Evidence of meeting #76 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
4:10 p.m.
Conservative
4:10 p.m.
Liberal
4:10 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
Well, I'd like to come back to the patient-reported outcome measures work, which I think is critically important to the future of our health care system.
What we're seeing is that there's only one nation in the world, and that is England, that is currently collecting population-based outcome measures on just a very narrow sliver of supply-sensitive and preference-sensitive care conditions. I think it should be cross-spectrum for the population so that we get a sense of where the resources are needed and which patients are suffering.
We need to start collecting this data when the patients are on the wait-lists, not just pre- and post-operatively but really through the whole trajectory of their care. When they show up at their GP's office with chronic pain and unmanageable conditions, and their quality of life is going down, that's when we should start measuring them.
4:10 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Thank you.
First, to Dr. Guirguis, just so I'm clear with regard to your Lakeview Surgery Centre, are you the sole owner of that, or do you have other doctors that you are in partnership with?
4:10 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
I am the primary owner, yes.
4:10 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Okay. So when you were designing this and building this, you used, as I think you said in your presentation, your own money.
4:10 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
Yes. It was funded...and it was an ambitious project.
4:10 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Just on that part of it, then, you would have had a fair bit to do with the actual concept and design of the building.
4:10 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
Correct.
4:10 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
You mentioned in there all the technical features that are in the design of that building.
How do you go about doing that? Are there companies in Canada or the United States? Or who do you deal with to come in and design it and basically lay out the technology to use?
4:10 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
That's an excellent question.
I was looking for one person to coordinate the whole project, but unfortunately there isn't one coordinator who exists to lead the whole design of an advanced surgery facility.
I went to guidelines that had been established over the last 20 years by the Canadian association for ambulatory surgery facilities. They have literally pages of guidelines to meet the standards of safety and effectiveness for a surgery facility. I basically followed them and then contracted out engineers who had a background in health care design, and architects. In terms of the building, we worked with the building department in Barrie, Ontario.
It took about nine months to build the facility. We opened in May 2009. It was ambitious. It took a lot of energy and capital costs, and obviously operational costs. We realized afterward that we were undercapitalized, but thankfully it's going well.
4:10 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
You could probably spend a whole hour talking about the technological innovations just in your building.
4:10 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
Absolutely, and I didn't want the message to get lost in obesity. I think both are important. I was using obesity as a model to say that out-of-hospital facilities can actually function quite safely and have great potential to save taxpayer dollars. I think that's a key message in this. The colleges across the country now are recognizing that and licensing the facilities for safety.
In Ontario, for example, 350 facilities were inspected. Three hundred passed and are licensed, but the vast majority of those are cosmetic surgery facilities. Lakeview is very unique in that we're administrating health care and chronic care through the lap band program.
4:15 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
I wish I had 15 minutes to ask you all the questions I have here, but there is one other question I wanted to ask you. You mentioned that OHIP covers the cost of the procedure, but then obviously you have your staff and all the other ongoing overhead. Does that fee you get from OHIP cover it all then, or how else do you...?
4:15 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
That's an excellent question. I think that's pivotal to the whole concept of out-of-hospital facilities.
Initially when I started the project I was very altruistic, and I really wanted to do the whole scope of general surgery. Then the sobering reality hit me that from the standpoint of funding, it wouldn't be possible to do the majority of publicly funded procedures while being respectful of the Canada Health Act, which I support.
I believe the future of health care will be performing out-of-hospital surgery-facility procedures in facilities that are owned privately but funded by the government so you can deliver public health care privately, if you will, while still being respectful—
4:15 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
I have just one other question, because my time is running short.
Given that it just started in 2009, it's not as though you have a decade's worth of experience, but do you have data to compare whether your patients have gotten infections? When you compare all that to getting the procedure in a hospital, how do you stack up? I would think you're way ahead of them.
4:15 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
We looked at our data for hernia procedures, and we found that our results, for an out-of-hospital facility, were better. We looked at it objectively. A medical student studied our results, and we found there was a slight decrease, for example, in infection rates and other outcomes.
4:15 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
I have one last quick question, because I don't know anything about what you're doing.
How did you learn how to install that thing? You probably think it's crazy that I'm asking you that, but you're a doctor, so how did you learn? Did you get certified on how to do this? Could you give us a second on that?
4:15 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
First of all you need to be a board-certified general surgeon to do this procedure. It's done laparoscopically, so with a minimally invasive surgery.
We have some of the basic skills, but because it is a new procedure, we are mentored by a surgeon who has performed over 1,000 of these procedures. There's a systematic mentorship program. In our case it was Dr. Steve Miller from Drummondville, Quebec. He came to Lakeview. He showed us how to do the first few procedures. Then he assisted, and then he stepped aside and watched us perform the procedure. After approximately 25 cases, he certified us and felt we were safe to perform these alone.
It's much like a pilot who's learning to fly a new airplane. He still has the fundamental skills of flying, but he will have to learn the idiosyncrasies of a specific procedure. It's an excellent question.
4:15 p.m.
Conservative
4:15 p.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry. I wish you did, Mr. Lobb, because those were very interesting questions.
We can go on to the next five-minute lineup. Maybe you could persuade somebody to let you ask some questions there too.
We'll start with Dr. Sellah.
February 28th, 2013 / 4:15 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
Thank you, Madam Chair.
My thanks to our two guests for coming here to shed a little more light on the issue for us.
My question is for Mr. Sutherland.
I listened carefully to your presentation. You said that Canada was the last of 11 developed countries in terms of access to specialized care. You also talked about the pay-for-performance funding policy, whereby payment is used as an incentive to health care providers to achieve a certain benchmark.
In your view, could pay-for-performance funding be effective in promoting innovation in health care systems? Could you also give us an example of how this works in Canada or elsewhere, please?
4:20 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
I believe that activity-based funding is an innovation in Canada. It does not mean that it's an international innovation, as many countries have transitioned to activity-based funding. The United States was first off the mark in the late 1970s, followed by some states in Australia, which since have been followed essentially by all the Nordic countries, France, and England, Ireland, Germany, and Japan.
While it's definitely not an innovation, there's much we can learn from those systems. I don't think you can take a cookie-cutter approach to these very complex systems and apply them in an entirely different country's context, such as ours, where we have fee-for-service physicians who are very powerful, plus a global budget-based hospital system. Contextualizing that will be very tricky in Canada. That's why I think it's a very innovative approach for both Ontario and British Columbia to proceed in this way.
