Dear Colleagues, Last year is history and now MSPEI must continue to grow as a challenging 2014 presents itself. I am excited at the prospect, as I don’t think we could be better positioned. We have a promising new Executive Director in Ms. Lea Bryden who will bring to the task a wealth of experience and skill. In my conversations with her, I am thrilled to appreciate her vision and feel confident she understands and respects physician interests in this province. It is worth reviewing 2013, as it was an unprecedented year for MSPEI growth and relevance. As a product of members’ initiative, generosity of time, and sharing of ideas and perspectives, MSPEI was able to accomplish a remarkable agenda. One of the recurring messages we heard last year was the desire for our members to be engaged on issues that impact their professional lives. What you have before you is an attempt to give you context for the issues that will be dominating our horizon for the next few months. It is not meant to be comprehensive but rather an invitation to you as members to investigate further. The first is a 2013 Operations Report: a simple listing of initiatives and work that MSPEI has conducted on your behalf. The next two are for context. On behalf of the Board and at the request of the Department of Health and Wellness, I provided a letter to Deputy Minister Mayne following a visit he made to our Board meeting to discuss government’s perspective on the challenges in our health care system. The next is a letter from Dr. Mayne to members to define the issues from his perspective. If you read nothing else it is important for each member to study this letter as it paints the landscape as government sees it and it will encourage you to ask the questions that need to be asked as we work toward the answers together. Happy New Year, David Bannon, President
OPERATIONS 2013 Government, NGO, CMA Relations MSPEI and Health PEI Meetings - monthly CMA/PTMA CEO teleconferences - monthly CMA/PTMA Communications Director teleconferences - monthly CEO Meetings Presidents and CEO’s Meetings – quarterly Atlantic Provinces CEO Forum CMA Annual General Meeting and General Council CMA Health Policy and Negotiations Conference Physicians Resource Planning Committee meeting Joint Consultation Committee meetings Council for a Smoke Free PEI/PETRA Major MSPEI Initiatives MSPEI Representation on NP Integration to Primary Care Pilot working group (ongoing) MSPEI Strategic Map (January-April) MSPEI Response to Better Access Better Care (March - May) MSPEI Road Show (Spring) EMR Team – (Summer/ongoing) ED Search (August – December) Negotiations Team Recruitment (August/September) Primary Healthcare Summit (August – December) Governance Review - Ongoing Money Talks Working Group Recruitment – Ongoing Summer Medical Student Program (spring-summer) NEW - MSPEI Identity (logo); social media presence Other: MSPEI hosts CMA Town Hall “What Makes Us Sick” (March) Addictions Clinic Day (October) PMI Event (September) Young Physician Engagement Session – (September) Resident & Medical Students Teaching Day QEH (July) Dalhousie Medical School Reception (September) Medical Resident and Student Holiday Reception (December) MSPEI Annual General Meeting (June) Right Brain Released – 4th Annual MSPEI art show (June) Kids Run Club initiative for PEI planning (fall) Welcome Breakfasts (QEH/PCH)
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Letter from
Dr. David Bannon
Letter from
Dr. Michael Mayne
President, Medical Society of PEI
Deputy Minister of Health & Wellness, PEI
November 29, 2013
January 9, 2014
Dear Dr. Mayne,
Dear Dr. Members,
I am writing on behalf of the Medical Society of PEI Board of Directors. The Board has asked me to express their appreciation for agreeing to meet with us October 16 when you were invited in your capacity as Deputy Minister of Health and Wellness to present information on current challenges in the health care system. There was unanimous consent that these conversations are invaluable to promote collaboration and communication as we have significant work ahead to make our Island health system sustainable for all.
Over the past two years, the leadership in the Department of Health has been working closely with yours to enhance communication and develop a stronger working relationship. As I have shared with your President and the Executive, I strongly believe that improvements to our system can only happen as a collective.
