Some health professionals in Ontario are calling on the provincial government to boost the fees they’re paid under programs such as Ontario Health Insurance Plan (OHIP), citing rising costs exacerbated by the recent spike in the minimum wage.
Professionals such as physiotherapists and optometrists say it has been years since they received an increase in fees for certain services covered by the province, despite rising expenses and inflation. Now, the recent 21-per-cent hike in the minimum wage is putting a further squeeze on their operations. While most office staff and assistants to professionals are paid more than minimum wage, some are seeking a pay increase to widen the gap between those making the lowest wage, and to keep up with the rising costs of living. That’s putting pressure on the business owners to retain those workers, while also covering increasing expenses.
“We’re in a bind because our prices are set by the government, “ says Heather Shantora, chief executive officer of Hamilton-based pt Health, which has 80 physiotherapy clinics across Canada, including 42 in Ontario. She says many employees are seeking raises, but the company can’t afford it since it can’t adjust its prices. About 30 per cent of her revenue in Ontario comes from provincial health services, with the rest covered by extended health benefits offered by employers, people paying cash for services, or insurance to cover injuries from car accidents. She doesn’t want to raise prices on services not covered by the government, believing it would be unfair to those clients, who then may not seek care, and potentially drive away business. She also believes it’s not fair for other clients to subsidize those covered by the government.
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Ms. Shantora has written to the Minister of Health and Long-Term Care, Helena Jazcek, requesting an increase in the “episode of care” (EOC) – which is a series of treatments to patients – fee businesses like hers receive from the government. The current fee is $312 per EOC and the number of visits varies depending on the patient’s condition and treatment plans. The amount was based on average number of services provided to patients by designated physiotherapy clinics when the Community Physiotherapy Clinics program was initiated in 2013, according to a ministry spokesperson.
It has been five years since they’ve seen an increase and, given the higher labour costs, “it’s time for a raise,” Ms. Shantora says.
Ms. Shantora isn’t looking for a 20-per-cent-plus increase to match the growth in the minimum wage. In her letter to the minister, she suggests an increase to $339.44 per EOC – or about 9 per cent – which would be in line with inflation increases over the past five years, which she bases on information from the government. “I do think an inflationary adjustment is reasonable,” she wrote in the letter dated April 20.
Dorianne Sauvé, CEO of the Ontario Physiotherapy Association, supports the request from pt Health to adjust the fee paid per EOC to reflect rising costs of providing services, but says rising wages is just one issue. There is also a greater need and demand for their services amid a growing and aging population across the province.
“Many seniors have multiple conditions and their care is getting more complex,” Ms. Sauvé says, adding that many rely on community-based physiotherapy to live safely at home. A number of clinics that have contracts to provide EOCs have wait lists for these publicly-funded services. “If the fee doesn’t change, that adds pressure at the business level,” Ms. Sauvé says. “The resources needed has increased and that margin has narrowed.”
In an e-mail response to an interview request, a Health Ministry spokesperson said the ministry, “in collaboration with our local health partners, will continue to monitor the program to ensure continued access to services.”
Optometrists in the province are also seeking a fee increase for the services covered by OHIP, including eye exams for children 19 and under and seniors 65 and older, and medically necessary care for those 20 to 64, due to higher costs including higher labour expenses.
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Dr. Joshua Smith, president of the Ontario Association of Optometrists (OAO), says business owners are feeling pressure to pay office staff more, even though they already make above minimum wage.
“When the announcement came out about the two-stage minimum wage increase, that was a another big log on the fire,” he says, referring to the wage increase to $14 per hour from $11.60 that began Jan. 1 and the increase to $15 set for Jan. 1, 2019.
Dr. Smith says his profession hasn’t received an increase from OHIP since 2008. Optometrists receive between $42.50 and $47 from OHIP for a comprehensive eye exam. The cost paid by those not covered is more than twice that amount. The OAO’s fee guide recommends a fee of $192 for a comprehensive “oculo-visual assessment,” he says.
The industry has been told not to expect any changes while arbitration continues between the Ontario Medical Association (OMA) and the Ontario Ministry of Health and Long-Term Care, Dr. Smith says. “We’re stuck now in a holding pattern.” He’s also concerned the pending Ontario election may also limit the government’s ability to make a decision.
OMA president Dr. Nadia Alam says its members – Ontario’s 44,000 doctors – have also been affected by the increase in the minimum wage and, similar to other heath professionals, are unable to offset the additional costs by increasing fees. “This is yet another example of the provincial government failing to adequately fund health care and making it more challenging for physicians to practice in Ontario,” Dr. Alam said in an e-mail statement to The Globe.