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BUNDLED FUNDING MODEL FOR HIP AND KNEE REPLACEMENT SURGERY (QBP)
The Ministry of Health has introduced a bundled funding payment model for integrated acute to post-acute (including rehab) pathways for multiple procedures or conditions. The bundled care model for unilateral hip or knee replacement patients has moved into full scale implementation with all 56 hospitals across Ontario that perform these surgeries participating for fiscal year 2019/20. The bundled care model will continue to expand to additional procedures. Implementation of bundled pathways for bilateral hip and knee replacement surgery and shoulder surgery across hospitals that have volunteered to participate in the expansion began on April 1, 2019. The Ministry is in consultation with key stakeholders to develop an approach for phased implementation of bundled pathways for stroke and coronary artery bypass graft surgery (CABG). It is suspected that participation in all these models will be mandatory by 2020-2021.
Through this model, the funding follows the patient regardless of where they receive care, including home and community care. The model is based on having one single payment made to the bundle holder (usually a hospital site) who then establishes partnerships to provide needed follow up care, including rehabilitation. Since bundle holders hold all the funding, they are responsible for providing or paying for all post-acute services a patient needs within their bundled course of care. Partnerships can be made with inpatient, outpatient, home-based, and clinic-based care, such as Community Physiotherapy Clinics (CPCs) and private physiotherapy clinics. If a CPC is involved with the partnership, there is no change to CPCs’ existing funding agreements with the ministry, as bundled care is separate from Episode of Care (EOC) funding.
More information on this model can be found on the Bundled Care website. Additionally, there are many resources available through Health Quality Ontario’s Bundled Care Community of Practice group on Quorum (registration required), which includes FAQs, webinars, and contact information of all bundle holders. It also provides the opportunity for information exchange between those involved with implementing the bundled care model.
New Member Resource
OPA has revised the member resource on implementing the Bundled Care model, Bundled Care (Integrated Funding Models)- Negotiations and Agreements. This member resource is applicable for community-based providers involved with various bundled pathways, providing guidance on how to approach various aspects of implementing the Bundled Care model. It includes considerations when entering into agreements and developing mutually beneficial partnerships with bundle holders and more.
If you have any further questions about bundled care or require any additional support, please contact Gonxhe Kastrati, Policy Analyst.
Member Webinar: Successfully Implementing the Bundled Care Model – Login for Recording
This webinar was held on December 18, 2019. The focus was on enhancing opportunities for successful implementation of the bundled care model and developing successful partnerships between physiotherapy providers and bundle holders. Speakers included Paulette Gardiner Millar, PT and Director of Operational Communication & Quality Improvement with pt Health (community PT clinic provider) and Darryl Yardley, PT and Director of Brant Community Healthcare System (bundle holder).
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ADVANCED PRACTICE PROVIDER IN MUSCULOSKELETAL CENTRAL INTAKE MODEL OF CARE
On October 27, 2017 the former Minister of Health and Long-Term, Dr. Eric Hoskins announced the provincial expansion of a centralized intake, assessment and management model for musculoskeletal (MSK) conditions starting with hip and knee osteoarthritis, and low back. Building on the successful Central Intake Assessment Centre (CIAC) model for hip and knee arthritis, and the Inter-Professional Spine Assessment and Education Clinic (ISAEC), this investment is aimed at providing LHINs with assessment and planning resources to reduce wait times for diagnostic imaging and surgical consultations for MSK conditions.
On December 1, 2017, as part of establishing a centralized model, all LHINs in Ontario received funding for implementing Rapid Access Clinics (RACs) to enable better access to treatment for those experiencing hip, knee and low back pain. This model utilizes physiotherapists and other health care providers to expedite assessment, triage, and access to needed care. Following this, on December 18, 2017, the Ontario Government committed $37 million over the next three years for the expansion of RACs across the province. This will begin with care for hip and knee osteoarthritis and low back pain symptoms.
As of March 31, 2018 seven LHINs across Ontario have implemented a mandatory RAC referral for hip/knee. By the end of 2018/19 fiscal year, all LHINs will have a mandatory centralized pathway for hip/knee osteoarthritis and low back pain through an implemented RAC.
Implementation of this province wide initiative is being supported by Health Quality of Ontario’s program Adopting Research to Improve Care (ARTIC) which has created a series of webinars to assist organizations with implementing the model and to inform applicants of these new interprofessional opportunities. Archived webinars can be accessed here.
Advanced Practice Provider for MSK Rapid Access Clinic (RAC) for Hip and Knee
View the Advanced Practice Provider for hip and knee Role Profile and the Position Description.
As outlined in the position description, an APP in MSK Central Intake, Assessment and Management is typically a physiotherapist registered with the College of Physiotherapists of Ontario. The APP is a leader with advanced knowledge, skills and attitudes enabling them to effectively solve problems and address the needs of the patient with an MSK condition.
MSK Rapid Access Clinic for ISAEC
View the Advanced Practice Provider job descriptions – part time and full time for MSK Rapid Access Clinic for low back pain (ISAEC).