I wish to offer the Board’s perspectives on the information presented and reinforce our intention to partner with government in this important work. Furthermore, I would like to offer a brief summary on a number of activities initiated by the Medical Society we believe have potential to reach our mutual goals of cost containment, quality outcomes and system-wide efficiencies. First, the Board was appreciative and impressed by your detailed analysis provided around the issue of sustaining healthcare delivery in PEI. The Board is duly concerned with the predicted trajectory of spending surpassing 50% of provincial resources by 2018. It is clear that the current system is “sick” and action must be taken. The Board was impacted by the stark reality and better appreciates the potential outcomes of not addressing our province’s fiscal realities. As a result, they are also aware of the need for broader physician awareness. Part of your goal was to reach out to the Medical Society to work in partnership to drive changes needed to sustain the system. The Society is mandated by legislation to act as stewards of the healthcare system. To affect the kind of change needed, physicians must be agents of change. We must be accountable to the fiscal realities but not waiver from principles of safely delivered patient-centred, quality care. Frankly, the challenge is enormous. We support physicians taking the lead. I suggest that we are in fact doing just that evidenced by the following “grass root” initiatives. On December 13, the Society will host a MSPEI Primary Care Summit. This will be an interactive and high-level engagement workshop with end results. We are calling on our members to take a lead in identifying substantive changes needed to improve access to primary healthcare. In short, we are messaging
We have experienced significant improvements in the way health care is managed in Canada and Prince Edward Island. PEI took the much needed step to create a health authority which has legislated responsibility to operate the health care system. Health PEI is overseen by a Board of Directors, has a Chief Executive Officer and in general, is moving toward a system-based approach of patient care. As you know, Health PEI reports to the Minister whom is accountable to the public for health services, operations and value. The latter term of value can sometimes be contentious in health care. Many times I am reminded that health care decisions cannot be driven by costs. While our Canadian health care system takes great pride in being publicly funded, it has grown in costs to become such a large portion of the overall provincial budget, that we must collectively and more efficiently manage the growth of the system. In our single payer system, we must ensure that our actions provide effective patient outcomes and provide excellent value for the taxpayers that fund the entire system. A key message I have been sharing with the leadership of MSPEI is that our rapid pace of growth must be better managed. Health care constitutes approximately 43% of the current provincial budget and has an annual growth rate of approximately 6%. Continuing at this rate will mean that health care services will consume approximately 52% of the provincial budget by 2020. To put this into perspective, after accounting for health and education (education is approximately 20% of the budget) and social services (approximately 8% of the budget), only 20% of the entire budget will remain. All other services including transportation, justice, innovation and economic development will need to operate within significantly reduced resources. In addition to
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our primary care members that they must ‘own the problem of access’ and produce a solution. This workshop uses a formal problem solving structure to move the conversation from the hallways of our offices to a group exercise where real strategies can be articulated and discussed. The Summit, although directed to primary care physicians, is open to any physician who wishes to contribute. To provide necessary context and perspective, Health PEI’s Executive Leadership Team and representation from nurse practitioners are also invited. We recognize that the likely solution to access will be physicians taking leadership in their care teams incorporating a range of allied health professionals working to their most efficient scope and capacity. Being a leader in these teams also means taking responsibility to insure appropriate integration of these care providers to produce the highest quality and efficient system results. This initiative mirrors similar efforts across the nation where physician groups are recognizing the essential need for primary care reform to provide a foundation for inevitable system changes.
the above pressure, the Federal Government of Canada will begin to restrict the rate of increase of health transfers to provinces in 2016/17. Of our total health costs, the Federal government now accounts for only 20% of all of our total health expenditures.
Another collaborative initiative spearheaded by physicians – a key component for change management - is an area that members may have steered clear of in the past. We wish to delve into money matters. As we move closer to the forecasted “fiscal cliff,” past apprehension gives way to proactive effort. The Society has already proposed, and the concept welcomed by representatives in Health PEI, identifying areas of significant cost or waste and considering where savings or alternative courses of action might be taken without compromising principles of quality patient care. We are currently recruiting interested members to engage in this initiative. The MSPEI is pleased to partner with DHW to support the implementation of Choosing Wisely Canada with expected roll out April 2014. As you know, the CMA focus is on using this tool as a clinical guide for caregivers as well as a starting point for a broader conversation on what is appropriate evidenced based care. It is also expected that this will be effective in educating our patient population on appropriate interventions to many common problems. The Canadian Medical Association continues to work with national specialty society partners to facilitate the development of Choosing Wisely lists applicable across Canada. We anticipate we can jump start this campaign early next year by educating our members on the issue and driving the conversation on how this creative approach has remarkable power to speak to appropriateness of care and promote a system mentality. We believe that system thinking is critical to address our challenges and MSPEI is committed to a broad change management strategy using Choosing Wisely to its full potential. Like our national organization, MSPEI differentiates between
