Premier Doug Ford’s government gives a for-profit clinic more funding to perform certain OHIP-covered surgeries than it gives Ontario’s public hospitals to perform the same operations, CBC News has learned.
Ontario’s government has never before made public the rates it pays a private clinic in Toronto to perform thousands of outpatient day surgeries each year.
Through a freedom of information request, CBC News obtained documents that reveal those funding rates for the first time. You can see one of those documents for yourself at the bottom of this story.
Four senior officials who work in different parts of Ontario’s hospital system reviewed the documents, and all four say the rates being paid to the privately-owned Don Mills Surgical Unit Ltd. are noticeably higher than what the province provides public hospitals for the same procedures.
That discrepancy raises questions about the government’s imminent plans to expand the volume and scope of surgeries performed outside of hospitals, including the potentially lucrative field of hip and knee replacements.
Ford and his health minister have pitched this expansion as a cost-efficient way to get more surgeries done and reduce wait times.
Don Mills Surgical Unit Ltd. is part of Clearpoint Health Network, the largest chain of private surgical clinics in Canada. Clearpoint is wholly owned by Kensington Capital Partners Ltd., a private equity firm with $1.5 billion in investments. (Michael Aitkens)
However, many health-care professionals are concerned that outsourcing more surgeries to privately run for-profit clinics would merely shift resources from Ontario’s hospitals and boost clinic owners’ revenues, without actually shortening wait lists.
The documents show provincial agency Ontario Health contracted Don Mills Surgical Unit Ltd. at the following per-surgery funding rates in each of the three fiscal years starting from 2020-21:
$1,264 for each procedure classed as minor complexity (such as cataract surgery)
$4,037 for each moderate complexity surgery (such as a laparoscopic gallbladder removal)
$5,408 for each higher-complexity surgery (such as repairing a large tear of a rotator cuff).
The funding rates do not include how much the surgeon bills OHIP for each operation. The physician’s billing for a particular OHIP-covered surgery is identical whether it takes place in a hospital or a private clinic.
Here’s how much Doug Ford’s government pays a for-profit clinic to do OHIP-covered surgeries
Featured VideoCBC Toronto has learned that Premier Doug Ford’s government gives a for-profit clinic more funding to perform certain OHIP-covered surgeries than it gives Ontario’s public hospitals to perform the same operations. The figures are revealed in documents obtained through a freedom of information request. CBC’s Mike Crawley has the exclusive story.
‘Egregious’ overpayment: chief of surgery
In separate interviews, senior public hospital officials who reviewed how those rates applied to the 70 different surgeries on the Don Mills list said the province provides their hospitals less funding per surgery for identical procedures.
The officials spoke on condition of anonymity because they feared talking publicly about the province’s funding arrangements could bring financial repercussions to their hospitals.
“The overpayment for these minor things is egregious,” said the chief of surgery at a large Ontario hospital. “It doesn’t look like great value for money.”
Health Minister Sylvia Jones says the government’s plan to outsource more surgeries is ‘really about people having access and making sure that they’re not sitting on wait lists.’ (Frank Gunn/The Canadian Press)
The $4,037 of funding allotted to Don Mills Surgical Unit (DMSU) for each moderate complexity surgery is “very generous” compared with how hospitals are funded for comparable operations, the chief of surgery said.
A director of surgery at another hospital says those funding rates would allow significant profit to flow from the public purse to the clinic’s owners.
Ministry funding included ‘premiums’
“If I were running that centre, I would be a millionaire,” said the surgeon. “There’s a tonne of money to be made.”
A third senior health-care executive, who has led surgical programs at multiple hospitals in Ontario, described the rates as “much higher” than the per-surgery funding that flows to hospitals.
A spokesperson for Health Minister Sylvia Jones says the province contracted DMSU as part of its efforts to catch up on backlogs of publicly funded surgeries stemming from the COVID-19 pandemic.
The Ministry of Health “came to an agreement with DMSU on a pricing structure for day surgeries, grouped on their complexity and included price premiums. These premiums were also given to hospitals to incentivize increased surgeries,” said Jones’ spokesperson Hannah Jensen in an email.
