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.
NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.
The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.
Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.
“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”
More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.
Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.
The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.
However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.
Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.
“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.
What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.
In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.
Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.
Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.
Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.
However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.
Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.
Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)
There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.
“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.
That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.
Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.
“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.
Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.
When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.
The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.
The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.
Worldwide, around 585 volcanoes are considered active.
Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.
Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.
(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.
The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.
After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.
Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.
Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.
“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.
Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.
But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.
Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.
Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.
Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.
That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.
Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.
Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.
