors bill the government for each medical service provided. Proponents of fee-for-service say it gives doctors the incentive to see as many patients and provide as many services as possible. Hoffman wants some of the doctors on fee-for-service to adopt Alternative Relationship Plans (ARP), which she said are not only less expensive, but also reward doctors for the quality of care they provide.

Under clinical ARPs, doctors are paid for providing a set of services at a facility to a target population. There are several types. The annualized ARP, the most common in Alberta, provides compensation based on a formula that determines the number of full-time equivalents (hours per year or days per year) required to deliver services.

In Ontario, the most common ARP is the capitation model, under which physicians are paid a fixed fee per month for each patient registered with their practices, regardless of services received.

The Alberta Medical Association (AMA), which represents the province’s 8921 licensed physicians, supports the change. President Dr. Carl Nohr told CMAJ that ARPs are part of the move toward modernizing the health care system, which now deals with more chronic illness. They give doctors more flexibility, he said.

“They’ll be able to vary the amount of time they spend with individual patients, define how frequently they see patients — all in the context of what’s good for the patients and not necessarily from the business perspective.”

Neither the AMA nor Hoffman could specify the number of doctors they want to adopt this model. Nohr said compensation under an ARP will remain optional, but “our goal is to make it as attractive as possible and make changes to the model as we go, and hopefully over time see a substantial uptake.”

Alberta’s total health budget is $19.7 billion for 2015–16 — the second highest per capita ($4800) among the provinces. But, Hoffman said, “Given how much money is spent on health care in Alberta, the health outcomes in our province can and should be better.”

Hoffman said health care accounts for 45% of the government’s overall budget, and continues to grow faster than both inflation and the population, which grew 2.17% in 2015. If health care spending continues to rise by an average of 6% annually, it will account for 60% of the province’s budget in 20 years. Hoffman wants to decrease growth in health care spending to 2% annually in the next few years, but stressed this does not mean cutting funding; it means curbing spending growth.

Hoffman doesn’t know how much will be saved by changing the physician compensation system, but said “changing the way we pay doctors will have a ripple effect on the entire health system.”

The government’s contract with t

e AMA expires in 2018, and both parties are discussing redirecting funds and developing alternative compensation models. Nohr said they’re looking into a blend of ARP and fee-for-service among primary-care physicians.

One of the very good things that gives me hope for the future is that the profession and the government have a very good relationship,” Nohr said. “So there’s a collaborative, positive relationship between the Alberta Medical Association and the Ministry of Health and that creates the possibility for productive, useful change.”

the Canada Health Act is being held hostage

the False Creek Surgical Clinic in British Columbia

it has only

MG: We treat our employees based on merit. Whether they receive perks and raises and also enjoy job satisfaction is very much geared towards their productivity. They get paid really well, so it is a very pleasant working environment for all of us.

three operating rooms and uses the labour force from the public system in their off-times

From the perspective of the Workers Compensation Board, it’s quite hard for them not to send patients to us when you consider that it has been such a success story in provinces. In British Columbia, it is the norm for patients from the Workers Compensation Board to receive care in private facilities.

FC: It is said that one of the reasons the public healthcare establishment is resisting competition is that private clinics are typically not unionized, which means no union dues for public sector union bosses. Your view?

performs over 3,000 procedures a year

MG: I would say that is true.

Seniority and the advancement of an individual because of seniority is simply never going to occur in our system.

FC: The Maples Clinic has become synonymous in Manitoba with a single piece of equipment, your MRI machine.

FC: One of the government’s arguments is that they can produce an MRI scan for $300, compared to your price near $700.

MG: The Workers Compensation Board came up with a plan where they are willing to pay a premium in order to get patients back into the workforce faster. The prerequisite was that patients would be treated within a very short time frame—ten days from the time of consultation to surgery within 21 days—to get people back into the workforce faster. That has resulted in huge savings in lost wages, and that savings was actually expanded to businesses and corporations in the form of lower premiums

How much did they actually save in B.C. by using the False Creek clinic?

over two million dollars

In most other developed countries with universal access, the purchaser of health services is a different entity than the providers.

we should open up Medicare services to private insurers

The Workers' Compensation Board originally denied their applications for compensation benefits on the grounds their cancers were not occupational diseases. But rulings by the Workers Compensation Administrative Tribunal in 2010 and 2011 overturned those decisions and linked the cancers to the workplace.

One challenge in understanding the extent to which people in health care are injured at work is that injuries tend to be underreported. Generally the data used to measure health care worker injury is through workers’ compensation claims. A study of Canadian health care workers found that of 2,500 health care workers who experienced an injury, less than half filed a workers’ compensation claim.

Recent data from Alberta shows that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the mining and petroleum industry.