Within our provincial health expenditures, payments through the Master Agreement has grown approximately 78% since 2006 which now constitute approximately 25% of the cost of the entire health care system. There are several reasons for the rapid growth in the cost of the Master Agreement, including decisions made over the years by provincial and federal governments. What is clear is that our Master Agreement cannot continue to grow at this pace without placing considerable pressure on various other key aspects of the system. As I noted above, partnership with the MSPEI is critical to enhancing the stewardship of the health care system. We must work closely together over the next two years in order to prepare for a Master Agreement that will require significant improvements. In particular, and in concert with most other jurisdictions in Canada, the next Master Agreement must focus on utilization rates and appropriateness of testing as these categories represent areas of rapid increase in usage and total cost. Efforts being made now through “ Choosing Wisely ” of which the Canadian Medical Association is playing a key role will certainly help us be better prepared to improve the utilization rates within the health care system. Recently and on behalf of the Department of Health and Wellness, your leadership asked you to comment on various health care services that are insured by PEI Medicare. Your membership had a mixed reaction which ranged from a complete dismissal of the idea of de-insuring a service/test to recommending further discussion. Given the strong reaction of the membership, and as recommended by your leadership, the Department has agreed to discontinue the conversation on “delisting” at this time. As a system, we remain challenged to align usage with optimal patient outcomes based on the best scientific evidence available. I challenge us as a system to make decisions in the best interest of two groups – the patient and the collective. As we continue to discuss ways to improve the system including enhancing patient flow in our facilities, and begin the larger discussion of renewing the Master Agreement, I am pleased to hear that your recent summit on
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initiatives, such as Choosing Wisely Canada and actions such as the delisting of services for the purpose of flattening the growth of spending curve. Regardless of stated intentions, both physicians and patients have cast the process of delisting in a negative light as evidenced by physician responses to the recently circulated list of proposed delisted services. Appropriateness of care should not be approached as a mechanism to reduce costs to the system. Savings can be realized but they will be difficult to measure, slow to materialize and divert vital energy in a debate over how to adjust the Provincial Health Plan in an effort to impact physician activities. Moreover, the Board believes that a delisting strategy will neither halt nor significantly slow the escalation of healthcare spending. We need to focus on broader strategies that continue to support system thinking and change management to effect physician behavior and promote system sustainability.
primary health care resulted in significant interest in MSPEI playing a key role in ensuring every Islander is assigned to a family doctor. The government has struggled with this issue for far too long. Too many Islanders are not receiving timely primary care which results in additional pressure elsewhere in the system. I look forward to the opportunity that the Department can work closely with our general practitioners and MSPEI to ensure that all Islanders are rapidly assigned to a physician. I challenge us to solve this key issue in 2014.
Lastly, we recognize that we need to enter into the next rounds of negotiations on the Master Agreement with a new paradigm. We are preparing our team to appreciate the new realities. Discussion and debate over this critical contract must be deeply rooted in issues of system sustainability and the approach one of collaborative rather than distributive negotiations. We are working assiduously to educate our team and members about strategies considered in our sister provinces and testing them for relevance in PEI. We look forward to a creative rather than a contentious process. Following your presentation, you noted that most physicians did not choose medicine to become change managers or system thinkers. The reality, however, is that any physician practicing in PEI today will be confronted by fiscal challenges; it is simply a matter of time before those currently unaware are forced from the comfort of silo thinking to the challenge of system thinking. To ignore this reality is at the peril of losing not only the system and quality care for patients, but also the practice of medicine, as we know it. To summarize, the MSPEI Board recognizes that physicians, as stewards of our system, are obliged to be accountable and to work substantively with government aware that we are funded by public tax dollars and as the principle agent to control expenditures, we are responsible. I trust that this response evidences the Medical Society’s commitment to addressing the sustainability of the delivery of healthcare in PEI. I am looking forward to continuing to work together to find solutions.
In order to help us achieve this goal, I am pleased to inform you that Treasury Board has recently approved a process in which MSPEI will play a key leadership role in identifying a vendor and platform for a much needed EMR. The Department along with Health PEI will be working in partnership with MSPEI to establish the criteria for an EMR platform and importantly, MSPEI leadership has agreed to play a key decision and leadership role in this identification. This represents a significant shift in the way in which government has been deploying its electronic health record. By having physician leadership directly involved in establishing the criteria and selection of a platform, we are hopeful that there will be rapid and widespread uptake and utilization of an EMR. In closing, I want to thank your leadership in particular Dr. Dave Bannon and his Executive. I have had the pleasure to work directly with them and I believe that as long as we can have transparent communication, we can make progress and improvements that will benefit Islanders. Happy New Year. Sincerely yours, ďżź Michael Mayne, Deputy Minister of Health and Wellness MM/cj
Yours truly, David Bannon, MD President, Medical Society of PEI
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