Earlier this month, Jones defended the government’s outsourcing of surgeries and its plans to move more procedures outside of hospitals.
“It’s really about people having access and making sure that they’re not sitting on wait lists, they’re not having to wait at home, they’re not off work,” Jones said in an interview on Nov. 2.
‘Same physicians as hospitals,’ says Jones
CBC News asked Jones if she could commit that surgeries performed in private clinics under the government’s expansion plans will not cost the province more than in hospitals.
“What I can commit to is that regardless of where you get your surgery, you are being treated and assessed and having access to … licensed regulated healthcare professionals, the same physicians, doctors, anaesthetists who are practicing in our hospital system,” she said.
The people who run hospitals are deeply concerned that surgeons, anaesthetists and operating room nurses shifting to private clinics will weaken the ability of hospitals to provide the care expected of them.
That’s because surgeons who are attached to a hospital don’t just do scheduled surgeries: as part of their deal to have credentials at hospitals, they’re expected to put in clinical shifts and take turns being on call for emergency surgeries.
Documents obtained through a freedom of information request show the province provides Don Mills Surgical Unit $1,264 for each cataract removal. Hospitals are funded $508 per surgery and the non-profit Kensington Eye Institute says it receives $672. (Jacques Poitras/CBC)
CBC News requested an interview with senior officials from Don Mills Surgical Unit. The company declined the request, but sent a statement by email.
“The surgical services delivered through our state-of-the-art facility have been an integral part of the Ontario healthcare system for decades,” said Don Mills Surgical Unit’s director of operations, Sara Mooney.
‘High patient satisfaction’
“We operate within the funding levels and expected volume budgets assigned by the province to reduce wait times and restore quality of life for Ontarians who’ve been waiting for essential surgeries,” Mooney said. “Our high patient satisfaction rate is testimony to the quality of care provided.”
The documents show Don Mills Surgical Unit Ltd. was allocated $3.66 million in what’s described as “Private Hospital Surgical Recovery Funding” for 664 minor complexity surgeries, 465 moderate complexity and 175 higher complexity surgeries during each of the 2021-22 and 2022-23 fiscal years.
The documents do not show how many surgeries were actually carried out, nor which of the 70 different surgical procedures on the list were performed. The Ministry of Health said it could not provide a breakdown because DMSU does not submit “procedure-level data.”
CBC News asked Don Mills for specifics. Mooney said the surgeries provided under the program were orthopaedic, ear, nose and throat, cataract, general, and medically necessary plastic surgeries.
Former health minister Christine Elliott is registered to lobby Premier Doug Ford’s government on behalf of Clearpoint Health Network Inc., which runs Don Mills Surgical Unit. Her official lobbyist registration says her goal is to ‘engage the government in updating and increasing the base funding amount available to Clearpoint.’ She is pictured here with Ford in July 2018. (Chris Young/Canadian Press)
The documents also show Don Mills was funded an additional $1.3 million in 2022-23 to perform another 1,041 minor surgeries at $1,264 each. In December 2022, Ontario Health also gave it another $263,000 in what it described as “one-time funding to support the operation of private hospitals.”
Ontario’s end-of-year financial statements, the public accounts, show the Ministry of Health’s annual payments to Don Mills ran consistently at $1.32 million in the years leading up to the pandemic, and have quadrupled since, hitting $5.27 million in 2022-23. A government official confirmed that the private clinic is continuing to receive funding this year under the surgical recovery program.
Christine Elliott lobbying for the company
Don Mills Surgical Unit is part of Clearpoint Health Network, the largest chain of private surgical clinics in Canada.
Clearpoint is wholly owned by the $1.5 billion private equity firm Kensington Capital Partners Ltd., which launched the chain through a $35 million purchase of clinics in Ontario, Manitoba, Alberta and B.C. in 2019.
Last week, former health minister Christine Elliott registered to lobby the Ford government on behalf of Clearpoint. Her official registration says her lobbying goals are to “engage the government in updating and increasing the base funding amount available to Clearpoint.”
Clearpoint says about 90 per cent of the surgeries performed in its clinics across Canada are publicly funded.
