PALLIATIVE MEDICINE SECTION STRONGLY RECOMMENDS VOTING “YES” TO PPSA
Voting takes place March 22-27. Link to be sent via OMA to your email.
Dear Members,
Our Exec and Past Exec have pored over the Proposed Physician Services Agreement (PPSA) and had our questions answered by the Negotiations Task Force and OMA Economics. We unanimously recommend voting YES to the PPSA.
Here are the key points relevant to our Section:
Community Palliative On-Call (CPOC) will reopen. As part of HOCC reopening, $12.5 million of new funding will be made available as of April 2023, some of which will go to CPOC. New groups will be allowed to form. CPOC has been frozen since 2015. Many groups of physicians are doing the work with no remuneration at present.
Hospital On-Call Coverage (HOCC) will reopen. Up to $75 million of permanent additional HOCC funding will be provided to create burden-based HOCC teams. Although many (but not all) hospitals have HOCC, many palliative inpatient teams have been excluded from HOCC funding in the past, and many groups are doing the work with no remuneration at present. HOCC has also been frozen since 2015.
Palliative AFPs (referred to as APP in the PPSA document) may receive new funding and be allowed to expand. Up to $50 million of permanent additional AFP funding will be provided, some of which may go to the palliative AFP. New AFPs will be allowed to be created, and existing AFPs will be expanded. Our Section is aware of many grievances with the current AFP contract. There will be opportunities to request to improve and modernize the AFP through a proposed joint working group.
Our Section will receive the greatest relativity increase of all Sections as per the current CANDI/RAANI model, as we are grouped with Family Medicine FFS. Our Section’s Year 1 and 2 permanent increase will be about 3.3% as of April 2023. Lump sum payments and increases will be applied for FFS, CPOC, and AFP. A conservative estimate of our Section’s total permanent allocation over the term of the PPSA is a 6.9% increase, higher than all other Sections.
Virtual care willcontinue
. Our current K092, K093, K094, K095 palliative virtual codes will end September 30, 2022. Instead, existing codes such as A945 and K023 can be billed virtually. Initial palliative care consultation must be done either in-person or by video to establish the “comprehensive” nature of the care. K023 and other relevant palliative codes can then be billed by telephone, video, or in-person. We have confirmed with OMA Economics that G512 (palliative care case management fee) is eligible for MRP physicians for supervision and management of a patient’s palliative care regardless of whether that care is provided in person or not. More information on proposed changes to virtual careis available.
There is a commitment to address Gender Pay Equity, and there are improvements to the Pregnancy and Parental Leave Benefit Program. These are important parts of the PPSA that our Section has fought for, and are especially important given that the younger members of our Section are predominantly female.
Very importantly: The program changes suggested in the PPSA, including reopening CPOC, HOCC, and AFPs,cannot reopen if the PPSA is voted down and we go to arbitration. We have confirmed this with Negotiations. Thus, if the PPSA is voted down and we go to arbitration, it is very likely that these important programs will continue to be frozen for many years to come. Our Section has advocated both within the OMA and at the level of government and media, and this is the closest we have come to getting these programs reopened.
The OMA is organizing several townhalls for everyone to learn more about the PPSA and how it will affect them. OMA also has an FAQ area on its website. Voting takes place March 22-27. Watch for emails from the OMA regarding how to cast your vote.
Let’s get the funding to ensure we build the systems we need to work towards universal, high-quality, equitable access to palliative care in this province.
The Palliative Medicine Section Exec and Past Exec unanimously recommend voting YES to the PPSA.
Dr. Stephen Singh, Chair Dr. Joyce Cheung, Vice-Chair Dr. Jacqueline Carverhill, Secretary/Treasurer Dr. Pamela Liao, Past-Chair
Topics
1. OMA elections - Section executive update 2. HSO National long-term care services standards 3. MSPC update 4. Priority and Leadership Group 2022 ideas intake 5. Shortage of injectable methotrimeprazine (Nozinan) 6. In-Person Conference: Hospice Palliative Care Ontario (HPCO) Conference – April 24-26, 2022 7. Virtual Conference: Advanced Learning in Palliative Medicine (ALPM) – May 5-7, 2022 8. Use of Palliative Sedation Over Time: A mixed-methods study of Palliative Care Providers 9. Call for Awards 10. AGM notice
1. OMA elections – Section executive update
We’re delighted to welcome the new Section on Palliative Medicine Executive, Drs. Stephen Singh (Chair), Joyce Cheung (Vice-Chair), and Jacqueline Carverhill (Secretary/Treasurer).
Please join me in thanking our previous Executive - Drs. Pamela Liao, Wendy Kennette, Patrica Valcke, and Brian Berger - for their years of service to the Section and members. Dr. Liao will become past-chair, maintaining an Officer role on the Executive and continues to be the Priority and Leadership Group Delegate.
2. HSO National Long-Term Care Services Standard Public Review
HSO has recently launched a public review for their new National Long-Term Care Services Standard. Alongside the public review, HSO is also releasing a report “What We Heard Report #2: Findings from HSO’s National LTC Standard Consultation Workbooks and Town Halls”, summarizing the input from the over 1,984individuals who participated in our Consultation Workbooks and Town Halls in Fall 2021, including around 200 residents.
The draft standard will be open for feedback from January 27 to March 27. The consultation report is also available. We encourage you to participate in the public review, read the report, and share both opportunities with your networks. The feedback gathered during the public review will be reviewed, considered, and incorporated into the standard as applicable.
3. MSPC update
The section presented its proposals to the medical services payment committee on February 1, 2022. We will continue to keep you updated as this work progresses. If the PPSA is ratified, MSPC will become the Physician Payment Committee (PPC) and we will continue our advocacy with them for our Section.
