The June 1st, 2016, revisions to the Statutory Accident Benefits
Schedule will change how rehabilitation therapy is covered. But how
will it affect rehabilitation clinics on a business level, and what
will clinics have to do to adjust?
Many of the basics of how rehabilitation clinics work will not
change – the clinic will still require a license from the
Financial Services Commission of Ontario (FSCO) in order to accept
money directly from insurance companies, and individual therapists
will still need to be certified by professional organizations.
However, the scaling back of coverage, both in terms of money
provided for therapy and the time allotted for that therapy, will
have its own impact, and clinics will need to strike a new balance
between the needs of their patients and financial
Scaling back of coverage
The monetary reduction of coverage across all levels by itself
creates a problem – with less money available in statutory
benefits, patients become more likely to run out of money for their
therapy, and for it to happen faster. This can be a serious issue
when it comes to more specialized and complicated forms of therapy,
particularly as many of them are not covered by OHIP, leaving
patients without the ability to pay their bill once the insurance
money runs out. With this additional danger, clinics will need to
revise their policies on how to handle patients whose insurance
coverage is about to end – regardless of whether this means
referring them to additional sources of funding, providing service
for debt management, or creating a transition program to help them
at the end of their treatment.
The reduced time frame for rehabilitation of non-catastrophic
injury – lowered from 10 years to 5 years – will have
little effect in the first five years, but a considerable impact
after, causing clinics to increase their intake to maintain revenue
from long-term patients. However, this should happen without any
need for policy changes as clinics will be filling their
openings as they open up.
Of far more importance is the new oversight by insurance
companies regarding miscellaneous products and services. While this
will not impact most medical treatments and therapy, it will have
an impact on non-traditional services such as acupuncture and
massage therapy, which patients and clinics will now have to
demonstrate to the insurance provider as essential to recovery.
This means that a number of non-traditional services may no longer
see funding from settlements, leaving the patient – who may
be in no financial condition to pay for out-of-pocket therapies
– to foot the bill. As a result, clinics may need to
re-evaluate the services they offer outside of those specified in
the Statutory Accident Benefits Schedule, especially regarding
whether they will continue to offer those services.
Likewise, the new definition of "catastrophic" may
change what can be funded in more borderline cases. Patients who
are marginally ambulatory yet still completely incapacitated, or
who are suffering from severe chronic pain, may no longer fall
under the category of "catastrophic," resulting in
reduced funding for treatment. How clinics handle this new
situation will depend on the expense to the clinic of these
treatments – although in an ideal circumstance, a balance can
be struck that ensures that patients receive the therapy they need,
it may become necessary to reduce the therapy provided in cases
where there is an unsustainable overhead cost.
The changes to the Statutory Accident Benefits Schedule will
require clinics to re-evaluate how they do business, and how their
treatments are funded. This may require clinics to seek additional
sources of funding, or change the therapies they provide and how
they provide it. With enough care and compassion, hopefully a
balance can be struck between ensuring that patients receive the
therapy they need, and the sustainability of the clinic.
It's not often that our little blog intersects with such titanic struggles as the U.S. presidential race – and by using the term "titanic" I certainly don't mean to suggest that anything disastrous is in the future.
J.J. v. C.C., is an interesting case in which the court held that an automotive garage owes a duty to minor children to secure the vehicles on the premises by locking the cars and safely storing the car keys...
In Irwin v. Alberta Veterinary Medical Association, 2015 ABCA 396, the Alberta Court of Appeal found that the "ABVMA" failed to afford procedural fairness to a veterinarian undergoing an incapacity assessment.
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