A study of health care worker injuries in three British Columbia health regions from 2004 to 2005 found that injury rates are particularly high for those providing direct patient care – and highest among nursing or care aides (known as health care aides in Alberta, and personal support workers in Ontario).

83% of health care worker injuries were musculoskeletal in nature.

However, there have been efforts to mechanize some of the dangerous aspects of health care. Musculoskeletal injuries are the leading category of occupational injury for health care workers.

Evidence suggests that this is the case – a 2009 British study of over 40,000 workplace injury claims found that 89% were made by women, and 11% by men.

Gert Erasmus, senior provincial director of workplace health and safety for Alberta Health Services says that “health care is a people intensive business – combine that with physically demanding jobs and an aging workforce.”

The Canadian Federation of Nurses’ Unions notes nurses retire around the age of 56 – compared to the average Canadian worker at 62.

Experts also point to the changing work environments for many health care workers. There is a worldwide trend towards moving health care services out of hospitals into patients’ homes. Thease are uncharted waters for workplace safety and prevention of injury. Little is known about how often workers in peoples’ homes are injured and the kinds of injuries they are sustaining.

Gert Erasmus notes the tremendous insecurity of providing health care inside patients’ homes. “They [health care workers in homes] work in an environment that is not controlled at all, which is fundamentally different than most industries and workplaces.” In this environment, workers are more likely to be alone, lacking back up from colleagues, and the help of aids such as mechanical lifts.

Miranda Ferrier, President of the Ontario Personal Support Worker Association says that each time a personal support worker enters a new patient’s home – they enter into the unknown. “You are lucky if you know anything about a client when you go into the home” she says.

“It’s perfectly fair that physicians have an interest in their income. Everybody does,” says Jeremiah Hurley, the chair of economics at McMaster University and a member of the Centre for Health Economics and Policy Analysis. In most societies, doctors are held in high regard and, in general, are fairly well compensated for their work. In a universal health care system, such as Canada’s, physician compensation is a major health care expenditure. How physicians are paid, and how much, can also affect clinical care.

But under current working conditions, Care Partners nurses are over-worked and stressed-out, paid by the visit, not by the hour, working many hours of unpaid overtime and with no paid vacations, said Castro. They also do their administrative work at home on their own time. "It's not just about money," said Castro. "A lot of our work issues all come back to quality of care issues." OPSEU is bargaining for a contract similar to what other agencies, such as VON, have in place for their staff, he said. Although CarePartners is working on a plan to look after its patients in the event of a strike, it's too soon to know whether there will be patients no longer able to stay in their homes, said vice-president Karen MacNeil. "It's too early to determine what the result would be."

The company is making plans to ensure the well-being of their patients, said MacNeil, and is committed to keeping the four Niagara clinics open--one each in Niagara Falls, Welland, St. Catharines and Vineland -with help "from other partners." They also plan to continue to provide service to the highest-needs patients, she said. "We're working with our community partners to have a contingency plan for every patient, based on their level of care needs. We're going through the process and seeing what the available resources are for their care," said MacNeil. A press release from CarePartners says the company has been committed to the bargaining process for the last 18 months, and is ready to return to the bargaining table. Talks broke off, the press release says, when the union insisted on compensation and employment demands that would be the equivalent of those provided to nurses in hospitals -- while publicly -- funded reimbursement rates for the services CarPartners provide have been frozen since 2009, the union's demand amounts to a more than 10% compensation increase. The reimbursement rate freeze is expected to continue throughout 2015, the press release says. "Compensation adjustments have been issued during this timeframe, however, the amount of the adjustments has been restricted as a direct result of the rate freeze within the sector," MacNeil said.

There’s not yet even an application to open a pay-for-plasma clinic in Alberta, but the issue already appears to be reaching crisis levels.

Never mind the fact that this practice has been ongoing for decades in Manitoba and for several years in other countries, Alberta’s health minister is being urged to take swift action to put a stop to it — and she appears willing to do so. 

In February, a company called Canadian Plasma Resources opened a clinic in Saskatoon. Plasma collected is used to make pharmaceutical products and other medical therapies, and donors are compensated to the tune of a $25 pre-loaded credit card. They’re now looking to open a clinic in British Columbia and possibly in Alberta and Manitoba in the coming years.

45 percent of the population."

middle class

Pew Research Center,

CEOs who have, broadly speaking, seen their compensation grow by 997 percent since 1978.

Workers, by contrast — as a recent report by the the Labor Center at the University of California, Berkeley points out — are forced to rely on federal assistance to compensate for their minuscule wages.

Paramedic Lisa Jennings says she was in a psychiatric ward, having contemplated suicide the night before, when she decided to start a grassroots movement for emergency workers suffering from post-traumatic stress disorder. 

Psychiatrist Jitender Sareen says he hopes that recent legislation adopted by some provinces will help first responders with PTSD to get access to treatment and other services quickly. (University of Manitoba)