The higher per-surgery funding to Clearpoint’s clinic debunks the government’s claims about the benefits of outsourcing OHIP-covered procedures, says Andrew Longhurst, a health policy researcher at Simon Fraser University.
“Having this [funding] information tells us that the main rationale that the government has used to argue for greater for-profit delivery simply doesn’t pass the sniff test,” said Longhurst in an interview.
“Taxpayers are having to pay significantly more to have the same procedures done in private, for-profit facilities, so investors can make a return,” Longhurst said. “I see that as a very bad deal for the public.”
To compare per-surgery funding rates, CBC News reviewed official funding documents called Hospital Service Accountability Agreements posted by a variety of Ontario hospitals.
Cataracts and knee arthroscopy
Two common procedures on the list at Don Mills that the province also funds on a per-procedure basis in hospitals are cataract surgery and arthroscopic knee surgery.
While the contract shows the province provides Don Mills $1,264 for each cataract operation, the funding agreements with hospitals show $508 per procedure.
She paid thousands more than she needed to at a private clinic
8 months ago
Duration 3:12
Featured VideoHealth Canada reports show private, for-profit clinics are upselling patients on extra services they don’t need. One Ontario patient says a private clinic had her sign off on additional services that cost her thousands and even tried to get her to have another surgery that she didn’t need.
“Knee arthroscopy with meniscus repair” is defined as a Level 2 or moderate complexity procedure in the Don Mills agreement, funded at $4,037 per surgery.
The funding to hospitals for “knee arthroscopy (degenerative meniscus and joint)” ranges from $1,273 per surgery at Toronto’s University Health Network to $1,692 each at Sunnybrook Health Sciences Centre.
‘No justification’
“There’s no justification for this that I can possibly think of,” said Dr. Dick Zoutman, a former chief of staff at two major hospitals in the province, now a board member of the union-backed Ontario Health Coalition
“The costs to the Ontario taxpayers are substantially more for exactly the same service,” said Zoutman in an interview. “Frankly, I think it’s nonsense.”
The health minister’s spokesperson says it’s not possible to make an accurate comparison between the funding Ontario gives to an independent facility like DMSU and the funding given to a hospital to provide the same procedure, because hospitals also receive separate global operating budgets.
“Community surgical and diagnostic centres receive one-time funds for procedures only and have to absorb any capital or operating costs, unlike hospitals,” said the spokesperson. “These centres may have higher costs for purchasing equipment or, in some cases, having to rent equipment.”
On the Clearpoint Health Network website, the company says the Don Mills Surgical Unit is a state-of-the-art facility that includes six operating rooms. ‘Our facility delivers thousands of OHIP procedures annually to assist in the efficient and effective management of many wait list procedures,’ the website says. (Clearpoint Health Network)
However, hospital officials say the global operating budgets fund the many other things hospitals do beyond outpatient surgery. They also question why the province would subsidize a private clinic’s costs by paying it more money per procedure.
“I don’t really understand the decision-making process [the province] used for setting these particular rates,” said a senior hospital executive.
There is “no point” in the government outsourcing surgeries to for-profit clinics if they can’t perform surgeries more cost-effectively than hospitals can, the executive said. “You would be wasting taxpayers’ dollars.”
Ontario doctors have urged the government to create non-profit surgical centres in its move to expand the scope of surgeries performed outside of hospitals.
The government allocated $300 million across Ontario in 2022-23 to tackle the increased backlog of surgeries and diagnostic procedures driven by the pandemic, the bulk of which went to hospitals.
“A single rate setting-approach should be established for both public hospitals and private clinics offering the same clinical services,” said Anthony Dale, president of the Ontario Hospital Association, in a statement.
The government’s plan to increase the number of surgeries done outside hospitals includes adding hip and knee replacements to the list in 2024. The current per-procedure funding to hospitals is around $8,100 for each knee replacement and $8,900 for each hip replacement.
HAMILTON – It remains faint but Bo Levi Mitchell and the Hamilton Tiger-Cats still have a playoff pulse.
Mitchell threw two touchdown passes as Hamilton defeated the Ottawa Redblacks 37-21 in the CFL’s annual Hall of Fame game Saturday afternoon. The Ticats (4-9) earned a second straight win to move to within six points of the third-place Toronto Argonauts (7-6) in the East Division.
