Commission on the Reform of Ontario's Public Services

Recommendation 5-53: Encourage hospitals to specialize so all are not trying to provide all
services regardless of their comparative advantages.
To a degree, proper funding incentives will energize this shift; if a certain reimbursement rate
is set for an activity, hospitals that cannot provide the service within that rate will gravitate
away from it. More specialty clinics should also be encouraged, because they can cost less
and provide better quality. Again, a proper funding model should support this.
Recommendation 5-54: Given the burden of alternate level of care (ALC) patients on hospital
capacity, hospitals must become more effective in optimizing this capacity while applying best
practices in planning patient discharges. Further, small hospitals with large ALC populations
must be assessed with a goal of redefining their role in care for the elderly. Again, funding
should be aligned appropriately.
Recommendation 5-55: Use hospitalist physicians to co-ordinate inpatient care from
admission to discharge. Hospitalists should work with Family Health Teams to better
co-ordinate a patient’s moves through the health care continuum (acute care, rehabilitation,
long-term care, community care and home care).
Physicians
Recommendation 5-56: Make primary care a focal point in a new, integrated health model.
Recommendation 5-57: Regional health authorities must integrate physicians into a rostered
health system and adopt the appropriate measures to address compensation issues across
disciplines; that is, the proper blend of salary/capitation and fee-for-service.
The primary goal for physician performance should be prevention and keeping people out of
hospitals. Collective administrative support would allow physicians to concentrate on providing
better care, a value proposition that should appeal to them.
Recommendation 5-58: Reduce the sole proprietorship nature of the offices of many primary
care physicians and encourage more interdisciplinary integration through performance
incentives and accountability.
Recommendation 5-59: Compensate physicians using a blended model of salary/capitation
and fee-for-service; the right balance is probably in the area of 70 per cent salary/capitation
and 30 per cent fee-for-service.
Physicians’ compensation, and especially performance pay, should be linked to positive health
outcomes that are linked to strategic targets, not to the number of interventions performed.
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