Background and details
As part of The Current State of Vision Care report information was provided on the:
current volume of completed cataract surgeries by hospital site
total cases allocated and completed
number of open cases and wait time for open cases as of March 31, 2014
how these times compare to the target wait time of 182 days
The report outlined the future need for cataract surgery to 2026 and compared volumes to both future total population projections and senior population estimates.
Excerpt from the Current State of Vision Care report, page 57.
Table 7.0 Crude (unadjusted) forecast of the need for cataract surgery by county using all age groups as the reference population, South West LHIN, 2012 and 2026
ALL AGE GROUPS
Sources: Intellihealth - DAD, NACRS 2012/13; Source: Ontario Ministry of Finance, Population Projections, Spring 2013 (NACRS Coded procedures starting with 1CL and DAD inpatient cataract procedures)
*proportion of current cases/population applied to future population in 2026, no adjustments
*Grey-Bruce data is blended since cataract cases are completed in Owen Sound only
45 Table 8.0 Crude (unadjusted) forecast of the need for cataract surgery by county using seniors as the reference population, South West LHIN, 2012 and 2026
AGE 65 PLUS
Sources: Intellihealth - DAD, NACRS 2012/13; Source: Ontario Ministry of Finance, Population Projections, Spring 2013 (NACRS Coded procedures starting with 1CL and DAD inpatient cataract procedures)
*proportion of current cases/population applied to future population in 2026, no adjustments
*Grey-Bruce data is blended since cataract cases are completed in Owen Sound only London data from Statistics Canada, 2011 Census, CMA, City of London area profile Middlesex data from Middlesex County website
Table 7 shows the relatively modest impact of the overall population growth on the expected volume of cataract surgeries in 2026. However, Table 8 tells a dramatically different story as it uses seniors and not the overall population as its point of reference. This table reflects the variability in the growth of seniors across the LHIN and as such provides a more realistic profile. In percentage terms the difference is between a growth in the need for cataract surgery of 9.6% based on total population and a growth of 56.8% in the volume of cataract surgeries based on the seniors population.
County boundaries do not accurately reflect patient flow as it relates to receiving health care, however the data suggests there is a correlation between the senior population and allocation of current cataract volumes. Other factors such as diabetes impact the need for cataract surgery but the number of seniors is the major factor.
In summary, the information in Table 8 shows using seniors as the reference population is an appropriate proxy for both current and future need for cataract surgery.
Equitable distribution of cataract surgeries – a population based model
Based on comparisons with two other jurisdictions in Ontario [Hamilton, Niagara, Haldimand, Brant LHIN and Champlain LHIN], it was determined, to be equitable and based on the current seniors population that the number of completed cataracts in the South West LHIN should increase to approximately 13,000 a year. This would represent 8.2 cataracts per 100 seniors.
46 Table 9.0
Distribution of cataract surgeries by county based on an equitable, population based model, 2012 and 2026
County
This population-based approach would result in the South West LHIN being allocated a total of 13,037 cataracts based on the equity formula to address current need and if the formula was applied consistently it would result in an average increase of 4% each year to 2026 when 20,348 cataracts would be allocated to the LHIN.
Future State Recommendation 24.1
At the present time, specific hospital volume allocations are made by the MOHLTC. The Ministry should
determine the overall LHIN allocation but give the LHINs a mandate to allocate volumes within their geographic catchment area.
Future State Recommendation 24.2
The South West LHIN should receive an on-going base increase in the allocation of cataract surgeries based on an equitable population-based model that reflects the seniors population within LHIN boundaries.
Target of Recommendation:
Ontario Ministry of Health and Long-Term Care South West LHIN
Hospitals providing cataract surgery services in the South West LHIN
Financial and Resource Impact:
Allocation of resources required to support additional procedures as well as staff time and supplies. The assumption is that the additional procedures can be done using existing medical resources.
Intended Outcome of Recommendations 24.1 and 24.2:
The allocation and distribution of cataract surgeries within and outside the LHIN is based on equity and reflects the growing seniors population in the province and in the LHIN.
47 Future State Recommendation 24.3
The South West LHIN, overall, should receive a year-over-year increase of four per cent (4%) based on the adjusted baseline year of F2012-3; and the distribution of seniors by county. A cataract surgery rate of 8.2 cataract surgeries per 100 seniors should be used as an appropriate population-based allocation method by the LHIN.
Target of Recommendation:
Ontario Ministry of Health and Long-Term Care South West LHIN
Hospitals providing cataract surgery services in the South West LHIN
Financial and Resource Impact:
Allocation of resources required to support additional procedures on a year-over-year basis including staff time and supplies.
Over time additional medical resources will be needed to address the growing need. This matter was addressed earlier in this report
Intended Outcome :
People throughout the LHIN will have equitable access to cataract surgery on an on-going basis.
In addition to the recommendations outlined above, at the present time, hospitals are unable to plan with any predictability, what their cataract volumes will be for the upcoming year until well into the year in which they are operating. In order to manage the volume of procedures for the benefit of all concerned, steps should be taken to allocate surgical volumes at least three months before the beginning of the fiscal year; that is, by December for the upcoming April-March fiscal year.
Future State Recommendation 24.4
The South West LHIN, together with all other LHINs and the MOHLTC should take the necessary steps to decide and inform hospitals of their QBP-based surgical volumes [in this instance cataract surgery] at least three months before the upcoming fiscal year.
Target of Recommendation:
Ontario Ministry of Health and Long-Term Care South West LHIN
Hospitals providing cataract surgery services in the South West LHIN
Financial and Resource Impact:
Allocation of resources required to support timely allocation of volumes
Intended Outcome :
Hospitals and ophthalmologists will know and therefore be able to develop and implement their cataract surgery operating plan proactively.
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