Ontario adding 20,000 publicly funded hip and knee surgeries at private clinics

Ottawa Citizen

a day ago

Some Ontario residents will undergo hip and knee surgeries at private clinics under a $115 million expansion announced by Health Minister Sylvia Jones this week.
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Jones said the move will add up to 20,000 OHIP-covered orthopedic surgeries and reduce wait times. The province issued a call for applications in what is being called a significant shift toward more privatization of health care across the province.
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The long-promised move to creating standalone surgical facilities for orthopedic surgeries in Ontario has been promoted as a means of reducing wait times and taking pressure off hospitals. But critics note that many hospital operating rooms sit empty much of the time. With more funding, they could do more surgeries. Meanwhile, research from Alberta suggests a similar shift in provincial health dollars to private surgery operators has undermined the public health system, increased wait times for some key surgeries and increased health-care costs.
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At least one of the community surgical centres will likely be located in Ottawa. In 2023, the Ottawa Hospital formed a partnership with a group of orthopedic surgeons known as the Academic Orthopedic Surgical Associates of Ottawa. The group, known as AOAO, has been renting vacant operating room space at Riverside Hospital and performing orthopedic day surgeries on low-acuity patients on weekends.
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At the time, TOH President and CEO Cameron Love said the hospital planned to work with AOAO and the province to build a private, standalone surgical centre that would function as The Ottawa Hospital's 'high efficiency' orthopedic centre for patients requiring day surgery, leaving more complex cases for hospital operating rooms. He said the proposed facility would operate full time, in contrast to the weekend surgeries currently performed at Riverside. New rules around private surgical centres appear to prohibit groups from renting existing hospital space.
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The plan for stand-alone orthopedic surgical centres comes a week after Jones announced a $155 million investment to add 57 surgical and diagnostic centres for MRIs, CT scans and GI endoscopy services, which provincial officials said would connect 1.2 million people to the services. The province has said it will announce the locations of those facilities in the coming weeks.
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There have long been for-profit independent health facilities offering diagnostic and other procedures, along with cataract surgery in Ontario. There are currently 900 community surgical diagnostic centres in the province, the majority of which offer diagnostic imaging. The latest announcement represents a new expansion into standalone clinics for orthopedic surgeries, something done in other provinces, notably Alberta.
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Research by Andrew Longhurst of the Alberta-based Parkland Institute has found that hip, knee and shoulder surgeries outsourced to private, for-profit providers in Alberta cost more and contribute to rising wait times for other surgeries, including colorectal cancer surgery.
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In an interview, Longhurst said a key concern of the influx of health dollars to private operators is the negative impact it has on the public hospital system.
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'Public hospitals are being starved of staff and funding, while private providers receive inflated payments for the lowest complexity surgeries,' Longhurst said.
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Among those concerns is that the opening of private surgical centres for the least complex cases worsens shortages of anesthsiologists and surgical nurses in the public system, increasing wait times for more complex cases, he said.
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Longhurst also said funding privately-operated surgical centres also opens the door for upselling or extra billing.
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'We hope we don't see the pervasive extra billing we have seen in other provinces,' Longhurst said. But he noted that numerous Ontario patients have complained about being upsold or charged extra for cataract surgery and being unclear about costs, despite assurances from the province that upselling and extra billing would not happen.
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Longhurst said that unless a provincial government strictly limits procedures in standalone clinics to those covered by OHIP, the water can be muddied in terms of what is legal and what is extra billing by a privately owned clinic.
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'All of this – based on patterns and facts from other provinces – makes me quite concerned about the can of worms the government is opening.'
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Provincial funding to the clinics will consist of facility costs per procedure – $6,530 for primary unilateral hip joint replacement procedures and $5,797 for primary unilateral knee joint replacement procedures.
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In its call for applications, the Ministry of Health said that funding is considered a 'bundled payment,' meaning it should cover pre-operative and post-operative care and rehabilitation as well as the surgery. The province will not pay for the construction of the centre or any other associated costs. The document says facility costs 'may undergo periodic review or rate review under the sole discretion of the ministry, at any time.'