Thursday, March 24, 2016

One Asshole's (Informed) Opinion: I still don't get Twitter

I don't see how you can debate public policy 140 characters at a time.

So the Ontario doctors' Twitterverse remains 100% atwit over the ongoing impasse between the OMA (Ontario Medical Association) and the government. There are news stories here and there, complete with soundbites and spin. But most of what I see is digital shouting with @symbols and #hashtags that are supposed to raise awareness or get people rallying to the cause or whatever. I read the tweets and retweets and try to decipher the hashtags, and this is what it reminds me of:

So I decided to perform a civic duty and help non-twittering people try and make sense of news stories like the one linked below. The issues are complicated, important, and concern billions of dollars in public spending. If you think this can be resolved through a platform that's ideal for punch lines and not much else, you have my utmost admiration.

Ontario health minister slams ‘out of control billing’ by some doctors

So...what the fuck is going on with Ontario's doctors?

Let's backtrack a few years to 2012. The agreement between the province and the OMA around the doctors' fee schedule was expiring, and a new one needed to be negotiated. The doctors were coming off a contract that gave them around 11-12% over the previous four years (the specifics escape my farting brain), but now the province was broke. The economy was gutted during the financial crisis, and the province was looking at deficits for the foreseeable future. They looked to the Physicians' Services Agreement (PSA) as a way to find savings.

The 2012 deal included a modest fee cut for doctors, with the expectation that somewhere between $2-3 billion in system savings would come about, with hundreds of millions directly from the PSA budget. The cuts affected doctors paid by fee-for-service (FFS) as well as those in other payment models, but for the sake of understanding assume all docs are paid FFS.

The 2-3 billion in savings never materialized. There are various explanations for why the cuts didn't work. Older doctors might have kept working to beef up their retirement savings, doctors might have added an extra patient or two each day to make up the difference in their bottom line. Regardless of the reasons, the province went into the next set of negotiations expecting to get those savings, on top of more money saved from the 2014 PSA.

Negotiations broke down and eventually went to conciliation. There was some headway made during the conciliation process, but ultimately the doctors rejected the government's "final offer". The sticking point was savings that the province insisted needed to come from the PSA, while the OMA's position was that savings could be found elsewhere or other sources of revenue could be found. Unfortunately, the parties had no process in place to resolve the dispute, such as binding arbitration. 

That's when things got ugly.

With no end in sight to the impasse, the government imposed its own PSA. The "deal" included unilateral cuts to doctors' fees, deeper than those that were agreed upon in negotiations and elimination of many doctors' performance bonuses. The government also put in place a hard cap on what it would spend on doctors, with some yet-to-be-revealed clawback mechanism if all doctors' billings exceed the cap.

The OMA is working through the courts to get arbitration rights, but that could take years. There's no evidence that the province intends to come back to the table, yet it recognizes only the OMA as its negotiating partner.

That's the heart of the matter as I've come to understand it. Rather than go into it further, I invite you to post questions or comments. And you need not limit yourself to 140 characters.

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