Response to an Ontario Ministry of Health and Long-Term Care Applied Health Research Question Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18 Prepared By Sue Schultz, Rick Glazier, Erin Graves, Michael Schull and Rinku Sutradhar Submission Date May 3, 2019 Submitted To Negotiations Branch Negotiations and Accountability Management Division Ontario Ministry of Health and Long-Term Care ICES Project No. 2018 0866 010 004 Corresponding Authors Dr. Michael Schull ICES 2075 Bayview Avenue, G-Wing Toronto, ON M4N 3M5 Tel: 416-480-4055, ext. 4297 [email protected] Sue Schultz, Senior Epidemiologist [email protected] Note: This file replaces the 2017 update which contained results to 2015/16. Acknowledgement This study was supported by ICES (formerly the Institute for Clinical Evaluative Sciences), which is funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions are those of the authors and are independent from the funding source. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. © ICES. All rights reserved. Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18 Study Population All active Ontario physicians. Time Frame The study reports physician payments for Ontario and by specialty for the years 2005/06 to 2017/18. Although previous reports have included payment estimates for 2000/01 to 2004/05 as well, the data for these years are known to be incomplete. The decision was made to exclude these early years to ensure comparable data across all years with respect to trends over time. Inclusion/Exclusion Criteria Cohort inclusion criteria Physicians were included if they had an Ontario postal code and payments in at least one of the payment databases held at ICES: OHIP, Architected Payments and GAPP/DSS. Physicians whose total payments for the year were negative (-) were not included in the final totals. Cohort exclusion criteria Out of province physicians, out of country physicians and clinical fellows were excluded from the physician totals. Claims that included dummy physician numbers (e.g., for processing reciprocal medical billings), duplicate claims and technical fees were excluded when estimating payment totals and calculating physician full-time equivalents (FTEs). Physicians were excluded if their total payments from all sources was ≤ 0. Specialty Groupings For the purpose of calculating FTEs, specialties were grouped as follows: · All pediatric medical subspecialties were aggregated as Pediatric Subspecialties. · GP/FP includes Community Medicine/Public Health and physicians from any other specialty whose functional specialty was GP/FP. FP/Emergency Medicine physicians were only included if their functional specialty was GP/FP; otherwise, they were included with Emergency Medicine. · Medical Genetics and Neonatal-Perinatal Medicine were included with Pediatrics. · Gynecological Oncology was included with Obstetrics & Gynecology (OB/GYN). · Pediatric General Surgery was included with General Surgery. · Medical Biochemistry and Medical Microbiology were combined into Laboratory Medicine. · Hematological Pathology and Neuropathology were included with General Pathology. · Occupational Medicine was included with Internal Medicine. No FTE was calculated for physicians or physician numbers identified as ‘Dummy Number,’ ‘Fellow,’ ‘Out of Country’ or ‘Out of Province.’ Analysis The total payment amount for each physician for each year was calculated by summing payments from all sources. For the purpose of calculating FTEs, specialties with small numbers of physicians (such as Pediatric Subspecialties) were grouped together. Each physician's specialty during a given year was based on their self-reported specialty, which was then compared with their practice-based specialty. An FTE was calculated for each physician. This is a relative number that indicates where a physician's total payments fall on the distribution of payments within their specialty using the methodology developed by Health Canada. For each grouped specialty, the mean total payments per physician and per FTE were calculated. We also calculated the median and percentiles for total payments per physician by specialty. We also report the total payments to all physicians in the specialty for each year and the breakdown by payment source (i.e., Fee-for-Service (FFS), Academic Health Science Centre (AHSC), Alternate Payment Plan (APP), Emergency Department Alternative Funding Agreement (EDAFA), Primary Care Model, and Other). In accordance with the ICES re-identification risk assessment policy, payment sources were combined into an All Others category where there were payment amounts from one or more sources that were based on fewer than 6 physicians. An empty cell indicates no payments from the source in the year indicated. For primary care physicians, an additional analysis breaks out their mean payments by primary care model and payment category. An empty cell indicates no payments fell within the category in the year indicated. Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18 3 Total and mean payments per physician and per FTE Median and percentiles of payments per physician Total payments from all Number of Mean payments Mean payments Specialty Year sources physicians FTEs per physician per FTE 10th percentile 25th percentile 40th percentile Median 60th percentile 75th percentile 90th percentile All Ontario 2005/06 5,808,590,712.53 23,148 21,839.6 250,932.72 265,965.91 36,559.75 117,858.48 180,245.43 226,495.18 269,766.99 348,773.20 484,848.73 All Ontario 2006/07 6,354,870,838.67 23,380 22,179.4 271,807.99 286,520.73 44,342.52 130,626.31 196,861.29 244,903.57 293,393.00 380,042.26 515,419.94 All Ontario 2007/08 6,754,008,998.89 23,939 22,880.9 282,134.13 295,181.64 45,166.90 133,416.55 206,002.22 250,076.34 302,895.13 391,031.66 535,037.22 All Ontario 2008/09 7,690,648,768.88 24,525 23,528.0 313,584.05 326,872.63 53,159.82 151,331.40 223,619.71 277,697.63 336,530.64 434,956.95 592,467.79 All Ontario 2009/10 8,111,121,575.20 25,354 24,322.2 319,914.87 333,486.38 57,126.10 150,676.44 228,185.06 283,418.42 339,968.65 442,017.09 602,341.82 All Ontario 2010/11 8,583,670,949.66 26,151 25,190.4 328,234.90 340,751.13 52,918.63 153,518.11 233,455.71 290,995.37 348,788.79 454,650.79 620,617.85 All Ontario 2011/12 9,328,553,049.97 27,075 26,042.1 344,544.90 358,210.34 59,697.00 162,446.41 247,020.04 304,093.67 365,556.83 472,120.18 648,522.72 All Ontario 2012/13 9,416,901,100.62 27,725 26,738.6 339,653.78 352,183.44 58,498.67 164,368.87 246,455.09 305,031.99 364,776.20 469,752.99 636,687.53 All Ontario 2013/14 9,804,501,805.90 28,621 27,604.1 342,563.22 355,182.44 59,414.65 164,068.04 246,779.05 305,761.59 366,865.51 471,177.78 642,835.50 All Ontario 2014/15 9,942,545,777.38 29,560 28,521.0 336,351.35 348,604.23 51,851.88 155,574.05 237,196.19 297,475.98 358,945.09 464,243.33 639,294.12 All Ontario 2015/16 10,008,870,419.36 30,211 29,244.4 331,298.88 342,249.13 51,881.46 153,514.75 234,912.90 291,974.80 352,354.44 457,293.51 627,414.88 All Ontario 2016/17 10,203,234,263.64 30,994 30,117.4 329,200.31 338,781.86 56,914.29 154,061.30 232,401.91 289,014.01 347,566.04 452,820.59 622,325.09 All Ontario 2017/18 10,657,944,073.05 32,034 31,148.1 332,707.25 342,169.71 56,677.91 155,054.04 234,141.51 289,363.10 350,350.18 455,528.97 632,917.18 Payments overall and by source Total payments Specialty Year from all sources FFS AHSC APP EDAFA PC model Other All Ontario 2005/06 5,808,590,712.53 4,929,152,624.17 87,629,599.14 314,327,576.18 201,458,344.70 238,394,634.72 37,627,933.62 All Ontario 2006/07 6,354,870,838.67 5,155,517,637.86 83,570,842.21 341,850,511.90 230,686,825.17 456,613,608.26 86,631,413.27 All Ontario 2007/08 6,754,008,998.89 5,308,558,005.62 108,284,903.39 410,703,095.24 271,772,726.97 567,656,076.36 87,034,191.32 All Ontario 2008/09 7,690,648,768.88 5,599,781,312.63 319,246,123.74 474,694,891.74 294,169,519.28 860,868,502.83 141,888,418.65 All Ontario 2009/10 8,111,121,575.20 5,814,363,487.80 218,777,923.85 482,096,308.00 303,851,688.00 1,126,451,958.08 165,580,209.47 All Ontario 2010/11 8,583,670,949.66 6,122,438,583.19 205,962,804.54 479,795,174.84 308,504,803.69 1,317,667,697.24 149,301,886.15 All Ontario 2011/12 9,328,553,049.97 6,625,390,303.50 232,564,803.57 538,310,031.25 361,808,307.43 1,376,052,677.55 194,426,926.66 All Ontario 2012/13 9,416,901,100.62 6,438,596,042.83 233,555,108.55 549,329,690.86 378,030,657.29 1,623,294,633.48 194,094,967.61 All Ontario 2013/14 9,804,501,805.90 6,660,795,332.67 246,299,091.55 582,119,638.95 410,041,700.63 1,698,317,877.02 206,928,165.07 All Ontario 2014/15 9,942,545,777.38 6,761,414,766.35 227,430,401.62 629,678,335.16 396,396,098.61 1,776,519,465.87 151,106,709.78 All Ontario 2015/16 10,008,870,419.36 6,797,184,670.39 223,694,656.85 622,455,449.55 414,781,031.32 1,815,998,778.39 134,755,832.86 All Ontario 2016/17 10,203,234,263.64 6,935,107,438.58 221,378,775.41 669,946,082.46 420,275,599.37 1,821,328,041.59 135,198,326.24 All Ontario 2017/18 10,657,944,073.05 7,288,923,946.89 225,002,232.42 713,130,735.35 436,039,134.51 1,856,118,764.58 138,729,259.29 Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18 4 Total and mean payments per physician and per FTE Median and percentiles of payments per physician