Hamilton visits Toronto on Friday night.
“Obviously they’re (wins) huge now,” Mitchell said. “We didn’t do ourselves any favours by getting into this position and not being able to really control our own destiny.
“But right now, we need certain people to win at certain times. Our job is to go out there and try to win the next five, then the next three after that.”
Mitchell finished 20-of-27 passing for 299 yards and an interception. He entered weekend action leading the CFL in passing yards (3,383) and TD strikes (21).
Greg Bell’s 15-yard TD run at 11:30 of the fourth and two-point convert put Hamilton up 36-21 after backup Jeremiah Masoli led Ottawa on two scoring drives. Following a 13-yard TD strike to Andre Miller at 2:53, Masoli found Dominique Rhymes on a 10-yard touchdown pass at 7:43 before Khalan Laborn’s two-point convert cut Hamilton’s lead to 29-21.
“When you’re scoring from (15) yards out on a run play, that makes offence easy,” Mitchell said. “It’s one of those things when you get down there as a quarterback, it takes you sometimes five, eight, 10 plays and now it’s ‘OK, now we have to create some stuff and find something.’
“When you hand the ball off and you’re scoring from (15) yards, it makes the offence really easy.”
Ottawa (8-4-1) would have clinched a playoff spot with a victory.
Ottawa committed six turnovers (three interceptions, two fumbles, once on downs) before an announced Tim Hortons Field gathering of 22,119. Lawrence Woods III also returned a punt 83 yards for a touchdown at 11:51 of the first quarter that put Hamilton ahead 10-3.
“You’ve got to bring your best every single week and this wasn’t our best, all of us, from coaches to the players,” said Ottawa head coach Bob Dyce. “If you don’t play great for four quarters, I don’t care who you’re playing you’re not going to have a successful day.
“We should’ve made the tackle (on Woods), we had him wrapped up it’s that simple. Even though we didn’t make the play on that, there should’ve been extra bodies there to clean it up when he did break the tackle.”
Hamilton also tied the season series with Ottawa 1-1. The teams meet again at TD Place on Oct. 25.
“If we didn’t turn it over today I would’ve said we played really well offensively and that to me is what the biggest difference is,” said Hamilton head coach Scott Milanovich. “Even the turnovers today (interception, fumble), at least they were in their end and we weren’t giving them a short field.
“The biggest play of the game was Woodsie’s return. It got us jump-started, gave us the lead and we were kind of off after that.”
Ottawa starter Dru Brown was 17-of-27 passing for 164 yards and an interception. Masoli entered late in the third and finished 13-of-19 passing for 183 yards with two TDs and two interceptions, but Dyce said Brown will start next weekend against Montreal (10-2-1), which earned a 19-19 tie Saturday night with Calgary (4-8-1).
The Canadian Football Hall of Fame’s ’24 class of S.J. Green, Chad Owens, Weston Dressler, Vince Goldsmith and Vince Coleman, along with builders Ray Jauch and Ed Laverty (posthumously), was honoured at halftime. All were enshrined Friday night.
Steven Dunbar Jr. and Ante Litre had Hamilton’s other touchdowns. Marc Liegghio kicked two field goals, three converts and two singles.
Ottawa’s Lewis Ward booted two field goals and a convert.
Mitchell culminated a five-play, 96-yard march with a 20-yard TD pass to Litre at 13:34 of the third. It followed Jonathan Moxey’s interception.
Liegghio’s single at 7:05 of the third put Hamilton up 22-6.
Mitchell’s 54-yard TD strike to Dunbar at 14:18 of the second staked Hamilton to its 21-6 halftime lead. The advantage was well-deserved as the Ticats had more first downs (12-six), net offensive yards (260-144) and scored on both offence and special teams.
Mitchell was 14-of-20 passing for 210 yards and a TD, but his interception cost Hamilton at least a field-goal attempt. Dunbar had five receptions for 113 yards and the touchdown.
Brown completed 13-of-21 passes for 127 yards.
