The Ottawa Hospital says it will oversee thousands of new cataract surgeries that are coming to private clinics in Ottawa. The surgeries were announced last week as part of the Ontario government’s plan to expand the number and range of surgeries offered at private clinics throughout the province.
The province has approved a total of 14,000 additional cataract surgeries each year in Ottawa, Windsor and Kitchener as a first step in the private clinic expansion plan that will see hip- and knee-replacement surgeries done in private clinics in Ontario beginning in 2024.
Two private Ottawa clinics have been approved to perform half of those new surgeries, said Cameron Love, president and CEO of The Ottawa Hospital. The hospital has already been working in a public-private partnership with one of those clinics — Focus Eye Center — since 2020, he said, and will now work in partnership with both clinics.
The second clinic, Herzig Eye Institute Ottawa, announced earlier that it has received a license to perform 5,000 of the new cataract surgeries each year. Love said the surgeries will be “fully integrated” into the hospital. That means, among other things, that patients will be registered with The Ottawa Hospital and surgeons who work at the clinics will also work at the hospital.
The hospital currently does most of the cataract surgeries performed in the city each year, at about 11,000, along with the majority of other eye surgeries, with most done at the Riverside campus. But the hospital needs more capacity, Love said, especially since the backlog in cataract surgeries has grown during the pandemic.
The province’s plan to give independent health facilities a bigger share of surgeries and procedures has been met with criticism by those who see it as a threat to public health care. Among concerns are that it will draw health workers from the public system and that patients will face “upselling” pressure to spend money on services not covered by OHIP, such as upgraded lenses.
Critics also note that the province will be paying significantly higher fees for each operation performed at independent clinics compared to hospitals. According to a request for proposal document, the province will pay independent health facilities $605 for each unilateral cataract surgery. The average rate for the same procedure in hospitals is $455.
During a recent news conference in Windsor, Health Minister Sylvia Jones sidestepped a question about why the facility fees for independent clinics are higher than for public hospitals, saying only that the fee is “a formula for compensating based on patients who are served.”
Others say the issue is complex because hospitals also receive core funding for operations. The facility fees are separate from standard OHIP fees, which each surgeon receives for the procedure.
Dr. Bob Bell, a former deputy minister of health in Ontario, says the initiative will cost Ontarians more, both because of the higher facility fees and because of the potential for upselling, which has already been flagged as a problem by the province’s auditor general .
Bell said the cataract surgery expansion should go to public hospitals, many of whom say they have capacity but need more provincial funding to expand.
“It is a good thing to do more surgery, and ambulatory surgery is what we need to be doing,” Bell said. “But why this preference for the for-profit sector?”
Bell says the government’s direction will be putting profits in the pockets of clinic owners and reflects heavy lobbying from the for-profit health sector.
“There are a bunch of guys who are close to the premier who are going to make a fortune from this, the Greenbelt and Highway 413,” said Bell.
Love, meanwhile, said the new legislation promised by the province as part of the expansion provides opportunities for hospitals to build capacity and partnerships with the private sector to the benefit of patients.
“You can’t move complex neurosurgeries to the community, but you can move lower level, high volume (surgeries) into the community.”
All patients at the independent clinics will be overseen by the hospital’s department of ophthalmology, he said. There will be a single patient list, with priority given to more serious cases.
Love noted that most cataract surgery patients want a standard, OHIP-covered lens, but some want a specific lens. “It is a personal choice.” It is similar, he said, to give orthopedic patients the option of a lighter cast, at a cost.
But part of the partnerships will also mean integrating standards of care, quality oversight and metrics, he said.
And Love noted that the hospital has not lost any staff at Focus Eye Centre, which has already been doing 3,000 cataract surgeries a year, integrated with The Ottawa Hospital.
A hospital spokesperson said it currently takes about 10 months from the time a patient and surgeon decide on the procedure to surgery in Ottawa. The Ottawa Hospital is aiming to cut that wait time in half over the next six months.
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