View the Practice Leader job description for MSK Rapid Access Clinic for low back pain (ISAEC).
As outlined in the job descriptions, ISAEC is an innovative model of care providing patients with low back pain assessment, education and evidence-based self-management plans. The ISAEC model of care is being implemented across the LHINs as part of the MSK RAC implementation.
Advanced Practice Provider FAQ
The OPA received very positive responses from our members regarding the emerging Advanced Practice Provider Role within the centralized intake, assessment and management model for hip, knee, and low back musculoskeletal (MSK) conditions. The following FAQ answers member questions regarding the APP role, qualifications, and the hiring process.
Read the FAQ
If you are a physiotherapist interested in learning more about these opportunities, or if you are an organization looking to hire a physiotherapist for the APP position, please contact Gonxhe Kastrati, Policy Analyst at the Ontario Physiotherapy Association at 416-322-6866 ext.225.
PHYSIOTHERAPISTS IN PRIMARY HEALTH CARE
Physiotherapy in Primary Care During COVID-19 Pandemic
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OPA Primary Health Care Community of Practice
The Community of Practice (CoP) is a way for PTs in Primary Health Care to pool their knowledge and experiences in this unique practice area. The CoP shares resources, ask questions, collaborates, receives information and updates from OPA as well as provide input into ongoing advocacy work in this sector.
If you are a PT working in Primary Care, and would like to join our community, please contact Amanda Smart, PT, Director, Practice, Policy and Member Services.
Are you a physiotherapist working in a primary health care team?
Contact Maryam Ahmed, Coordinator, Member Services & Programs to learn about available resources and supports, and to connect with other PTs working in primary health care.
More and more, physiotherapists are playing a key role in primary health care teams across the province. Changes to government policy, and the recent investment of 38.3 new full time equivalent physiotherapist positions in primary health care organizations is seeing more Ontarians accessing physiotherapy as part of their interprofessional primary health care. The documents and resources below will help organizations, physiotherapists, and patients better understand the role primary health care physiotherapists play in the Ontario Health System. Primary health care organizations include:
Learn more about the role of Physiotherapists in Primary Health Care
Webinar Series – Physiotherapists in Primary Health Care in Ontario
Are you integrating a physiotherapist into your health care team? Our expert panel discusses the evidence and opportunities for primary health physiotherapy services and answers questions about the role physiotherapists play in providing comprehensive community-centred care.
Watch the webinar
Webinar Slide Deck PHC Organisations
Are you interested in pursuing opportunities in a primary health care team? Our expert panel of physiotherapists discusses the evidence and opportunities for primary health physiotherapy services and how physiotherapists can apply their skills from work in other sectors in these exciting new roles.
Watch the webinar
Webinar Slide Deck PHC Physiotherapists
Mock Job Description
This Mock Job Description may be useful in guiding organizations develop their own physiotherapist position for their team. The description is general in nature, recognizing that physiotherapists in Primary Care Teams will be hired for a range of programming and to meet specific needs of the community; additional responsibilities and qualifications may be required.
Sample Interview Questions for Primary Health Care Physiotherapist Position
These Primary Care Sample Interview Questions have been created to assist organizations in adapting their interview tools when interviewing a physiotherapist for a primary health care position. Physiotherapists applying for a primary health care position can also use these questions to help prepare for interviews. Questions are meant to be general so that they can be modified to reflect the specific patient populations, programs and/or services that the physiotherapist will be involved in; not all questions in this document will be applicable to all positions.
For more information please contact Maryam Ahmed.
Scope of Practice
Many organizations are bringing a physiotherapist onto their team for the very first time. To learn more about the Scope of Practice of physiotherapists in Ontario, please visit the College of Physiotherapists of Ontario. Also available on the website are key statutory and non-statutory College documents, including the Standards for Professional Practice for Physiotherapists. Physiotherapists with additional skills and competencies may perform a number of authorized activities in Ontario. For additional information, read the Essential Competency Profile for Physiotherapists working in Canada.
Community-Based Publicly Funded Physiotherapy Services and other Programs
The OPA has developed LHIN-specific navigation tools for physiotherapists in all sectors to use when assisting patients and families to access publicly funded physiotherapy services and other programs in the community. The tools include brief descriptions and contact information for community-based publicly funded physiotherapy services (including CPCs) as well as other community programming such as wellness programming, funding, and equipment resources.
TIME™ PROGRAM WEBINAR
TIME™ is a group program which increases access to exercise and promotes health and well-being for people with balance and mobility challenges living in the community. Developed by physiotherapists at Toronto Rehab, the TIME™ program is a unique collaboration between health care and community recreation organizations. Since its initiation in 2007, physiotherapists continue to have an integral role in the TIME™ program through fitness instructor training, mentoring and ongoing program support. View the webinar to learn how TIME™ is an alternative service model building capacity for safe and appropriate exercise in the community. Learn more about the TIME™ Program.
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