Liegghio’s missed 47-yard attempt went for the single at 12:45 to put Hamilton ahead 14-6. It followed a Kiondre Smith catch that was ruled incomplete and at the very least cost the Ticats a first down that would’ve kept the drive alive.
Ward’s 30-yard kick at 9:15 had pulled Ottawa to within 13-6.
Liegghio’s 19-yard field goal at 5:13 pushed Hamilton’s lead to 13-3. It followed the defence stopping Ottawa’s Dustin Crum on third-and-one, giving the Ticats possession at the Redblacks 40.
Liegghio’s 47-yard field goal opened the scoring at 2:42 before Ward tied in with a 24-yard boot at 8:44.
UP NEXT
Redblacks: Host the Montreal Alouettes (10-2-1) next Saturday, Sept. 21.
Tiger-Cats: Visit the Toronto Argonauts (7-6) on Friday.
This report by The Canadian Press was first published Sept. 14, 2024.
TORONTO – Needing three points to keep their playoff push alive, Toronto FC’s Jonathan Osorio and Deandre Kerr stepped up with first-half goals against Austin FC on Saturday with goalkeeper Sean Johnson doing his bit at the other end.
A 76th-minute goal by Austin’s Owen Wolff made for a nervy ending but TFC hung on for a 2-1 win.
While Toronto (11-15-3) remains on the Major League Soccer playoff bubble in eighth place in the Eastern Conference (the eighth- and ninth-place teams in each conference square off in a wild-card playoff with the winner facing the top seed in the conference), other results went their way.
Seventh-place Charlotte, 10th-place Atlanta and 11th-place Philadelphia all lost while ninth-place D.C. United tied.
Toronto midfielder Alonso Coello called it “a game we had to win.”
“It’s a big win … To see that fight tonight was important,” added coach John Herdman.
Austin (9-12-7) came into the game in 11th place in the West, two points below ninth-place Minnesota. The Texas side has won just one of its last six league games (1-4-1).
Austin outshot Toronto 7-6 (6-2 edge in shots on target) in the first half but found itself trailing 2-0 at the break as Toronto took advantage of its chances and the visitors didn’t in their first-ever visit to BMO Field, before an announced crowd of 25,538.
Toronto had a dream start, catching Austin on the counterattack in the seventh minute. A sliding Austin player dispossessed an onrushing Kerr, who had been set free by a long ball from Coello, but the ball bounced to Osorio, who beat goalkeeper Brad Stuver with a rising shot.
It was the Toronto captain’s second goal of the season in league play and his 65th for TFC in all competitions. Only Sebastian Giovinco (83) and Jozy Altidore (79) scored more in Toronto colours.
TFC went ahead on another counterattack in the 30th minute after an Austin giveaway. Osorio found Richie Laryea outpacing his marker and the wingback unselfishly sent a perfect low cross across goal for Kerr to knock home for his third of the season.
Wolff, the son of Austin head coach Josh Wolff, made it interesting with his late strike. The 19-year-old U.S. youth international, controlling a long ball, beat defender Raoul Petretta and then waited out Johnson before slotting it home for his first of the season.
Toronto survived a nervy six minutes of stoppage time as Austin pressed for the equalizer. Austin outshot Toronto 14-9 (8-3 in shots on target) and had 52.5 per cent possession.
The win evened Toronto’s home record at 7-7-0, while Austin slipped to 3-8-3 on the road.
It was a costly evening for Austin with defender Brendan Hines-Ike, midfielder Jhojan Valencia and star attacker Sebastian Driussi allpicking up cautions to miss Wednesday’s game with Los Angeles FC due to yellow-card accumulation.
Toronto defender Shane O’Neill will miss Wednesday’s game against visiting Columbus for the same reason. Toronto could be short mid-week, too. The hope is veteran centre back Kevin Long, who missed Saturday’s game after tweaking his hamstring in training, will be good to go.
Toronto has five games remaining, including three more at home as it looks to return to the post-season for the first time since 2020 when it lost to Nashville after extra time at the first hurdle.
It is a challenging road.
TFC hosts Columbus, the New York Red Bulls and Inter Miami while playing away at the Colorado Rapids and Chicago Fire. All but Chicago are in playoff positions.
