UNIVERSITY HEALTH NETWORK- TORONTO REHABILITATION INSTITUTE VOLUNTARY INTEGRATION BUSINESS CASE CONFIDENTIAL DRAFT May 12, 2011 Submitted by: _________________ ___________________ Dr. Robert Bell Mr. Mark Rochon President and CEO President and CEO University Health Network Toronto Rehabilitation Institute 1 1. Executive Summary On June 30, 2011 Toronto Rehabilitation Institute (Toronto Rehab) and University Health Network (UHN) plan to voluntarily integrate their clinical, research and education programs and support services to become Canada’s premier academic hospital. This integration will create a world leading health sciences centre that provides integrated programs in acute, rehabilitation, complex continuing and long-term care for adults. The goal of integration is to improve the experiences of patients and residents through novel models of care across acute, rehabilitation, complex continuing care and long term care continuum in a wide range of clinical programs. This voluntary integration will also provide a rich environment to further Ontario’s focus on interprofessional education and teaching. Toronto Rehab is home to one of the largest rehabilitation research programs in North America. Research strengths of Toronto Rehab will be joined with those of UHN to advance research ranging from outcomes research and evidence based practice across the care continuum to technologies that improve therapeutic interventions and support people at home. A major emphasis on rehabilitation research will continue into the future. 2. Principles and Commitments The hospitals intend to effect the proposed integration in a manner that is as close as possible to the features of a statutory amalgamation. As such, given that in these circumstances UHN is a Special Act Corporation (University Health Network Act, 1997) and Toronto Rehab is a Letters Patent corporation, an asset transfer will be used to complete the integration. Effective June 30, 2011 Toronto Rehab will transfer all of its right, title and interest in and to its assets to UHN and UHN will assume all of the liabilities of Toronto Rehab. The following principles and commitments have been agreed to Integration will enhance quality and accessibility of rehabilitation services for patients including a focus on earlier rehabilitation services for acute patients as appropriate and informed by evidence and best practice. UHN will guarantee current levels of rehabilitation services. Any resulting savings from integration will be reinvested in post-acute care. While it is difficult to estimate savings at this early stage, it is anticipated that approximately $3-5M will be to be freed up for reinvestment. As a result, enhanced post acute services will soon be in place to the benefit of patients. UHN will guarantee that post-acute care care, commitment and partnerships currently in place through Toronto Rehab to other acute hospitals such as St. Joseph’s Health Centre, St. Michael’s Hospital, Sunnybrook Health Sciences Centre and Mt. Sinai Hospital, will be honoured. In addition, the many other partnerships with other referral partners will also 2 continue. Variances from service delivery volumes are not contemplated as a consequence of this integration. The new integrated organization will have a focus on research in rehabilitation. Substantial annual financial support will be provided by UHN to continue this focus. This incremental financial support will not be derived from TCLHIN operating funds. UHN will enter a post integration project charter with TCLHIN for continued monitoring and evaluation through the HSAA accountability agreement. 3. Clinical Quality and Outcome Opportunities The clinical teams of Toronto Rehab and UHN are very excited by the new opportunities that integration offers to enhance the quality and outcomes of care for patients, residents and their families. The expected outcomes of the integration are aligned with the Toronto Central LHIN’s key priorities that aim to act as catalysts for a broader, system-wide transformation and make a difference for people in the community: Reduce emergency room (ER) wait times Reduce alternate level of care (ALC) days Improve the value and affordability of health services Improve access to services and outcomes for people with diabetes Improve access to services and outcomes for people with mental illness and/or addictions Programs of UHN are highly compatible with those of Toronto Rehab and numerous clinical and academic partnerships already exist, as shown below. Current partnerships Clinical Area Toronto Rehab University Health Network Joint replacement and Musculoskeletal osteoarthritis rehab, trauma Arthritis Program and fractures Stroke rehab, Acquired brain injury rehab, Spinal cord Krembil Neurosciences Neurosciences injury and disease, Alzheimer Program diseases and dementia, multiple sclerosis Heart Disease, Cardiac Rehab Cardiac Peter Munk Cardiac Program and Prevention, Heart Health Geriatrics, seniors care, Medical and Community Care, Complex medical services psychogeriatrics. diabetes, Emergency, Mental Health and dialysis Addictions, dialysis Princess Margaret Cancer Pain management, palliative Program, Multi Organ Specialty programs care Transplant, Critical Care and Surgical Services, Medical 3 Current partnerships Clinical Area Toronto Rehab University Health Network Imaging and Laboratory Medicine Integration is favoured by our mutual interests in research, inter-professional education, Neuroscience, Musculoskeletal, Cardiovascular and Geriatric care. In most of our clinical offerings we provide substantially different components of the continuum of care, suggesting that integration of services will provide our patients with more seamless service. The continuum also offers opportunity for most cost-effective care by eliminating “waiting times” at the interface between our organizations that not only degrade patient outcomes but also increase costs. By integrating our services, we will achieve internationally leading programs in: Spinal Cord Injury and Spine Degenerative Disease, Neurovascular Treatment, Medical Complex Care, Cardiovascular Care and Malignant Hematology Rehabilitation. Spinal Cord Injury & Spine Degenerative Disease Following the opening of the Krembil Discovery Center in 2013 there is enormous potential for integration of research and clinical activities at Toronto Western Hospital and Lyndhurst Hospital. The addition of Lyndhurst’s expertise to the current acute spinal expertise at TWH would immediately create an enormous opportunity for recruitment of both clinicians and researchers interested in spinal cord injury and spine degenerative disease. Needless to say this is a crucial area of importance for clinical care and research in an aging population and we would rapidly become a world leading Spine Center. Neurovascular Treatment The TC LHIN focus and our mutual institutional attention to Neurovascular disease has shown both organizations that we can improve outcomes and reduce costs by bringing our Neurovascular Programs under single governance- mandating that the planning for rehabilitation and best possible outcome begins the minute that the patient is admitted with stroke or aneurysm. The movement of rehab resources “upstream” in the continuum of care will likely have its biggest impact in the treatment of neurovascular patients. Medical Complex Care There is no question that patients with complex medical conditions require an integrated continuum of care from the community through the ER, medical unit and back to the community. Attention to rehabilitation needs is sorely lacking in the current configuration of services. Integrating acute medical care with a focus on post-acute treatment environments and a return to monitoring in the community would be a tremendous step forward that integration of our services could enable. 4 Malignant Hematology Leukemia, myeloma, lymphoma and bone marrow transplant patients have substantially improved survival compared to results achieved ten years ago- but we pay little or no attention to their functional outcomes. Their outcomes would be dramatically improved by integration of care and integration of medical staff. Integrated Cardiac Program The integration of Toronto Rehab Cardiac Rehab and the Peter Munk Cardiac Center would offer enormous opportunity for extending the current emphasis on “personalized” cardiology and “genomic prediction” of outcome. At present the proportion of patients taking advantage of cardiac rehabilitation following major incidents is less than optimal and this integration should increase referrals between our programs. A higher level of patient satisfaction with transitions between acute, rehab and post acute care is expected to be achieved post-integration. Greater development and adoption of evidenced based care models that include acute, rehab and post acute phases will occur in each program. Providing more effective transitions in care will increase the ability to meet and exceed quality measures such as reduced readmissions, improved patient outcomes and streamlined process improvements. We also anticipate that fewer ALC days and shorter wait times in both rehabilitation and acute care will result. 4. Education and Research Enhanced interprofessional education programs and excellence in education for medicine, nursing, rehabilitation, occupational therapy, physical therapy and speech language pathology amongst others is expected as a result of the integration. Toronto Rehab and UHN are both leaders