Ontario proposal to cap psychotherapy panned by mental health docs

By Sabrina Nanji February 11, 2019

Doctors are gearing up to battle the provincial government’s proposal to cap psychotherapy treatment and cleave their pay in a move the Ontario Medical Association (OMA) says would see the neediest mental health patients suffer most.

It’s one battle in the ongoing war between Ontario and the OMA, which represents roughly 30,000 practicing physicians, who are in the middle of a binding arbitration process to settle a five-year contract dispute.

The arbitration board’s decision isn’t expected until spring, but the OMA hopes to negotiate certain aspects such as access to medical mental health services separately on a “bilateral committee” made up of health ministry and OMA representatives.

Queen’s Park Today obtained a redacted version of the OMA’s mental health physicians’ unit’s draft arguments.

The Ministry of Health and Long-Term Care is offering to pay physicians in full for the first 24 hours of psychotherapy a patient receives per year, but it wants to claw back fees by 50 per cent for any care provided after that.

The ministry says the clawback will save $13.2 million annually and boost access to mental health care.

“Claims utilization data also suggests that there are some physicians in Ontario who are providing a high volume of psychotherapy to a small number of patients for an extended period of time, with uncertain clinical benefit, while also limiting access for new patients,” the ministry’s 230-page submission to government-appointed arbitrators William Kaplan, Ron Pink and Kevin Smith reads.

The OMA section’s response says that is baseless. Of particular concern is patients with higher needs, such as those who are suicidal or experiencing post-traumatic stress disorder, who may not have received all the care they need after 24 hours of therapy.

Physicians say the move will disincentivize long-term therapy and won’t really increase access to services for new patients because there are already long waitlists for psychotherapy.

“The reason we object is because this puts patients’ health at risk. Restricting much needed medical services on the basis of incomplete or biased evidence for political convenience is absolutely unacceptable,” the doctors say.

The crux of the government’s argument is that physicians have been billing more for doing less.

Health Minister Christine Elliott said the government is committed to engaging in meaningful conversations with doctors, but did not address specific questions about the proposed changes.

“We remain optimistic for an agreement that will respect doctors while balancing the need to provide patients with the care they deserve and the sustainability of our health care system,” she said in an email.