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.
TORONTO – Will Taylor Swift bring chaos or do we all need to calm down?
It’s a question many Torontonians are asking this week as the city braces for the arrival of Swifties, the massive fan base of one of the world’s biggest pop stars.
Hundreds of thousands are expected to descend on the downtown core for the singer’s six concerts which kick off Thursday at the Rogers Centre and run until Nov. 23.
And while their arrival will be a boon to tourism dollars — the city estimates more than $282 million in economic impact — some worry it could worsen Toronto’s gridlock by clogging streets that already come to a standstill during rush hour.
Swift’s shows are set to collide with sports events at the nearby Scotiabank Arena, including a Raptors game on Friday and a Leafs game on Saturday.
Some residents and local businesses have already adjusted their plans to avoid the area and its planned road closures.
Aahil Dayani says he and some friends intended to throw a birthday bash for one of their pals until they realized it would overlap with the concerts.
“Something as simple as getting together and having dinner is now thrown out the window,” he said.
Dayani says the group rescheduled the gathering for after Swift leaves town. In the meantime, he plans to hunker down at his Toronto residence.
“Her coming into town has kind of changed up my social life,” he added.
“We’re pretty much just not doing anything.”
Max Sinclair, chief executive and founder of A.I. technology firm Ecomtent, suggested his employees avoid the company’s downtown offices on concert days, saying he doesn’t see the point in forcing people to endure potential traffic jams.
“It’s going to be less productive for us, and it’s going to be just a pain for everyone, so it’s easier to avoid it,” Sinclair said.
“We’re a hybrid company, so we can be flexible. It just makes sense.”
Swift’s concerts are the latest pop culture moment to draw attention to Toronto’s notoriously disastrous daily commute.
In June, One Direction singer Niall Horan uploaded a social media video of himself walking through traffic to reach the venue for his concert.
“Traffic’s too bad in Toronto, so we’re walking to the venue,” he wrote in the post.
Toronto Transit Commission spokesperson Stuart Green says the public agency has been working for more than a year on plans to ease the pressure of so many Swifties in one confined area.
“We are preparing for something that would be akin to maybe the Beatles coming in the ‘60s,” he said.
Dozens of buses and streetcars have been added to transit routes around the stadium, and the TTC has consulted the city on potential emergency scenarios.
Green will be part of a command centre operated by the City of Toronto and staffed by Toronto police leaders, emergency services and others who have handled massive gatherings including the Raptors’ NBA championship parade in 2019.
“There may be some who will say we’re over-preparing, and that’s fair,” Green said.
“But we know based on what’s happened in other places, better to be over-prepared than under-prepared.”
Metrolinx, the agency for Ontario’s GO Transit system, has also added extra trips and extended hours in some regions to accommodate fans looking to travel home.
A day before Swift’s first performance, the city began clearing out tents belonging to homeless people near the venue. The city said two people were offered space in a shelter.
“As the area around Rogers Centre is expected to receive a high volume of foot traffic in the coming days, this area has been prioritized for outreach work to ensure the safety of individuals in encampments, other residents, businesses and visitors — as is standard for large-scale events,” city spokesperson Russell Baker said in a statement.
Homeless advocate Diana Chan McNally questioned whether money and optics were behind the measure.
“People (in the area) are already in close proximity to concerts, sports games, and other events that generate massive amounts of traffic — that’s nothing new,” she said in a statement.
“If people were offered and willingly accepted a shelter space, free of coercion, I support that fully — that’s how it should happen.”
This report by The Canadian Press was first published Nov. 13, 2024.
TORONTO – Hundreds of Taylor Swift fans lined up outside the gates of Toronto’s Rogers Centre Wednesday, with hopes of snagging some of the pop star’s merchandise on the eve of the first of her six sold-out shows in the city.
Swift is slated to perform at the venue from Thursday to Saturday, and the following week from Nov. 21 to Nov. 23, with concert merchandise available for sale on some non-show days.
Swifties were all smiles as they left the merch shop, their arms full of sweaters and posters bearing pictures of the star and her Eras Tour logo.
Among them was Zoe Haronitis, 22, who said she waited in line for about two hours to get $300 worth of merchandise, including some apparel for her friends.
Haronitis endured the autumn cold and the hefty price tag even though she hasn’t secured a concert ticket. She said she’s hunting down a resale ticket and plans to spend up to $600.
“I haven’t really budgeted anything,” Haronitis said. “I don’t care how much money I spent. That was kind of my mindset.”
The megastar’s merchandise costs up to $115 for a sweater, and $30 for tote bags and other accessories.
Rachel Renwick, 28, also waited a couple of hours in line for merchandise, but only spent about $70 after learning that a coveted blue sweater and a crewneck had been snatched up by other eager fans before she got to the shop. She had been prepared to spend much more, she said.
“The two prized items sold out. I think a lot more damage would have been done,” Renwick said, adding she’s still determined to buy a sweater at a later date.
Renwick estimated she’s spent about $500 in total on “all-things Eras Tour,” including her concert outfit and merchandise.
The long queue for Swift merch is just a snapshot of what the city will see in the coming days. It’s estimated that up to 500,000 visitors from outside Toronto will be in town during the concert period.
Tens of thousands more are also expected to attend Taylgate’24, an unofficial Swiftie fan event scheduled to be held at the nearby Metro Toronto Convention Centre.
Meanwhile, Destination Toronto has said it anticipates the economic impact of the Eras Tour could grow to $282 million as the money continues to circulate.
But for fans like Haronitis, the experience in Toronto comes down to the Swiftie community. Knowing that Swift is going to be in the city for six shows and seeing hundreds gather just for merchandise is “awesome,” she said.
Even though Haronitis hasn’t officially bought her ticket yet, she said she’s excited to see the megastar.
“It’s literally incredible.”
This report by The Canadian Press was first published Nov. 13, 2024.
OTTAWA – Via Rail is asking for a judicial review on the reasons why Canadian National Railway Co. has imposed speed restrictions on its new passenger trains.
The Crown corporation says it is seeking the review from the Federal Court after many attempts at dialogue with the company did not yield valid reasoning for the change.
It says the restrictions imposed last month are causing daily delays on Via Rail’s Québec City-Windsor corridor, affecting thousands of passengers and damaging Via Rail’s reputation with travellers.
CN says in a statement that it imposed the restrictions at rail crossings given the industry’s experience and known risks associated with similar trains.
The company says Via has asked the courts to weigh in even though Via has agreed to buy the equipment needed to permanently fix the issues.
Via said in October that no incidents at level crossings have been reported in the two years since it put 16 Siemens Venture trains into operation.
This report by The Canadian Press was first published Nov. 13, 2024.