4. Priority and leadership group 2022 ideas intake
The OMA’s priority and leadership 2022 member ideas intake is open, and you are encouraged to submit new ideas, as well as build upon your colleagues’ ideas. The 2022 idea intake will close on April 3. Remember this process is open to all OMA members, so please encourage your colleagues to submit their ideas.
5. Shortage of injectable methotrimeprazine (Nozinan)
As many of you are aware, there is a current shortage of injectable methotrimeprazine (Nozinan). New supply will not be available until mid-April 2022. The Drug Shortages Unit at Health Canada recently convened a Tier Assignment Committee (TAC) for Nozinan injection. Dr Ebru Kaya participated as an ad hoc member, representing the CSPCP. Nozinan injection was designated Tier 3 status and added to the list until shortages are resolved which is anticipated on April 14, 2022. What you need to know
Nozinan injection is commonly used, especially for end of life. For those patients for whom an alternative is being sought, availability, cost and coverage of alternatives should be considered prior to prescribing. The following agents may be considered as alternatives: - Injectable Haldol 5mg/mL (0.5 – 1 mg SC/IV q4h prn) - Injectable lorazepam 4mg/mL (0.5 – 1 mg SC q4h prn) - Injectable Loxapine 50mg/mL - Injectable midazolam – all vial sizes - Injectable Phenobarbital – 120mg/mL and 30mg/mL How you can help
We anticipate members will need to be proactive in prescribing safe and effective alternatives where possible. Members may need to provide mentoring and education to less experienced practitioners when considering alternatives. Please feel free to forward this to your colleagues who may not have access to this information. CSPCP will update members if supply returns sooner than expected.
6. In-Person Conference: Hospice Palliative Care Ontario (HPCO) Conference – April 24-26, 2022
Hospice Palliative Care Ontario (HPCO) will hold its annual HPCO Conference in-person this year at the Sheraton Parkway Toronto North Hotel & Suites. The theme is “Access, Equity, and Compassion: The Future of Quality Hospice Palliative Care”. They look forward to welcoming you along with industry experts and trailblazers who will share innovative, forward-looking, evidence-based research, hospice palliative care advances and a content rich and inspiring educational program.
7. Virtual Conference: Advanced Learning in Palliative Medicine (ALPM) – May 5-7, 2022
Registerbefore March 31, 2022 to take advantage of early bird discounted registration rates!
The Canadian Society of Palliative Care Physicians (CSPCP) will hold its annual Advanced Learning in Palliative Medicine (ALPM) Conference virtually again this year. It will run on three consecutive half days, from May 5-7, 2022. ALPM is a key learning event for palliative care physicians, family doctors and physician specialists who want to enhance their knowledge of palliative care. Medical residents and medical students are also welcome. Learn, network, and earn CFPC and Royal College certified CME credits from the comfort of your home or office.
Learning Objectives: By the end of this conference, participants will be able to: - Apply acquired knowledge in advanced palliative medicine to treat patients living with a wide range of life-threatening illnesses - Educate medical colleagues (practicing physicians and learners) about palliative care - Recognize the importance of advocating for improved access to palliative care in local, regional, and national settings
8. Use of Palliative Sedation Over Time: A mixed-methods study of Palliative Care Providers
Members are invited to participate in a study examining the use of palliative sedation by Palliative Care providers. This is a qualitative research study conducted by members of the Division of Palliative Care at the University of Toronto and Sunnybrook Health Sciences Centre. The study will consist of a brief online survey which will take no more than 10 minutes
to complete. The study seeks to explore how the use of palliative sedation has changed over time, and which factors influence the practice patterns of palliative care practitioners when using palliative sedation. After completing the survey, there is an option to participate in an additional semi-structured interview at a later date. This study has received institutional ethics clearance.
Please note that we are only recruiting participants for whom palliative care has been part of their practice for at least five years.
Award of Excellence Each year, the OMA Section on Palliative Medicine presents an “Award of Excellence” in palliative care to a physician practicing in Ontario. The criteria used in the selection of this award are outlined in the nomination form. This award is now acknowledged with a $500 honorarium. Please consider submitting a nomination for this award using thenomination form.
Past recipients have included Dr. James Downar, Dr. Brian Berger, Dr. Joshua Shadd, Dr. José Pereira, Dr. John Swift, Dr. Lawrence Librach, Dr. Gillian Gilchrist, Dr. Elizabeth Latimer, Dr. Pippa Hall, Dr. Nina Horvath, Dr. Brian Kerley, Dr. Charmaine Jones, and Dr. Donna Ward.
Scholarly Project Student Award All residents in, or past graduates of a Palliative Medicine Program at McMaster, Queen’s, Ottawa, University of Western Ontario or the University of Toronto are invited to submit their “Scholarly Project” for presentation at the Annual General Meeting of the OMA Section of Palliative Medicine (date TBD).
Submitusingthis form. One or two projects shall be selected from all entries and the presenter(s) will receive a $250 honorarium.
For further information or to submit the application for either award, please contact kyle.dieleman@oma.org.
10. Notice of AGM 2022
The Section’s next AGM will take place late April/early May and notice will be provided per rules & regulations of the Section. Please look out for this notice via your preferred contact method.
The Ontario Medical Association (OMA) administers the distribution of communications for its various Constituency Groups, and therefore the views and the opinions expressed in this communication may not reflect the views, policies, and opinions of the OMA. The OMA does not warrant the accuracy, timeliness, or completeness of the information contained in this communication, nor does it accept any responsibility for its contents.
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