The only previous meeting between Toronto and Austin was in May 2023, when Zardes scored a 91st-minute winner to give Austin a 1-0 win over visiting Toronto, which was then mired at the bottom of the Eastern Conference. That loss prompted a post-game outburst from Italian star Federico Bernardeschi about TFC’s drab play.
Then-coach Bob Bradley benched Bernardeschi for the next game.
Current coach John Herdman made four changes to his starting 11 with Bernardeschi and Osorio returning from suspension and Coello and Kerr also slotting in. Coello, who had missed the last eight league games with a hamstring injury, was impressive in his 59-minute return.
Both Toronto and Austin suffered home losses last time out going into the international break. Toronto was beaten 3-1 by D.C. United while Austin lost 1-0 to Vancouver.
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This report by The Canadian Press was first published Sept. 14, 2024.
MONTREAL – CF Montreal is back in the win column after securing a 2-1 Major League Soccer win over Charlotte FC on Saturday night at Stade Saputo.
Montreal’s form had suffered of late, with just one win in MLS since July, but Laurent Courtois’ squad showed a level of poise and control over the tempo of the game that had not been seen since the beginning of the season.
“What we’ve changed in the last few weeks or months in terms of our methodology or coaching, is nothing. We did the exact thing, We had the exact same words, and we expressed them the exact same way,” said Courtois. “Today, everything just clicked.”
Caden Clark scored for the first time as a Montreal (7-12-9) player in the 23rd minute, in addition to Bryce Duke’s goal three minutes later that ended up being the winner, while Tim Ream found the back of the net for Charlotte (10-10-8).
Montreal had the first major scoring chance of the match after 15 minutes of play. With a free kick roughly 25 metres away from goal, Gabriele Corbo sent a near-perfect shot smashing off the crossbar.
Montreal would continue to dictate the tempo in the opening phase, finding first blood just seven minutes later.
Following a phenomenal triple-save from Charlotte goalkeeper Kristijan Kahlina, the ball fell to Clark who volleyed the ball into the wide-open net, picking up his first goal for the club.
“I think you don’t lose the feeling (of scoring), everything happens for a reason, you just can’t lose yourself in the chaos,” said Clark, who had missed a full season due to injury and was briefly without a club, but was grateful for Courtois’ confidence in him.
“(To have a coach’s confidence) is huge and is something I’ve had both ends of so you just can’t take advantage of that in the wrong way. I’m going to keep my discipline with the game plan and keep my head right.”
With momentum completely on their side, the home side doubled the lead just three minutes later. Montreal continued to build up play on the left flank and found a streaking Raheem Edwards in behind the defence who cut the ball back to Duke, sending the Stade Saputo crowd into a frenzy.
Just after the half-hour mark, Charlotte pulled one back through a set piece — something Montreal has struggled defending all season — as Ream rose above everyone at the back post to score his first with his new club.
The second half began in a similar fashion to the end of the first, with Charlotte pressing high up the pitch and forcing several turnovers in dangerous areas. After surviving the pressure, Montreal began to regain control of the game near the hour mark, enjoying the lion’s share of the possession while Charlotte looked to hit back on the counterattack.
“I think when we conceded that goal we were like ‘here we go again.’ 2-1 is a tough lead before halftime … and at the beginning of the half we kind of shot ourselves in the foot and they pressed a bit more, they moved a bit more forward and that opened some gaps,” said captain Samuel Piette.
“I was happy with that, it shows character. At the end of the day, we just wanted the three points and that’s what we got.”
As the game progressed, Charlotte pushed harder to find an equalizer but to no avail. With only one shot on target conceded, the second-worst defence in the league put up an impressive front and confidently rebuffed every single Charlotte attack.
“I’m a big fan of the back five’s performance in their discipline, competitiveness, and synchronization with balls in behind,” said Courtois.
“We can’t explain sometimes in a game it’s not there, they’re capable and today they showed it. Let’s see tomorrow.”
UP NEXT
Both teams are back in action on Sept. 18 away from home as Montreal will look to avenge a 5-0 rout against the New England Revolution while Charlotte visits Orlando City SC.
This report by The Canadian Press was first published Sept. 14, 2024.
